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Tan W, Yuan K, Ji K, Xiang T, Xin H, Li X, Zhang W, Song Z, Wang M, Duan F. Targeted versus Empiric Embolization for Delayed Postpancreatectomy Hemorrhage: A Retrospective Study of 312 Patients. J Vasc Interv Radiol 2024; 35:241-250.e1. [PMID: 37926344 DOI: 10.1016/j.jvir.2023.10.026] [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: 06/12/2023] [Revised: 09/22/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023] Open
Abstract
PURPOSE To assess the safety and clinical effectiveness of empiric embolization (EE) compared with targeted embolization (TE) in the treatment of delayed postpancreatectomy hemorrhage (PPH). MATERIALS AND METHODS The data of patients with delayed PPH between January 2012 and August 2022 were analyzed retrospectively. In total, 312 consecutive patients (59.6 years ± 10.8; 239 men) were included. The group was stratified into 3 cohorts according to angiographic results and treatment strategies: TE group, EE group, and no embolization (NE) group. The χ2 or Fisher exact test was implemented for comparing the clinical success and 30-day mortality. The variables related to clinical failure and 30-day mortality were identified by univariable and multivariable analyses. RESULTS Clinical success of transcatheter arterial embolization was achieved in 70.0% (170/243) of patients who underwent embolization. There was no statistical difference in clinical success and 30-day mortality between the EE and TE groups. Multivariate analyses demonstrated that malignant disease (odds ratio [OR] = 5.76), Grade C pancreatic fistula (OR = 7.59), intra-abdominal infection (OR = 2.54), and concurrent extraluminal and intraluminal hemorrhage (OR = 2.52) were risk factors for clinical failure. Moreover, 33 patients (13.6%) died within 30 days after embolization. Advanced age (OR = 2.59) and intra-abdominal infection (OR = 5.55) were identified as risk factors for 30-day mortality. CONCLUSIONS EE is safe and as effective as TE in preventing rebleeding and mortality in patients with angiographically negative delayed PPH.
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Affiliation(s)
- Wenle Tan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Kai Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Kan Ji
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Tao Xiang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hainan Xin
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiaohui Li
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wenhe Zhang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhenfei Song
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Maoqiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Feng Duan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, People's Republic of China.
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Lanza E, Muglia R, Solbiati LA, Tramarin M, Poretti D, Pedicini V. Emergency Transarterial Embolization in Postoperative Hip Bleeding: Indications, Techniques, and Results in a Retrospective Cohort. J Arthroplasty 2018; 33:2273-2278. [PMID: 29544971 DOI: 10.1016/j.arth.2018.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study is to report the results of transarterial embolization (TAE) in the setting of postoperative bleeding after hip surgery. METHODS We retrospectively evaluated 40 patients (male:female = 15:25, median age = 68 years) who underwent TAE from 2006 to 2016: 77.5% underwent total hip arthroplasty, 20% open reduction internal fixation, and 2.5% external fixation. Preangiographic multidetector computed tomography angiography was performed in 20 (49%) cases, and 9 of them showed arterial extravasation. Twenty-seven TAEs were performed within a week from surgery; active bleeding was seen in 33 (80.5%) angiograms. Gelatin sponge, microparticles, coils, n-butyl cyanoacrylate, and combinations of them were used as embolic materials. RESULTS Bleeding was controlled in all cases. The most frequently embolized arteries were branches of the deep femoral artery (n = 17). Permanent embolization agents (microparticles, coils, n-2-butyl-cyanoacrylate) were used in 88% of cases; temporary agents (gelfoam) in 12%. One procedure was complicated by arterial dissection. Hospital discharge averaged 20 days post-TAE (median = 17, range = 3-104). One-month survival rate was 97.5%. One patient died of ischemic bowel perforation. CONCLUSION TAE is safe and effective in stopping the bleeding of the hip region and should be performed early, to avoid irreversible ischemic damage. Multidetector computed tomography angiography can be used to confirm doubtful evidence of ongoing bleeding. Several embolic materials can be used, each one offering different advantages. Low complication and mortality rates were observed. TAE seems to be the ideal first-line intervention when postoperative bleeding of the operated hip is detected.
