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European Radiology

, Volume 26, Issue 10, pp 3456–3465 | Cite as

Endovascular management of delayed post-pancreatectomy haemorrhage

  • Edwige Pottier
  • Maxime RonotEmail author
  • Sebastien Gaujoux
  • Manuela Cesaretti
  • Louise Barbier
  • Alain Sauvanet
  • Valérie Vilgrain
Vascular-Interventional

Abstract

Objectives

To assess the patient outcome after endovascular treatment of delayed post-pancreatectomy haemorrhage (PPH) as first-line treatment.

Methods

Between January 2005 and November 2013, all consecutive patients referred for endovascular treatment of PPH were included. Active bleeding, pseudoaneurysms, collections and the involved artery were recorded on pretreatment CT. Endovascular procedures were classified as technical success (source of bleeding identified on angiogram and treated), technical failure (source of bleeding identified but incompletely treated) and abstention (no abnormality identified, no treatment performed). Factors associated with rebleeding were analysed.

Results

Sixty-nine patients (53 men) were included (mean 59 years old (32–75)). Pretreatment CT showed 27 (39 %) active bleeding. In 22 (32 %) cases, no involved artery was identified. Technical success, failure and abstention were observed in 48 (70 %), 9 (13 %) and 12 patients (17 %), respectively. Thirty patients (43 %) experienced rebleeding. Rebleeding rates were 29 %, 58 % and 100 % in case of success, abstention and failure (p < 0.001). Treatment failure/abstention was the only factor associated with rebleeding. Overall, 74 % of the patients were successfully treated by endovascular procedure(s) alone.

Conclusion

After a first endovascular procedure for PPH, the rebleeding rate is high and depends upon the success of the procedure. Most patients are successfully treated by endovascular approach(es) alone.

Key Points

After a first endovascular procedure for PPH the rebleeding rate is high

The rebleeding rate is significantly associated with initial technical success

Three-quarters of the patients are successfully treated by endovascular procedure(s) alone

Keywords

Surgery Bleeding Interventional radiology Angiography Embolization 

Notes

Acknowledgements

The scientific guarantor of this publication is Valérie Vilgrain. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Edwige Pottier
    • 1
  • Maxime Ronot
    • 1
    • 2
    • 3
    Email author
  • Sebastien Gaujoux
    • 4
  • Manuela Cesaretti
    • 4
  • Louise Barbier
    • 4
  • Alain Sauvanet
    • 2
    • 4
  • Valérie Vilgrain
    • 1
    • 2
    • 3
  1. 1.Department of RadiologyBeaujon Hospital, University Hospitals Paris Nord Val de SeineClichyFrance
  2. 2.University Paris DiderotParisFrance
  3. 3.INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3ParisFrance
  4. 4.Department of SurgeryAPHP, University Hospitals Paris Nord Val de Seine, BeaujonClichyFrance

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