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Gautam S, Neupane A, Singh G, Sharbatji M. Upper gastrointestinal bleed secondary to large right hepatic artery pseudoaneurysm: a case report. Oxf Med Case Reports 2024; 2024:omae090. [PMID: 39161849 PMCID: PMC11331630 DOI: 10.1093/omcr/omae090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 06/17/2024] [Accepted: 06/27/2024] [Indexed: 08/21/2024] Open
Abstract
Hepatic artery pseudoaneurysm (HAP) is a serious rare life-threatening complication of Gastrointestinal surgeries that is often overlooked in diagnostic evaluation due to its rarity. We present a case of 71 years female, with a surgical history of gastric sleeve surgery, Roux-en-Y gastric bypass, and cholecystectomy, presenting with features of upper GI bleeding. Multiple diagnostic modalities were used and finally Magnetic Resonance Mesenteric Angiogram was able to pinpoint the location of the GI bleed as a hepatic artery pseudoaneurysm. Primary surgical repair used to be the mainstay treatment option for managing visceral aneurysms. However, due to advances in technology, embolization as well as implantation of covered stent grafts have become the preferred treatment for such lesions.
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Affiliation(s)
- Swotantra Gautam
- Department of Internal Medicine, Advent Health, 601 East Rollins Street, Orlando, Florida 32803, United States
| | - Aakash Neupane
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan-18, Sunsari 56700, Nepal
| | - Gurdeep Singh
- Department of Internal Medicine, Advent Health, 601 East Rollins Street, Orlando, Florida 32803, United States
| | - Mohamad Sharbatji
- Department of Internal Medicine, Advent Health, 601 East Rollins Street, Orlando, Florida 32803, United States
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2
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Jabłońska B, Mrowiec S. Endovascular Treatment of Hepatic Artery Pseudoaneurysm after Pancreaticoduodenectomy: A Literature Review. Life (Basel) 2024; 14:920. [PMID: 39202663 PMCID: PMC11355561 DOI: 10.3390/life14080920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/13/2024] [Accepted: 07/22/2024] [Indexed: 09/03/2024] Open
Abstract
Pancreaticoduodenectomy (PD) is a complex surgical procedure performed in patients with periampullary tumors located within the pancreatic head, the papilla of Vater, the distal common bile duct, and the duodenum. In advanced tumors, the operative technique involves the need for dissection and divestment of the arteries located within the pancreaticoduodenal field, including the common hepatic artery (CHA) and the proper hepatic artery (PHA) and its branches. The second most important cause of post-PD visceral aneurysms is irritation of the peri-pancreatic arterial wall by pancreatic juice in a postoperative pancreatic fistula (POPF). Hepatic artery pseudoaneurysm (HAP) is a very dangerous condition because it is usually asymptomatic, but it is a rare and potentially lethal pathology because of the high risk of its rupture. Therefore, HAP requires treatment. Currently, selective celiac angiography is the gold-standard diagnostic and therapeutic management for postoperative bleeding and pseudoaneurysm in patients following PD. Open surgery and less invasive endovascular treatment are performed in patients with HAP. Endovascular treatment involves transarterial embolization (TAE) and stent graft implantation. The choice of treatment method depends on the general and local conditions, such as the patient's hemodynamic stability and arterial anatomy. In patients in whom preservation of the flow within the hepatic artery (to prevent hepatic ischemia complications such as liver infarction, abscess, or failure) is needed, stent graft implantation is the treatment of choice. This article focuses on a review of two common methods for endovascular HAP treatment. In addition, risk factors and diagnostic tools have been described.
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Affiliation(s)
- Beata Jabłońska
- Department of Digestive Tract Surgery, Medical University of Silesia, 40-752 Katowice, Poland;
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3
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Zhao YQ, Yang YY, Yao SY, Dong XF. Hepatic artery pseudoaneurysm: three case reports and literature review. Front Med (Lausanne) 2024; 11:1422895. [PMID: 39050537 PMCID: PMC11266017 DOI: 10.3389/fmed.2024.1422895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/11/2024] [Indexed: 07/27/2024] Open
Abstract
Laparoscopic surgery is extensively applied in the treatment of hepatobiliary diseases. Hepatic artery pseudoaneurysm (HAP) is a rare complication following hepatic biliary surgery through laparoscopy. The clinical manifestations of HAP are diverse and can be fatal. Given its severity, rapid assessment and management are crucial to ensuring a good prognosis. Here, we report three cases of HAP; two underwent laparoscopic surgery due to cholelithiasis, and another caused by trauma. The first case exhibited a pseudoaneurysm involving the distal portion of the right hepatic artery main trunk. The second patient had a pseudoaneurysm at the bifurcation of the left and right hepatic arteries. The third case involved a patient with a pseudoaneurysm involving a branch of the right hepatic artery. The main clinical manifestations of all three cases were bleeding from the biliary tract (the first two cases showed postoperative bleeding in the T-tube, while the third case exhibited gastrointestinal bleeding). The final diagnosis was obtained through digital subtraction angiography. The three patients underwent successful transcatheter arterial embolization operation and a follow-up revealed they were disease-free and alive. This article aims to highlight a rare complication of laparoscopic hepatobiliary surgery and share our experience in early diagnosis and treatment of HAP.