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Affiliation(s)
- Ezio Lanza
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Riccardo Muglia
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Rozzano, Milano, Italy; Humanitas University, Residency Program in Radiology, Pieve Emanuele, Milano, Italy
| | | | - Marco Tramarin
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Dario Poretti
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Vittorio Pedicini
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Rozzano, Milano, Italy
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Storace M, Martin JG, Shah J, Bercu Z. CTA As an Adjuvant Tool for Acute Intra-abdominal or Gastrointestinal Bleeding. Tech Vasc Interv Radiol 2017; 20:248-257. [DOI: 10.1053/j.tvir.2017.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Song W, Yuan Y, Peng J, Chen J, Han F, Cai S, Zhan W, He Y. The delayed massive hemorrhage after gastrectomy in patients with gastric cancer: characteristics, management opinions and risk factors. Eur J Surg Oncol 2014; 40:1299-306. [PMID: 24731269 DOI: 10.1016/j.ejso.2014.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 12/02/2013] [Accepted: 03/22/2014] [Indexed: 01/28/2023] Open
Abstract
AIMS This study was designed to investigate the clinical features of delayed massive hemorrhage (DMH) after gastrectomy in patients with gastric cancer (GC). METHODS This study retrospectively reviewed 1536 GC patients with major gastrectomy between 1998 and 2011. Based on the time onset of postoperative bleeding, patients were divided into early postoperative hemorrhage (EPH), delayed massive hemorrhage (DMH), and no-bleeding groups. Postoperative mortality, bleeding treatment, and risk factors of hemorrhage were explored. RESULTS In sum, 15 (0.9%) patients suffered from DMH, with three (20%) dead cases. None of 18 (1.2%) patients with EPH died, but there were three dead cases in no-bleeding group. DMH had more extra-intestinal bleeding (P = 0.037) than EPH. Angiographic embolization was performed in 12 (80%) of DMH patients and successful in ten cases. Surgical procedures were applied in only two embolization-failed cases. Extended lymphadenectomy (P = 0.038), vascular skeletonization (P = 0.012) and advanced TNM stage (P < 0.001) were correlated with DMH. CONCLUSIONS DMH can be successfully managed with angiographic embolization, followed by alternative surgery. Extensive lymphadenectomy and vascular skeletonization should be discreetly performed during gastrectomy.
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Affiliation(s)
- W Song
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Y Yuan
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - J Peng
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - J Chen
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - F Han
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - S Cai
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - W Zhan
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Y He
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
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Zhou CG, Shi HB, Liu S, Yang ZQ, Zhao LB, Xia JG, Zhou WZ, Li LS. Transarterial embolization for massive gastrointestinal hemorrhage following abdominal surgery. World J Gastroenterol 2013; 19:6869-6875. [PMID: 24187463 PMCID: PMC3812487 DOI: 10.3748/wjg.v19.i40.6869] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 07/29/2013] [Accepted: 08/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical results of angiography and embolization for massive gastrointestinal hemorrhage after abdominal surgery.
METHODS: This retrospective study included 26 patients with postoperative hemorrhage after abdominal surgery. All patients underwent emergency transarterial angiography, and 21 patients underwent emergency embolization. We retrospectively analyzed the angiographic features and the clinical outcomes of transcatheter arterial embolization.
RESULTS: Angiography showed that a discrete bleeding focus was detected in 21 (81%) of 26 patients. Positive angiographic findings included extravasations of contrast medium (n = 9), pseudoaneurysms (n = 9), and fusiform aneurysms (n = 3). Transarterial embolization was technically successful in 21 (95%) of 22 patients. Clinical success was achieved in 18 (82%) of 22 patients. No postembolization complications were observed. Three patients died of rebleeding.
CONCLUSION: The positive rate of angiographic findings in 26 patients with postoperative gastrointestinal hemorrhage was 81%. Transcatheter arterial embolization seems to be an effective and safe method in the management of postoperative gastrointestinal hemorrhage.
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Abstract
Significant gastrointestinal (GI) bleeding in the postoperative period is an uncommon complication of surgery. The management of GI bleeding within the postoperative period is complex because of a larger differential for the source of bleeding and a more complex risk/benefit analysis. There is minimal published literature specific to the management of postoperative GI bleeding, and the infrequency, complexity, and variability of the clinical setting of this complication confound simplistic consideration of its cause and therapy. This article outlines a systematic evaluation of the patient, treatment options, and assessment of risk/benefit ratio for various treatment options.
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Affiliation(s)
- Seon Jones
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN 37212-3755, USA
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Zhang J, Zhu X, Chen H, Qian HG, Leng JH, Qiu H, Wu JH, Liu BN, Liu Q, Lv A, Li YJ, Zhou GQ, Hao CY. Management of delayed post-pancreaticoduodenectomy arterial bleeding: interventional radiological treatment first. Pancreatology 2011; 11:455-63. [PMID: 21968388 DOI: 10.1159/000331456] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 07/27/2011] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the diagnosis and treatment of delayed post-pancreaticoduodenectomy arterial bleeding (DPPAB). METHODS Records of 336 patients who underwent pancreaticoduodenectomy (PD) between January 2000 and December 2010 were retrospectively analyzed. Detailed data of patients with DPPAB were assessed by a thorough review of medical records. RESULTS 14 patients developed DPPAB. The mean time interval between the initial surgery and DPPAB was 33 days (range 7-72). Three patients experienced sentinel bleeding 5-8 days before DPPAB. All DPPAB patients had intra-abdominal septic complications before bleeding. The overall prevalence of success of angiography and transcatheter arterial embolization (TAE) was 85.7% (12/14), including 3 patients who achieved complete hemostasis by TAE after unsuccessful re-laparotomy. The prevalence of mortality of DPPAB was 28.6% (4/14). After hemostasis was achieved, intra-abdominal septic complications were controlled by percutaneous catheter drainage or re-laparotomy with drain replacement. CONCLUSION Angiography and TAE are recommended as the first-line diagnostic and treatment choice for DPPAB, respectively. Surgical intervention should be preserved to eliminate the cause of bleeding.
