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Endovascular treatment of delayed hemorrhage developing after the pancreaticoduodenectomy procedure

Endovaskuläre Behandlung von verzögerten Nachblutungen nach Pancreato-Duodenektomie

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Summary

Aim and background

Delayed hemorrhage after pancreaticoduodenectomy (PD) is still one of the most common causes of mortality. However, the case series regarding interventional treatment of delayed hemorrhage after PD are limited. In this retrospective study, we aimed to evaluate functional outcomes of interventional treatment of late hemorrhages developing after PD.

Material and methods

We retrospectively evaluated 16 patients who received endovascular treatment for delayed arterial hemorrhage after PD procedure. Postsurgical nonhemorrhagic complications, time of hemorrhage, site of hemorrhage, endovascular treatment technique, postprocedural complications, and mortality rates were obtained.

Results

Mean duration of delayed hemorrhage after PD was 18 days. Computed tomography angiography images for the hemorrhage period were available for 15 patients. We observed extravasation alone in seven patients and pseudoaneurysm alone in five. Pushable coil was used in 15 patients and covered stent in 1. Two patients died due to hepatic failure, and one patient died because of multiple organ dysfunction syndrome (MODS).

Conclusions

Delayed hemorrhage after PD is difficult to identify, but accurate and early diagnosis is of vital importance. To date, most appropriate management of this complication remains unclear. Although endovascular treatment techniques may vary for every patient, it is a reliable and effective method for halting hemorrhage. Therefore, interventional procedures must be primarily considered rather than surgical interventions.

Zusammenfassung

Ziel und Hintergrund

Verzögerte Nachblutungen nach Pankreato-Duodenektomie (PD) sind noch immer die häufigste postoperative Todesursache. Trotzdem gibt es nur eine begrenzte Zahl von Fallserien bezüglich einer interventionellen Therapie von verzögerten Nachblutungen nach PD. In der vorliegenden retrospektiven Studie war es unser Ziel, funktionelle Ergebnisse der interventionellen Behandlung von verzögerten Nachblutungen nach PD zu evaluieren.

Methoden

Wir evaluierten retrospektiv 16 Patienten, bei denen eine endovaskuläre Therapie einer verzögerten Nachblutung nach PD durchgeführt worden war. Postoperative nicht-blutungsbedingte Komplikationen, Zeitpunkt der Blutung, Lokalisation der Blutung, Technik der endovaskulären Therapie, Komplikationen nach der Prozedur und Mortalität wurden erhoben.

Ergebnisse

Die mittlere Dauer bis zum Auftreten der verzögerten Nachblutung nach PD betrug 18 Tage. CT-Angiographie-Bilder der Blutungsperiode waren bei 15 Patienten verfügbar. Bei sieben Patienten beobachteten wir ein Extravasat und bei fünf Patienten ein Pseudoaneurysma. Bei 15 Patienten wurden Coils zur Blutstillung verwendet. Bei einem Patienten wurde ein gedeckter Stent plaziert. Zwei Patienten starben als Folge von Leberversagen, ein Patient wegen MODS.

Schlussfolgerungen

Verzögerte Nachblutungen nach PD sind schwierig zu erkennen. Eine frühe und korrekte Diagnose ist aber von vitaler Bedeutung. Bis heute ist unklar, welches das am besten geeignete Management dieser Komplikation ist. Obwohl die endovaskuläre Technik bei jedem Patienten anders sein kann, ist die Methode zur Blutungsstillung verlässlich und wirksam. Interventionelle Maßnahmen sollten daher als Therapie erster Wahl – vor chirurgischen Interventionen – in Erwägung gezogen werden.

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Conflict of interest

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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Authors and Affiliations

  1. Department of Intervention Radiology, Canakkale 18 Mart University Medicine Faculty, Canakkale, Turkey

    Gurhan Adam MD, Fatma Uysal MD, Mustafa Resorlu MD &  Huseyin Ozdemir

  2. Department of Surgery, Canakkale 18 Onsekiz Mart University, Canakkale, Turkey

    Sukru Tas MD

  3. Department of Radiology, Ege University, Izmir, Turkey

    Celal Cinar MD, Halil Bozkaya &  Mustafa Parildar

  4. Department of Anesthesia, Ege University, Izmir, Turkey

    Fusun Adam MD

  5. Department of Surgery, Ege University, Izmir, Turkey

    Omer Vedat Unalp MD

  6. Department of Gastroenterology, Çanakkale State Hospital, Çankkale, Turkey

    Erdem Koçak

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  1. Gurhan Adam MD
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  2. Sukru Tas MD
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  3. Celal Cinar MD
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Correspondence to Gurhan Adam MD.

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Adam, G., Tas, S., Cinar, C. et al. Endovascular treatment of delayed hemorrhage developing after the pancreaticoduodenectomy procedure. Wien Klin Wochenschr 126, 416–421 (2014). https://doi.org/10.1007/s00508-014-0557-x

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