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Affiliation(s)
| | | | | | - Xiao-Feng Dong
- Department of Hepatobiliary, Pancreas and Spleen Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Kim Y, Kim JH, Kim JH, Kim GH, Ko HK, Chu HH, Shin JH, Gwon DI, Ko GY. Stent-Graft Placement for Hepatic Arterial Hemorrhage after Pancreaticobiliary Surgery: Long-Term Clinical Outcomes. J Vasc Interv Radiol 2024; 35:963-970. [PMID: 38519001 DOI: 10.1016/j.jvir.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024] Open
Abstract
PURPOSE To evaluate the safety and long-term clinical outcomes of stent-graft placement to treat hepatic arterial hemorrhage after pancreaticobiliary surgery. MATERIALS AND METHODS Outcomes were retrospectively evaluated in 61 patients (50 men and 11 women; mean age, 63 years) who underwent stent-graft placement for delayed arterial hemorrhage (after 24 hours) after pancreaticobiliary surgery from 2006 to 2023. Bleeding sites included the gastroduodenal artery stump (n = 54), common or proper hepatic artery (n = 5), and right hepatic artery (n = 2). The stent-grafts used were Viabahn (n = 27), Comvi (n = 11), Jostent (n = 3), Covera (n = 11), and Lifestream (n = 7). Technical and clinical success and adverse events (AE) were evaluated. After stent-graft placement, overall survival (OS), hemorrhage-free survival (HFS), and stent patency were evaluated. RESULTS The technical and clinical success rates of stent-graft placement were 97% and 93%, respectively. The severe AE rate was 12% and was significantly higher in patients who underwent pylorus-sacrificing rather than pylorus-preserving surgery (P = .001). None of the severe AEs were associated with patient mortality. Median OS after stent-graft placement was 854 days, and median HFS was 822 days. The 1-, 3-, 5-, and 10-year stent patency rates were 87%, 84%, 79%, and 72%, respectively. CONCLUSIONS Stent-graft placement was safe and provided long-term control of hepatic arterial hemorrhage after pancreaticobiliary surgery.
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Affiliation(s)
- Yonghun Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Radiology, Ajou University Hospital, Ajou University College of Medicine, Suwon, South Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Radiology, Ajou University Hospital, Ajou University College of Medicine, Suwon, South Korea.
| | - Ji Hoon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Sekino H, Ishii S, Ishigame T, Ando T, Kawamoto N, Endo Y, Kuroiwa D, Ito H. Coil embolization of a celiac artery pseudoaneurysm under balloon-assisted flow control: A case report. Radiol Case Rep 2024; 19:2282-2285. [PMID: 38559651 PMCID: PMC10978447 DOI: 10.1016/j.radcr.2024.02.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
Coil migration can occur when coil embolization is used for treating pseudoaneurysms associated with large arteries. The double microcatheter technique is useful for preventing coil migration; the balloon catheter can reduce blood flow and active bleeding upon balloon inflation, and can also compress the bleeding point and arrest bleeding temporarily. We report a case describing the management of a pseudoaneurysm with coil embolization using double microcatheters and a balloon catheter to control blood flow and prevent coil migration. A 73-year-old male patient presented with a pseudoaneurysm of the celiac artery arising from the splenic artery stump following surgery. Coil embolization of the pseudoaneurysm using a double microcatheter embolization technique with a balloon catheter was considered. A balloon catheter was inserted into the celiac artery and active bleeding was temporarily arrested with the inflated balloon. First, a microcatheter was inserted into the balloon catheter, and another microcatheter was placed in the celiac artery. An electrical detachable coil was inserted into the proximal common hepatic artery just distal to the pseudoaneurysm. The second electrically detachable coil was inserted while the first coil remained attached. After detachment of the second coil, additional electrically detachable coils were inserted for similar embolization. The balloon was gradually deflated. Finally, the first coil was detached and we confirmed absence of the bleeding. Our case report demonstrated that a balloon catheter can control the flow vessels, and the double microcatheter embolization technique with a balloon catheter is useful for coil embolization in high-flow or large vessels.
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Affiliation(s)
- Hirofumi Sekino
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shiro Ishii
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Teruhide Ishigame
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Tatsuya Ando
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Natsumi Kawamoto
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yoshiki Endo
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Daichi Kuroiwa
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hiroshi Ito
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
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6
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Zhang JL, Yuan B, Zhang H, Wang MQ. Transcatheter arterial embolization with N-butyl cyanoacrylate for postoperative hemorrhage treatment following pancreatoduodenectomy. Emerg Radiol 2024; 31:179-185. [PMID: 38334821 DOI: 10.1007/s10140-024-02211-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE Postoperative hemorrhage (PPH) is a severe complication of pancreatoduodenectomy (PD) with a mortality rate of 5-20.2% and mortality due to hemorrhage of 11-58%. Transcatheter arterial embolization (TAE) has been widely recommended for PPH, however, TAE with N-butyl cyanoacrylate (NBCA) for PPH treatment has been reported rarely. Therefore, this study aimed to evaluate the safety and efficacy of TAE with NBCA for PPH treatment following PD. METHODS This retrospective study included 14 male patients (mean age, 60.93 ± 10.97 years) with postoperative hemorrhage following PD treated with TAE using NBCA as the main embolic agent from October 2019 to February 2022. The clinical data, technical and success rate, and complications were analyzed. RESULTS Among the 14 patients who underwent TAE, the technical and clinical success rates were 100 and 85.71%, respectively. Angiography revealed contrast extravasation in 12 cases and a pseudoaneurysm in 3 cases. One patient developed a serious infection and died 2 days after the TAE. CONCLUSION TAE with NBCA for PPH treatment following PD, especially for massive hemorrhage caused by a pancreatic fistula, biliary fistula, or inflammatory corrosion, can result in rapid and effective hemostasis with high safety.
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Affiliation(s)
- Jin Long Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People's Republic of China
| | - Bing Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Heng Zhang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
- Department of Radiology, National Clinical Research Center for Geriatric Diseases/Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Mao Qiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.
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Anns KM, Khan F, Aman M, Shahid J, Haq TUI, Memon WA, Saeed MA, Khalid A, Abbasher Hussien Mohamed Ahmed K, Akram S. Pseudoaneurysm of cystic artery stump after laparoscopic cholecystectomy managed successfully with branch hepatic artery embolization using jail technique. J Surg Case Rep 2024; 2024:rjae152. [PMID: 38495041 PMCID: PMC10942811 DOI: 10.1093/jscr/rjae152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Abstract
An unusual manifestation caused by cholecystitis, infection, or iatrogenic damage after cholecystectomy is a pseudoaneurysm of the cystic artery. We report this rare illness in a 64-year-old man who visited the emergency room with hematemesis and anemia. The patient initially experienced acute cholecystitis and then underwent a laparoscopic cholecystectomy following which he developed a cystic artery pseudoaneurysm, secondary to infected fluid collection. Based on the patient's history and contrast-enhanced computer tomography abdomen, a diagnosis of pseudoaneurysm of the cystic artery was made. Angioembolization of the hepatic artery branch was performed to occlude the pseudoaneurysm.