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Affiliation(s)
- Ji Zhang
- Department of Hepatopancreatobiliary Surgery, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, PR China
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Kim YH, Kim JD, Visconti G, Kim JT. Life-threatening bleeding and radiologic intervention after aesthetic surgeries with minimal invasive approaches: report of two cases. J Plast Reconstr Aesthet Surg 2010; 63:e745-8. [PMID: 20643593 DOI: 10.1016/j.bjps.2010.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 05/28/2010] [Accepted: 06/04/2010] [Indexed: 11/26/2022]
Abstract
In this article, the authors report two cases of life-threatening bleeding after cosmetic surgeries that have been successfully treated with radiologic intervention. A 25-year-old female and a 35-year-old female presented at their institutions because of postoperative bleeding after intraoral mandibular angle ostectomy and endoscopic-guided trans-axillary breast augmentation, respectively. A ruptured traumatic pseudo-aneurysm of the right superficial temporal artery was diagnosed in the first case and a haematoma posterior to the right pectoralis major, due to active bleeding from a perforator of internal mammary artery, in the second case. Attempts were made to stop the haemorrhage using standard methods, but failed. Therefore, superselective microcatheter angioembolisation has been successfully performed in both the cases. At 22-month follow-up for the first case and at 12-month follow-up for the second case, the patients are asymptomatic and the cosmetic outcomes are being preserved. With radiologic intervention, the authors gained satisfactory results in the above-mentioned situations. Using this, with only local anaesthesia and the absence of incisions, a precise approach with immediate treatment to the haemorrhaging site is possible. This can be an excellent solution for arterial bleeding that is difficult to access anatomically after aesthetic surgeries, and in selected cases. Furthermore, this procedure is less disfiguring and preserves the aesthetic surgery outcomes.
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Affiliation(s)
- Youn-Hwan Kim
- Department of Plastic and Reconstructive Surgery, Hanyang University Hospital, 17 Haengdang-Dong, Seongdong-Gu, Seoul 133-792, South Korea
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Bogue CO, Alzahrani AI, Wales PW, John PR, Amaral JG. Delayed, life-threatening lower gastrointestinal hemorrhage in an infant after serial transverse enteroplasty: treatment with transcatheter n-butyl-2-cyanoacrylate embolization. Pediatr Radiol 2009; 39:1098-101. [PMID: 19582443 DOI: 10.1007/s00247-009-1328-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 05/19/2009] [Accepted: 06/02/2009] [Indexed: 10/20/2022]
Abstract
We report a case of n-butyl-2-cyanoacrylate glue embolization of life-threatening lower gastrointestinal (LGI) hemorrhage in a 10-month-old boy. The child had a history of gastroschisis and short-bowel syndrome. Six months prior to the LGI bleed, he had undergone a serial transverse enteroplasty (STEP) to lengthen his intestine. To the best of our knowledge this is both the first report of successful glue embolization for LGI bleeding in a child and also the first report of severe hemorrhage after the STEP procedure.
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Affiliation(s)
- Conor O Bogue
- Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto M5G 1X8, Canada.
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Ichihara T, Sato T, Miyazawa H, Shibata S, Hashimoto M, Ishiyama K, Yamamoto Y. Stent placement is effective on both postoperative hepatic arterial pseudoaneurysm and subsequent portal vein stricture: A case report. World J Gastroenterol 2007; 13:970-2. [PMID: 17352034 PMCID: PMC4065940 DOI: 10.3748/wjg.v13.i6.970] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To treat postoperative bleeding after hepato-pancreato-biliary surgery, interventional radiology has become essential. We report a case of coincidental pseudoaneurysm and jejunal varices that were both successfully treated by stent-grafts. After a pancreaticoduodenectomy, the patient developed a pseudoaneurysm in the hepatic artery and a stenosis in its periphery. After establishing hepatic arterial flow by placing stent-grafts over both the pseudoaneurysm and the stenosis, the pseudoaneurysm was embolized with microcoils. Nine months later, the patient developed jejunal varices caused by a severe stricture in the main trunk of the portal vein. Percutaneous transhepatic portography was performed and stent-grafts were placed over the stenotic segment. A venoplasty using stent-grafts normalized the portal blood flow and the jejunal varices vanished. Although stenosis occurred due to scarred tissues from leakage after pancreaticoduodenectomy, stent-grafts were useful for managing jejunal bleeding post-operatively.
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Affiliation(s)
- Toshiaki Ichihara
- Department of Gastroenterological Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
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