Transcatheter Arterial Embolization of Angiographically Visible and Occult Renal Capsular Artery Hemorrhage in 28 Patients

Safety and effectiveness of transarterial embolization for splenic artery hemorrhage in patients undergoing radical gastrectomy

Background Perigastric lymph nodes are dissected during gastrectomy, potentially resulting in life-threatening postoperative bleeding. Purpose To evaluate the safety and effectiveness of transarterial embolization (TAE) for bleeding from the splenic artery in patients who underwent gastrectomy. Material and Methods Between January 2004 and December 2016, 14,523 patients underwent gastrectomy at our institution, and ten patients (nine men; mean age = 64.7 years; age range = 51-80 years) underwent TAE for postoperative bleeding from the splenic artery. The location of bleeding was classified as either: (i) the main splenic artery (MSA) or (ii) the parenchymal splenic artery (PSA). The clinical outcomes of TAE were explored. Results Bleeding occurred at a median of 13.5 days (range = 4-34 days) after gastrectomy. The onset of bleeding was late in all patients and clinically manifested as abdominal bleeding in seven patients and luminal bleeding in three patients. Technical and clinical success rates were 100% and 70%, respectively. The three major complications occurred only in patients with MSA bleeding, resulting in two 30-day mortality cases and one splenic abscess with fistula formation to the jejunum. The causes of death were infarctions in the spleen and/or remnant stomach and sepsis. Conclusion TAE seems to be effective in stabilizing patients with bleeding from the splenic artery. Moreover, TAE with curative intent may be performed for bleeding from the PSA; however, further resection of the remnant stomach and/or spleen seems to be required to avoid sepsis and mortality in case of bleeding from the MSA.

Postembolization Intratumoral Chronic Bleeding, without the Classic CT Feature of Active Extravasation, in Tuberous Sclerosis Complex-Related Renal Angiomyolipoma: Two Case Reports

Two patients with tuberous sclerosis complex each had multiple bilateral renal angiomyolipomas. After undergoing embolization for a ruptured angiomyolipoma, patient 1 experienced long-lasting abdominal fullness; contrast-enhanced computed tomography (CECT) revealed a large chronic hematoma without contrast extravasation. Patient 2 underwent embolization for the largest right renal angiomyolipoma which contained a chronic hematoma. 2 weeks later, the symptom of abdominal fullness presented, and CECT revealed that the preexisting hematoma had enlarged without contrast extravasation. In both cases, a second embolization of the angiomyolipomas resulted in shrinking of the intratumoral hematomas and alleviation of the associated symptoms. Therefore, chronic postembolization intratumoral bleeding from renal angiomyolipoma may present as a persistently large or growing hematoma with an associated symptom of abdominal fullness but without the typical CECT feature of active extravasation.

Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding

BACKGROUND

The aim of this study was to retrospectively investigate the feasibility and safety of transcatheter arterial embolization in the management of postgastrectomy arterial bleeding.

METHODS

Between January 2004 and July 2015, 13,246 patients underwent total or subtotal gastrectomy at our institution, and 24 patients (18 men; mean age 66.8 years; range 42-80 years) underwent transcatheter arterial embolization for postoperative arterial bleeding identified on angiography.

RESULTS

Postgastrectomy arterial bleeding occurred after subtotal gastrectomy in 14 patients (58%) and after total gastrectomy in 10 patients (42%), after a mean of 17 days (range 1-57 days). It manifested itself as luminal bleeding in 10 patients and as abdominal bleeding in 14 patients. Technical success was achieved in all 24 patients (100%). The clinical success rate was 79% (19-24); there were three transcatheter-arterial-embolization-related major complications that resulted in death within 30 days (12%), one case of recurrent bleeding, and one case of persistent bleeding. The cause of death included infarctions in the spleen and/or remnant stomach (n = 2) and bowel perforation (n = 1). The commonest bleeding focus was the gastroduodenal artery (46%, 11 patients), followed by the splenic artery (29%, 7 patients). By surgery type, the gastroduodenal artery was the commonest site of bleeding in subtotal gastrectomy (64%, 9/14) and the splenic artery was commonest site of bleeding in total gastrectomy (50%, 5/10).

CONCLUSIONS

Transcatheter arterial embolization demonstrated high technical and clinical success rates with an acceptable complication rate in the management of postgastrectomy arterial bleeding. However, transcatheter arterial embolization may not be the best treatment option in patients who have undergone subtotal gastrectomy and bled from the splenic artery owing to the high risk of infarctions of the remnant stomach and the spleen.