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Affiliation(s)
| | - Faheemullah Khan
- Department of Radiology, The Aga Khan University Hospital, Karachi 74200, Pakistan
| | - Muhammad Aman
- Department of Radiology, The Aga Khan University Hospital, Karachi 74200, Pakistan
| | - Jehanzeb Shahid
- Department of Radiology, The Aga Khan University Hospital, Karachi 74200, Pakistan
| | - Tanveer U I Haq
- Department of Radiology, The Aga Khan University Hospital, Karachi 74200, Pakistan
| | - Wasim Ahmad Memon
- Department of Radiology, The Aga Khan University Hospital, Karachi 74200, Pakistan
| | - Muhammad Arif Saeed
- Department of Radiology, James Paget University Hospital, Great Yarmouth NR31 6BN, United Kingdom
| | - Amna Khalid
- Medical College, King Edward Medical University, Lahore, 54000, Pakistan
| | | | - Saba Akram
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi 74200, Pakistan
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Tsurkan VA, Shabunin AV, Grekov DN, Bedin VV, Arablinskiy AV, Yakimov LA, Shikov DV, Ageeva AA. [Endovascular technologies in the treatment of patients with blunt abdominal trauma]. Khirurgiia (Mosk) 2024:108-117. [PMID: 39140952 DOI: 10.17116/hirurgia2024081108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Trauma is one of the leading causes of disability and mortality in working-age population. Abdominal injuries comprise 20-30% of traumas. Uncontrolled bleeding is the main cause of death in 30-40% of patients. Among abdominal organs, spleen is most often damaged due to fragile structure and subcostal localization. In the last two decades, therapeutic management has become preferable in patients with abdominal trauma and stable hemodynamic parameters. In addition to clinical examination, standard laboratory tests and ultrasound, as well as contrast-enhanced CT of the abdomen should be included in diagnostic algorithm to identify all traumatic injuries and assess severity of abdominal damage. Development of interventional radiological technologies improved preservation of damaged organs. Endovascular embolization can be performed selectively according to indications (leakage, false aneurysm, arteriovenous anastomosis) and considered for severe damage to the liver and spleen, hemoperitoneum or severe polytrauma. Embolization is essential in complex treatment of traumatic vascular injuries of parenchymal abdominal organs. We reviewed modern principles and methods of intra-arterial embolization for the treatment of patients with traumatic injuries of the liver and spleen.
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Affiliation(s)
- V A Tsurkan
- Botkin Moscow City Clinical Hospital, Moscow, Russia
| | - A V Shabunin
- Botkin Moscow City Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - D N Grekov
- Botkin Moscow City Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - V V Bedin
- Botkin Moscow City Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - A V Arablinskiy
- Botkin Moscow City Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - L A Yakimov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - D V Shikov
- Botkin Moscow City Clinical Hospital, Moscow, Russia
| | - A A Ageeva
- Botkin Moscow City Clinical Hospital, Moscow, Russia
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Izumi H, Yoshii H, Fujino R, Takeo S, Nomura E, Mukai M, Suda S, Tomita K, Kamei S, Ogawa Y, Hasebe T, Makuuchi H. Endovascular treatment of postoperative hemorrhage after pancreatectomy: a retrospective study. BMC Gastroenterol 2023; 23:379. [PMID: 37936060 PMCID: PMC10631063 DOI: 10.1186/s12876-023-03022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Ruptured aneurysm is a serious complication of distal pancreatectomy (DP) or pancreatoduodenectomy (PD) that can be life-threatening if not treated promptly. This study aimed to examine the efficacy of a Viabahn stent graft for stopping bleeding after pancreatectomy. METHODS Between April 2016 and June 2022, we performed 245 pancreatectomies in our institution. Six patients experienced postoperative bleeding and underwent endovascular treatment. RESULTS All six cases of bleeding occurred post-PD (3.7%). The bleeding was from gastroduodenal artery (GDA) pseudoaneurysms in three patients, and Viabahn stent grafts were inserted. All three patients did not show liver function abnormalities or hepatic blood flow disorders. One patient with a Viabahn stent graft experienced rebleeding, which required further management to obtain hemostasis. Of the six cases in which there was hemorrhage, one case of bleeding from the native hepatic artery could not be managed. CONCLUSIONS Using the Viabahn stent graft is an effective treatment option for postoperative bleeding from GDA pseudoaneurysms following PD. In most cases, using this device resulted in successful hemostasis, without observed abnormalities in hepatic function or blood flow.
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Affiliation(s)
- Hideki Izumi
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, Ishikawa, Hachioji, Tokyo, 1838, 192-0032, Japan.
| | - Hisamichi Yoshii
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, Ishikawa, Hachioji, Tokyo, 1838, 192-0032, Japan
| | - Rika Fujino
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, Ishikawa, Hachioji, Tokyo, 1838, 192-0032, Japan
| | - Shigeya Takeo
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, Ishikawa, Hachioji, Tokyo, 1838, 192-0032, Japan
| | - Eiji Nomura
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, Ishikawa, Hachioji, Tokyo, 1838, 192-0032, Japan
| | - Masaya Mukai
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, Ishikawa, Hachioji, Tokyo, 1838, 192-0032, Japan
| | - Satoshi Suda
- Department of Radiology, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan
| | - Kosuke Tomita
- Department of Radiology, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan
| | - Shunsuke Kamei
- Department of Radiology, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan
| | - Yukihisa Ogawa
- Department of Radiology, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan
| | - Hiroyasu Makuuchi
- Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, Ishikawa, Hachioji, Tokyo, 1838, 192-0032, Japan
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Marra P, Muglia R, Capodaglio CA, Dulcetta L, Carbone FS, Sansotta N, Pinelli D, Celestino A, Muscogiuri G, Bonanomi E, Fagiuoli S, D'Antiga L, Colledan M, Sironi S. Current Endovascular Management of Arterial Complications After Pediatric Liver Transplantation in a Tertiary Center. Cardiovasc Intervent Radiol 2023; 46:1610-1620. [PMID: 37831217 PMCID: PMC10616219 DOI: 10.1007/s00270-023-03557-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/02/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Pediatric liver transplant surgery is burdened by arterial complications whose endovascular treatment is not standardized. We report the outcomes of a cohort of pediatric recipients with hepatic artery complications treated by endoluminal procedures. MATERIALS AND METHODS From December 2019 to December 2022, consecutive transplanted pediatric patients who underwent endovascular treatment of hepatic artery complications were reviewed. The analysis included: type of complication (occlusion, stenosis, pseudoaneurysm); onset (acute = < 15 days, subacute = 15-90 days, late = > 90 days); endovascular technique (angioplasty, stenting); complications and outcomes. Technical success was defined as the opacification of the hepatic artery at the final angiogram with < 50% residual stenosis and no pseudoaneurysms. Clinical success was defined by graft's and patient's survival. RESULTS Seventeen patients (8 males; median age 33 months, IQR 9-103) underwent 21 hepatic arteriography procedures for predominantly acute or subacute occlusions (n = 7) or stenosis (n = 11) with concurrent pseudoaneurysms (n = 4). Primary and secondary technical success was achieved in 13/18 and 3/3 procedures, respectively, with overall technical success of 76%. Angioplasty alone was successful in 5/21 procedures; stent-retriever thrombectomy was performed in one occlusion with thrombosis; stenting was required in 9/17 (53%) patients. Clinical success was obtained in 14/17 (82%) patients with hepatic artery patency after a median of 367 days (IQR 114.5-500). Clinical failure occurred in 3 permanent occlusions, with 2 deaths and 1 re-transplantation. Procedure-related complications included minor events in 3/17 (18%) patients and 1/17 (6%) death. CONCLUSION In liver transplanted children with hepatic artery complications, endovascular treatment may provide clinical success, with stenting often required in acute and subacute conditions. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Paolo Marra
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy.
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.
| | - Riccardo Muglia
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Carlo Alberto Capodaglio
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Ludovico Dulcetta
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Francesco Saverio Carbone
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Naire Sansotta
- Department of Pediatric Hepatology, Gastroenterology, Transplantation, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Antonio Celestino
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Ezio Bonanomi
- Pediatric Intensive Care Unit, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Stefano Fagiuoli
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Gastroenterology, Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Lorenzo D'Antiga
- Department of Pediatric Hepatology, Gastroenterology, Transplantation, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Michele Colledan
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Sandro Sironi
- School of Medicine and Surgery, University of Milano Bicocca, 20126, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
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11
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Ayala D, Gonzalez J, Salazar JF, Chaves CER, Conde D, Olarte JCS. Endovascular approach of hepatic artery pseudoaneurysm after Whipple procedure: Case report and literature review. Int J Surg Case Rep 2023; 105:108103. [PMID: 37018946 PMCID: PMC10112170 DOI: 10.1016/j.ijscr.2023.108103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Pseudoaneurysms after pancreatoduodenectomy are an uncommon complication, but they are associated with life-threatening outcomes in up to 50 % due to the development of postoperative bleeding. They usually result as a consequence of local inflammatory processes, such as pancreatic fistula or intra-abdominal collections. The cornerstones of treatment are thus intraoperative management and early identification of the complication. CASE PRESENTATION We present a 62-year-old female patient in postoperative pancreatoduodenectomy due to a periampullary tumor, that presented upper gastrointestinal bleeding which required multiple transfusions. During hospitalization, the patient presented a refractory hypovolemic shock to conservative measures. It was documented intra-abdominal hemorrhage due to hepatic artery pseudoaneurysm that required endovascular management with common hepatic artery embolization, with successful bleeding control. CLINICAL DISCUSSION Pseudoaneurysms are the result of tissue damage after surgery. The usual clinical presentation is upper gastrointestinal bleeding unresponsive to conservative treatment that results in hemodynamic instability due to hypovolemic shock. Prevention is currently based on preoperative and intraoperative measures such as nutritional repletion, vessel protection, adequate hemostasis, and prevention and treatment of pancreatic leak and abdominal infection. Once documented, treatment can be endovascular or surgical. CONCLUSION The formation of pseudoaneurysms after pancreaticoduodenectomy is an uncommon and challenging complication. Early diagnosis, risk factor detection and a combined multidisciplinary approach lead to better outcomes, avoiding open surgical procedures that can increase morbidity and mortality rates.
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Xu L, Gu G, Li Y. Transcatheter arterial embolization of the common hepatic artery for pseudoaneurysm after a laparoscopic-assisted pancreaticoduodenectomy: A case report. Clin Case Rep 2023; 11:e6121. [PMID: 36789327 PMCID: PMC9909167 DOI: 10.1002/ccr3.6121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 02/11/2023] Open
Abstract
Common hepatic artery pseudoaneurysm is a rare and potentially life-threatening complication after pancreaticoduodenectomy, and the possible cause is unclear. We report a case of intraperitoneal hemorrhage after pancreaticoduodenectomy who was discharged after embolization under digital subtraction angiography. We conside that this complication may be related to iatrogenic injury.
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Affiliation(s)
- Lifeng Xu
- Department of General SurgeryAnhui Second People's HospitalHefeiChina
| | - Guosheng Gu
- Department of General SurgeryAnhui Second People's HospitalHefeiChina,Department of General SurgeryJinling Hospital, Nanjing University School of MedicineNanjingChina
| | - Yongxiang Li
- Department of General SurgeryThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
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13
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Wang J, Yang L, Xu L, Qin L, Cheng Y. Case report: Recurrent hemobilia due to hepatic artery pseudoaneurysm mimicking gastrointestinal tract bleeding. Front Med (Lausanne) 2023; 9:1048763. [PMID: 36698846 PMCID: PMC9870307 DOI: 10.3389/fmed.2022.1048763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Hemobilia, a rare form of upper gastrointestinal bleeding (UGIB), is a potentially fatal complication that usually occurs after iatrogenic hepatobiliary trauma. However, hemobilia is clinically challenging to diagnose and often gets too late to diagnose. We herein report a case of recurrent hemobilia due to hepatic artery pseudoaneurysm (HAP) that was initially misdiagnosed as gastrointestinal tract bleeding. However, the patient was treated successfully with percutaneous coil occlusion of the pseudoaneurysm. This case illustrates that hemobilia can present as a mimic of gastrointestinal tract bleeding, but this is often difficult to diagnose at first glance and often misleads clinicians, especially emergency physicians, into making an incorrect diagnosis. Familiarity with the clinical features of hemobilia can help raise clinical suspicion and facilitate the early diagnosis and treatment of hemobilia.
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14
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Aly AK, Yarmohammadi H, Bajwa R, Silk M, Hsu M, Moskowitz C, Santos E, Moussa AM. Stent Graft Placement for the Treatment of Hepatic Artery Injury in Patients with Cancer: Primary Patency and Clinical Outcomes. J Vasc Interv Radiol 2023; 34:79-85.e1. [PMID: 36265819 PMCID: PMC10445798 DOI: 10.1016/j.jvir.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the safety, primary patency, and clinical outcomes of hepatic artery stent graft (SG) placement for vascular injuries. MATERIALS AND METHODS Patients treated with hepatic arterial SG placement for vascular injuries between September 2018 and September 2021 were reviewed. Data on demographic characteristics, indication, stent graft characteristics, antiplatelet/anticoagulant use, clinical success rate, complications, and type of follow-up imaging were collected. Follow-up images were reviewed by 2 independent reviewers to assess primary patency. A time-to-event analysis was performed. The median duration of stent graft patency was estimated using Kaplan-Meier curves. A Cox proportional hazard model was used to evaluate factors related to stent graft patency. RESULTS Thirty-five patients were treated with hepatic arterial SG placement, 11 for postoperative bleeds and 24 for hepatic artery infusion pump catheter-related complications. Clinical success was achieved in 32 (91%) patients (95% CI, 77-98). The median primary patency was 87 days (95% CI, 73-293). Stent grafts of ≥6-mm diameter retained patency for a longer duration than that with stent grafts of smaller diameters (6 mm vs 5 mm; hazard ratio, 0.35; 95% CI, 0.14-0.88; P = .026; and 7+ mm vs 5 mm; hazard ratio, 0.27; 95% CI, 0.09-0.83; P = .023). Anticoagulation/antiplatelet regimen was not associated with increased stent graft patency duration (P > .05). Only minor complications were reported in 2 (5.7%) patients. CONCLUSIONS Stent grafts can be used safely and effectively to treat injuries of the hepatic artery. Stent graft diameters of ≥6 mm seem to provide more durable patency.
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Affiliation(s)
- Ahmed K Aly
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Hooman Yarmohammadi
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raazi Bajwa
- Division of Body Imaging, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mikhail Silk
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chaya Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ernesto Santos
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amgad M Moussa
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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15
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Chen Y, Huang W, Liu Q, Wang Q, Wang Z, Wu Z, Ding X, Wang Z. Covered stent treatment for arterial complications after pancreatic surgery: risk assessment for recurrence and peri-stent implantation management. Eur Radiol 2023; 33:1779-1791. [PMID: 36149482 PMCID: PMC9510453 DOI: 10.1007/s00330-022-09134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/07/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore the risk factors for recurrence of arterial complications after pancreatectomy during the period of covered stent implantation and to provide some opinions on peri-stent implantation management. METHODS Data on patients implanted with covered stents due to arterial complications after pancreatectomy between January 2017 and December 2021 were analyzed retrospectively. Technical success, clinical success, recurrence, and survival were evaluated to elucidate the practicability of covered stents. Wilson score, Random Forest, logistic regression, and Pearson's chi-square test with bootstrap aggregation were performed for determining the perioperative risk factors for recurrence. RESULTS Among all fifty-five patients, success stent implantation (technical success) was achieved 100%. Patients who were hemodynamically stabilized without further treatment for artery complications in situ (clinical success) accounted for 89.1%. Based on statistical analysis, pre-stent implantation pancreatic fistula was identified as a robust recurrence-related risk factor for preoperative assessment (p = 0.02, OR = 4.5, 95% CI [1.2, 16.9]; pbootstrap = 0.02). Post-stent implantation pancreatic fistula (p = 0.01, OR 4.5, 95% CI [1.4, 14.6]; pbootstrap < 0.05) and SMA branches or GDA stumps (p = 0.02, OR 3.4, 95% CI [1.1, 10.3]) were relevant to recurrence. The survival rate during hospitalization was 87.3%. All survivors were free from recurrence during the subsequent follow-up. Vasospasm and stent occlusion were observed as short-term and long-term complications, respectively. CONCLUSION A covered stent implantation is a feasible and effective treatment option for post-pancreatectomy arterial complications. Rigorous management of pancreatic fistula, timely detection of problems, sensible strategies during stent implantation, and reasonable anticoagulation therapy are necessary for a better prognosis. KEY POINTS • A covered stent is feasible for various artery-related complications after pancreatectomy and has an ideal therapeutic effect. • Pancreatic fistula during the perioperative period of the covered stent is an independent risk factor for recurrent arterial complications and SMA branches or GDA stumps are prone to be recurrent offending arteries. • Rigorous management of pancreatic fistula, timely detection of problems, sensible strategies during stent implantation, and reasonable anticoagulation therapy are necessary for a better prognosis.
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Affiliation(s)
- Yingjie Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Rd. (No.2), Shanghai, 200025, People's Republic of China
| | - Wei Huang
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Rd. (No.2), Shanghai, 200025, People's Republic of China
| | - Qin Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Rd. (No.2), Shanghai, 200025, People's Republic of China
| | - Qingbing Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Rd. (No.2), Shanghai, 200025, People's Republic of China
| | - Ziyin Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Rd. (No.2), Shanghai, 200025, People's Republic of China
| | - Zhiyuan Wu
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Rd. (No.2), Shanghai, 200025, People's Republic of China
| | - Xiaoyi Ding
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Rd. (No.2), Shanghai, 200025, People's Republic of China.
| | - Zhongmin Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Rd. (No.2), Shanghai, 200025, People's Republic of China.
- Department of Interventional Radiology, Luwan Branch of Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 149 Chongqing Rd. (S), Shanghai, 200020, People's Republic of China.
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Sato Y, Matsueda K, Osawa M, Inaba Y, Takahashi Y, Inoue Y, Oba A, Fukunaga Y, Shimizu Y. Interventional management for postoperative arterial bleeding in gastrointestinal surgery. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yozo Sato
- Department of Diagnostic Ultrasound & Interventional Radiology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kiyoshi Matsueda
- Department of Diagnostic Ultrasound & Interventional Radiology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Marie Osawa
- Department of Radiology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, Nagoya, Japan
| | - Yu Takahashi
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Inoue
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Atsushi Oba
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan
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17
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Min H, Yoon CJ, Lee JH, Choi WS, Yeo JB, Yoon YS, Cho JY, Lee HW, Lee JS. Covered stent placement for gastroduodenal artery stump hemorrhage after pancreaticoduodenectomy: long-term patency and risk factor of stent failure. Br J Radiol 2022; 95:20220022. [PMID: 36000821 PMCID: PMC9793492 DOI: 10.1259/bjr.20220022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate the long-term outcomes of covered stent placement in patients with gastroduodenal artery (GDA) stump hemorrhage after pancreaticoduodenectomy (PD) and to identify risk factors of stent failure. METHODS AND MATERIALS Covered stent was placed in total of 21 patients for GDA stump hemorrhage after PD from September 2012 to March 2021. Technical and clinical success, complications, and stent patency were retrospectively evaluated. Nine relevant variables were analyzed to determine risk factors for stent failure. RESULTS In 20 of 21 patients (95.2%), the GDA stump was completely excluded with covered stent placement. Immediate hemostasis was achieved in the 20 patients and rebleeding from jejunal artery occurred in one patient which was successfully embolized one day after the stent placement. There was no procedure-related complication or early mortality (<30 days). During follow-up period (median 655.5 days), stent thrombosis was found on CT in 10 patients (50.0%, 10/20) without any laboratory or CT abnormalities. One thrombosed stent migrated into the jejunum 20 months after placement. The six-month, one-year, and two-year stent patency were 81.9%, 52.9%, and 37.8%, respectively (median 620 days). The recurrence of primary malignancy was associated with stent failure (HR 5.70; 95% CI 1.18-27.76, p = 0.03). CONCLUSIONS Covered stent placement is an effective and safe management of postoperative GDA stump hemorrhage. Stent failure occurred frequently (50%) but did not cause liver ischemia. Stent failure was associated with recurrence of primary malignancy. ADVANCES IN KNOWLEDGE 1. Covered stent placement is an effective and safe management of postoperative GDA stump hemorrhage.2. Stent failure occurred frequently (50%) but did not cause liver ischemia.3. Stent failure was associated with recurrence of primary malignancy.
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Affiliation(s)
- Hooney Min
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | | | - Won Seok Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Bum Yeo
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Taalba M, Lefèvre-Scelles A, Roussel M. L’anévrysme de l’artère hépatique : une vésicule biliaire dont le contenu s’allume au Doppler couleur ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Watanabe Y, Nakazawa K, Takase K, Watanabe Y, Okada K, Aikawa M, Okamoto K, Koyama I. Outcomes of Arterial Embolization vs Covered Stents for Delayed Massive Hemorrhage After Pancreatic or Biliary Surgery. J Gastrointest Surg 2022; 26:1187-1197. [PMID: 35091861 DOI: 10.1007/s11605-022-05259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/22/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Covered stent placement (CSP) is gaining popularity for the management of delayed massive hemorrhage (DMH) after pancreatic or biliary surgery. However, early studies have produced conflicting results regarding the potential advantages of the procedure. We aimed to compare the short- and medium-term outcomes of arterial embolization (AE) and CSP for DMH. METHODS We analyzed data for patients who underwent AE or CSP as an endovascular treatment (EVT) for DMH from the common hepatic artery (CHA) and its distal arteries between January 2009 and December 2019. We evaluated the major hepatic complications, in-hospital mortality, and 1-year mortality associated with the procedures, according to age, sex, reintervention, arterial variant, interval between surgery and EVT, and portal vein stenosis. RESULTS All hemorrhages were treated using AE (n = 50) or CSP (n = 20). CSP was associated with no in-hospital mortality (32% vs. 0%, p = 0.003), and lower incidences of major hepatic complications (44% vs. 10%, p = 0.011) and 1-year mortality (54% vs. 25%, p = 0.035) compared with AE, respectively. There was no significant difference in technical success and reintervention rates. Compared with AE, the risk-adjusted odds ratios for CSP (95% confidence intervals) for major hepatic complications and 1-year mortality were 0.06 (0.01-0.39) and 0.19 (0.05-0.71), respectively. CONCLUSIONS CSP is superior to AE regarding major hepatic complications and in-hospital- and 1-year mortality in patients with DMH from hepatic arteries.
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Affiliation(s)
- Yukihiro Watanabe
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, 1397-1 Yamane350-1298, Japan.
| | - Ken Nakazawa
- Department of Radiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kenichiro Takase
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, 1397-1 Yamane350-1298, Japan
| | - Yuichiro Watanabe
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, 1397-1 Yamane350-1298, Japan
| | - Katsuya Okada
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, 1397-1 Yamane350-1298, Japan
| | - Masayasu Aikawa
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, 1397-1 Yamane350-1298, Japan
| | - Kojun Okamoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, 1397-1 Yamane350-1298, Japan
| | - Isamu Koyama
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, 1397-1 Yamane350-1298, Japan
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20
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Kageyama Y, Yamaguchi R, Tamai H, Katono Y. Endovascular management of pseudoaneurysms and aneurysms following gastrointestinal surgery. Asian J Surg 2022; 45:1165-1166. [PMID: 35227563 DOI: 10.1016/j.asjsur.2022.01.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/07/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Yumiko Kageyama
- Department of Surgery, Kasugai Municipal Hospital, Aichi, Japan.
| | - Ryuzo Yamaguchi
- Department of Surgery, Kasugai Municipal Hospital, Aichi, Japan
| | - Hiroaki Tamai
- Department of Vascular Surgery, Kasugai Municipal Hospital, Aichi, Japan
| | - Yuki Katono
- Department of Vascular Surgery, Kasugai Municipal Hospital, Aichi, Japan
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21
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Pedersoli F, Van den Bosch V, Sieben P, Barzakova E, Schulze-Hagen M, Isfort P, Keil S, Wiltberger G, Kuhl CK, Bruners P. Stent Graft Placement by Pseudoaneurysm of the Hepatic Arteries: Efficacy and Patency Rate in Follow-up. Cardiovasc Intervent Radiol 2021; 45:21-28. [PMID: 34734334 PMCID: PMC8716354 DOI: 10.1007/s00270-021-02993-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/14/2021] [Indexed: 12/27/2022]
Abstract
Purpose To investigate efficacy and patency status of stent graft implantation in the treatment of hepatic artery pseudoaneurysm. Materials and Methods A retrospective analysis of patients who had undergone endovascular treatment of hepatic artery pseudoaneurysms between 2011 and 2020 was performed. Medical records were examined to obtain patients’ surgical histories and to screen for active bleeding. Angiographic data on vascular access, target vessel, material used and technical success, defined as the exclusion of the pseudoaneurysm by means of a stent graft with sufficient control of bleeding, were collected. Vessel patency at follow-up CT was analyzed and classified as short-term (< 6 weeks), mid-term (between 6 weeks and 1 year), and long-term patency (> 1 year). In case of stent occlusion, collateralization and signs of hepatic hypoperfusion were examined. Results In total, 30 patients were included and of these, 25 and 5 had undergone stent graft implantation and coiling, respectively. In patients with implanted stent grafts, technical success was achieved in 23/25 patients (92%). Follow-up CT scans were available in 16 patients, showing stent graft patency in 9/16 patients (56%). Short-term, mid-term, and long-term short-term stent patency was found in 81% (13/16), 40% (4/10), and 50% (2/4). In patients with stent graft occlusion, 86% (6/7) exhibited maintenance of arterial liver perfusion via collaterals and 14% (1/7) exhibited liver abscess during follow-up. Conclusion Stent graft provides an effective treatment for hepatic artery pseudoaneurysms. Even though patency rates decreased as a function of time, stent occlusion was mainly asymptomatic due to sufficient collateralization.
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Affiliation(s)
- F Pedersoli
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - V Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - P Sieben
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - E Barzakova
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - M Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - P Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - S Keil
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - G Wiltberger
- Department of General, Visceral, and Transplantation Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - P Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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22
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Effect of Radiofrequency Ablation with Interventional Therapy of Hepatic Artery on the Recurrence of Primary Liver Cancer and the Analysis of Influencing Factors. JOURNAL OF ONCOLOGY 2021; 2021:3392433. [PMID: 34691177 PMCID: PMC8528625 DOI: 10.1155/2021/3392433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022]
Abstract
Background The probability of liver cancer recurring in patients after surgery is a serious threat to liver cancer patients. Radiofrequency ablation is widely employed in liver cancer cases. We explored the therapeutic effects and influencing factors of radiofrequency ablation combined with hepatic artery intervention in patients with recurrence of primary liver cancer surgery. Methods 90 patients with primary liver cancer postoperative recurrence admitted to our hospital from January 2014 to February 2017 were selected as the research objects. The patients were randomly divided into the control group (n = 45) and combined treatment group (n = 45). The combined treatment group received radiofrequency ablation combined with hepatic artery interventional therapy, and the control group received hepatic artery interventional therapy. The short-term efficacy, AFP levels before and after treatment, and long-term survival results of the two groups were compared. Single-factor and multifactor analyses of the clinical information of the combined treatment group were carried out to find out the factors affecting the therapeutic effect of radiofrequency ablation combined with hepatic artery intervention on patients with recurrence of primary liver cancer. Results The total effective rate of short-term curative effect of the combined treatment group was higher than the control group, and there was a statistically significant difference existing (P < 0.05). After treatment, two groups of patients' AFP levels were greatly lower than before treatment, the AFP levels of the combined treatment group were significantly lower than the control group, and there was a statistically significant difference (P < 0.05). The survival rates of patients in the combined treatment group at the sixth month, the first year, and the second year after treatment were significantly higher than those of the control group, and there was a statistically significant difference (P < 0.05). The univariate results showed that, in the combined treatment group, there were statistically significant differences between the effective group and the ineffective group in tumor diameter, intact capsule, liver cirrhosis, intrahepatic spread, and tumor adjacent to large blood vessels (P < 0.05). The outcomes of multivariate analysis indicated that tumor diameter ≥ 3 cm, incomplete capsule, intrahepatic spread, and tumor adjacent to large blood vessels were risk factors for ineffective recurrence of patients with primary liver cancer after radiofrequency ablation combined with hepatic artery intervention (P < 0.05). Discussion. Tumor diameter ≥ 3 cm, incomplete capsule, intrahepatic spread, and tumor adjacent to large blood vessels are risk factors for the ineffectiveness of radiofrequency ablation combined with hepatic artery interventional therapy for patients with recurrence of primary liver cancer. It is necessary to increase the range of radiofrequency treatment, increase the temperature of the radiofrequency needle, and strengthen postoperative follow-up interventions based on the specific conditions of the patient's tumor.
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Patel RK, Chandel K, Tripathy TP, Mukund A. Complications of transjugular intrahepatic portosystemic shunt (TIPS) in the era of the stent graft - What the interventionists need to know? Eur J Radiol 2021; 144:109986. [PMID: 34619618 DOI: 10.1016/j.ejrad.2021.109986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 02/07/2023]
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is created between a hepatic vein (HV) and the portal vein (PV) to alleviate the symptoms of portal hypertension. Despite high procedural success rates, a myriad of complications may occur at every step of TIPS creation. These complications may be attributable to the procedure itself or the shunt. Portal vein puncture is the most challenging and rate-limiting step, with extrahepatic portal vein puncture being the most devastating tabletop complication. Hepatic encephalopathy is the most common shunt-related complication after TIPS. Unlike bare metallic stents, covered stents have a longer patency rate and lower incidence of TIPS dysfunction. Most of the TIPS dysfunction that occurs with stent-grafts is due to technical errors and mechanical factors. TIPS revision often requires a combination of angioplasty, mechanical thrombectomy, and thrombolytics with a need for additional stenting in some cases. This review article focuses on procedure and shunt-related complications, as well as preventive and management strategies.
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Affiliation(s)
- Ranjan Kumar Patel
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
| | - Karamvir Chandel
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Tara Prasad Tripathy
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
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Lin YM, Lin EY, Tseng HS, Lee RC, Huang HE, Wang SE, Shyr YM, Liu CA. Preventive covered stent placement at the gastroduodenal artery stump in angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy. Abdom Radiol (NY) 2021; 46:4995-5006. [PMID: 34037809 DOI: 10.1007/s00261-021-03123-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of preventive covered stent placement at the gastroduodenal artery stump in patients with angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy. METHODS Between July 2006 and September 2018, patients undergoing computed tomography angiography or diagnostic angiography for sentinel hemorrhage after pancreaticoduodenectomy were retrospectively reviewed. Patients having angiogram-negative angiography and undergoing preventive covered stent placement or conservative treatment were included. Clinical outcomes, technique success, and complications were evaluated. RESULTS A total of 25 patients (mean age 62.5 years) were evaluated, including 15 patients underwent preventive covered stent placement at the gastroduodenal artery stump and 10 patients received conservative treatments. The clinical success rates were 50% (5/10) and 86.7% (13/15) for conservative treatments and covered stent groups, respectively (p = 0.07). In the conservative treatment group, delayed massive hemorrhage occurred in five patients, two of whom died of recurrent bleeding due to gastroduodenal artery pseudoaneurysm within 16 days, and two had intraluminal hemorrhage within 5 days. In the covered stent group, one patient had inferior pancreaticoduodenal artery pseudoaneurysm 1 day after the placement of the covered stent, and one had recurrent bleeding due to duodenal ulcer within 14 days. The 30-day mortality was 40% (4/10) and 0 in the conservative treatment and covered stent groups, respectively (p = 0.02). The difference in the overall survival was nonsignificant between the two groups (p = 0.23). CONCLUSIONS The preventive covered stent placement at the gastroduodenal artery stump is safe and reduces delayed massive hemorrhage and short-term mortality in patients with angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy.
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Roberts R, Sheth RA. Hepatic trauma. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1195. [PMID: 34430636 PMCID: PMC8350720 DOI: 10.21037/atm-20-4580] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/25/2021] [Indexed: 12/13/2022]
Abstract
Management of trauma-related liver injury has undergone a paradigm shift over the past four decades. In hemodynamically stable patients, the standard of care in the majority of level-one trauma centers has shifted to nonoperative management with high success rates, especially with low-grade liver injuries (i.e., grade I and II liver injuries). Advances in critical care medicine, cross-sectional imaging, and transarterial embolization techniques have led to the improvement of patient outcomes and decreased mortality rates in patients with arterial injuries. Currently, no consensus guidelines on appropriate patient selection criteria have been published by the Society of Interventional Radiology (SIR) or the American Association for the surgery of Trauma (AAST). Based off the current literature, nonoperative management with hepatic angiography and transarterial embolization (TAE) should be the treatment of choice in hemodynamically stable patients with clinical suspicion of arterial injury. TAE has been shown to improve success rates of nonoperative management and is well tolerated by most patients with low complication rates. Hepatic necrosis is the most common and concerning reported complication but can be reduced with selective approach and choice of embolic agent. The majority of literature supporting the use of TAE for trauma-related liver injury consists of retrospective case series and additional larger scale studies are needed to determine the efficacy of TAE in this setting. However, it is clear from the current literature that hepatic TAE is an effective and safer option to operative management in treating arterial hemorrhage in the setting of traumatic hepatic injury.
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Affiliation(s)
- Rene Roberts
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Rahul A. Sheth
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Shirai Y, Furukawa K, Ashida H, Gocho T, Onda S, Hamura R, Nakashima S, Ojiri H, Ikegami T. Endovascular micro-arterial stenting for arterial pseudoaneurysm after pancreatic surgery. Surg Today 2020; 51:1232-1236. [PMID: 32979122 DOI: 10.1007/s00595-020-02149-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/08/2020] [Indexed: 01/15/2023]
Abstract
Although arterial pseudoaneurysm is one of the most serious complications after pancreatic surgery, the best practice with maximum efficacy and minimum adverse effects to overcome such a serious situation has not yet been elucidated. We performed endovascular micro-arterial stenting (EMAS) to manage this serious situation while preserving a sufficient hepatic arterial flow, and herein report the technical details and challenges of the procedure. Dilation of the stent using a balloon catheter to adhere to the parent artery, and embolization of the surrounding artery to prevent type I and type II endo-leaks are the most important points for ensuring a successful procedure. We applied this technique to 6 cases of hepatic arterial pseudoaneurysm, with a mean size of 6.5 ± 1.3 mm. The mean time of the procedure was 81 ± 22 min, without adverse events, including hepatic necrosis or arterial bleeding. EMAS may be the ideal procedure for treating pseudoaneurysm after pancreatic surgery while preserving the hepatic arterial inflow.
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Affiliation(s)
- Yoshihiro Shirai
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan. .,Division of Gene Therapy, Research Center for Medical Science, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Kenei Furukawa
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hirokazu Ashida
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takeshi Gocho
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shinji Onda
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ryoga Hamura
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.,Division of Gene Therapy, Research Center for Medical Science, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shunsuke Nakashima
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Toru Ikegami
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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