1
|
Kamada Y, Hori T, Yamamoto H, Harada H, Yamamoto M, Yamada M, Yazawa T, Sasaki B, Tani M, Sato A, Katsura H, Tani R, Aoyama R, Sasaki Y, Okada M, Zaima M. Fatal arterial hemorrhage after pancreaticoduodenectomy: How do we simultaneously accomplish complete hemostasis and hepatic arterial flow? World J Hepatol 2021; 13:483-503. [PMID: 33959229 PMCID: PMC8080554 DOI: 10.4254/wjh.v13.i4.483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although arterial hemorrhage after pancreaticoduodenectomy (PD) is not frequent, it is fatal. Arterial hemorrhage is caused by pseudoaneurysm rupture, and the gastroduodenal artery stump and hepatic artery (HA) are frequent culprit vessels. Diagnostic procedures and imaging modalities are associated with certain difficulties. Simultaneous accomplishment of complete hemostasis and HA flow preservation is difficult after PD. Although complete hemostasis may be obtained by endovascular treatment (EVT) or surgery, liver infarction caused by hepatic ischemia and/or liver abscesses caused by biliary ischemia may occur. We herein discuss therapeutic options for fatal arterial hemorrhage after PD.
AIM To present our data here along with a discussion of therapeutic strategies for fatal arterial hemorrhage after PD.
METHODS We retrospectively investigated 16 patients who developed arterial hemorrhage after PD. The patients’ clinical characteristics, diagnostic procedures, actual treatments [transcatheter arterial embolization (TAE), stent-graft placement, or surgery], clinical courses, and outcomes were evaluated.
RESULTS The frequency of arterial hemorrhage after PD was 5.5%. Pancreatic leakage was observed in 12 patients. The onset of hemorrhage occurred at a median of 18 d after PD. Sentinel bleeding was observed in five patients. The initial EVT procedures were stent-graft placement in seven patients, TAE in six patients, and combined therapy in two patients. The rate of technical success of the initial EVT was 75.0%, and additional EVTs were performed in four patients. Surgical approaches including arterioportal shunting were performed in eight patients. Liver infarction was observed in two patients after TAE. Two patients showed a poor outcome even after successful EVT. These four patients with poor clinical courses and outcomes had a poor clinical condition before EVT. Fourteen patients were successfully treated.
CONCLUSION Transcatheter placement of a covered stent may be useful for simultaneous accomplishment of complete hemostasis and HA flow preservation.
Collapse
Affiliation(s)
- Yasuyuki Kamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Hidekazu Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Hideki Harada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Michihiro Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masahiro Yamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Takefumi Yazawa
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Ben Sasaki
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masaki Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Asahi Sato
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Hikotaro Katsura
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Ryotaro Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Ryuhei Aoyama
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Yudai Sasaki
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masaharu Okada
- Department of Cardiovascular Medicine, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masazumi Zaima
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Giorgakis E, Chong B, Oklu R, Jaroszewski DE, Knuttinen G, Mathur AK. Successful treatment of visceral pseudoaneurysm after pancreatectomy using flow-diverting stent device. Ann Hepatobiliary Pancreat Surg 2020; 24:114-118. [PMID: 32181440 PMCID: PMC7061036 DOI: 10.14701/ahbps.2020.24.1.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/27/2019] [Accepted: 01/19/2020] [Indexed: 11/17/2022] Open
Abstract
Aim of the study is the description of the successful management of gastroepiploic artery pseudoaneurysm with preservation of parent vessels using flow-diversion technology. The present report describes the application of a flow-diversion Pipeline™ Flex device for occlusion of a sidewall bleeding pseudoaneurysm on a patient who was status-post sub-total pancreatectomy and remote esophagectomy with a gastric conduit. The pseudoaneurysm was on the solitary vessel supplying the patient's conduit. Use of flow diversion technology excluded the sidewall pseudoaneurysm while maintaining gastric conduit perfusion. In our case, the application of flow diversion technology allowed the preservation of patency of the main arterial supply to the gastric conduit on a post-esophagectomy patient; loss of the right gastroepiploic artery in that case would had been otherwise catastrophic. Flow-diversion technology can be considered for the treatment of pseudoaneurysms post-pancreatic resections, especially when there is no other surgical or endovascular treatment option.
Collapse
Affiliation(s)
- Emmanouil Giorgakis
- Division of Transplantation and Hepatopancreatobiliary Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA.,Department of Solid Organ Transplantation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brian Chong
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Rahmi Oklu
- Department of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Dawn E Jaroszewski
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Grace Knuttinen
- Department of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Amit K Mathur
- Division of Transplantation and Hepatopancreatobiliary Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| |
Collapse
|
4
|
Fernández Conesa M, Milena Muñoz A, Valero González MÁ. Active bleeding due to a hepatic arterial pseudoaneurysm that occurred after acute cholangitis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:240. [PMID: 32054281 DOI: 10.17235/reed.2020.6483/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We read with interest the article by Guido Villa-Gómez, Manuel Alejandro Mahler and Dante Manazzoni "A new case of pseudoaneurysm of the right hepatic artery secondary to laparoscopic cholecystectomy". A 57-year-old cholecystectomized female was admitted due to abdominal pain with an analytical pattern of cholestasis and liver enzyme alterations, with cholangitis that progressed to septic shock of a biliary origin with gradual anemia and hypotension.
Collapse
|
5
|
Kundaragi NG, Asthana S, Reddy J, Lochan R. Hepatic arterial communicating arcades-Case series and review of literature. Indian J Radiol Imaging 2020; 29:462-467. [PMID: 31949354 PMCID: PMC6958894 DOI: 10.4103/ijri.ijri_413_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/10/2019] [Accepted: 10/09/2019] [Indexed: 11/22/2022] Open
Abstract
This case series describes the hepatic arterial communicating arcades and their importance in the endovascular management of hepatic artery pseudoaneurysm, pediatric post liver transplant lobar arterial occlusion, and lobar arterial stenosis due to gall bladder carcinoma. We describe new types of arterial communicating arcades which have not been described earlier.
Collapse
Affiliation(s)
- Nischal G Kundaragi
- Department of Interventional Radiology and Interventional Oncology, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Sonal Asthana
- Department of Hepatobiliary and Multi-Organ Transplantation Surgery, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Jayanth Reddy
- Department of Hepatobiliary and Multi-Organ Transplantation Surgery, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Rajiv Lochan
- Department of Hepatobiliary and Multi-Organ Transplantation Surgery, Aster CMI Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
6
|
Aoun C, El Rassi Z. Stent graft placement for an incidental finding of hepatic artery pseudoaneurysm post hepatectomy, a case report and literature review. Int J Surg Case Rep 2018; 49:191-193. [PMID: 30025337 PMCID: PMC6089781 DOI: 10.1016/j.ijscr.2018.06.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/14/2018] [Accepted: 06/30/2018] [Indexed: 12/04/2022] Open
Abstract
Hepatic artery pseudoaneurysm presentation, diagnosis, and treatment options. Stent graft placement post hepatic artery pseudoaneurysm is safe and effective. General and vascular surgeons should be on the case to manage any complication.
Introduction Hepatic artery pseudoaneurysm is usually iatrogenic, with bleeding occurring early or late postoperatively. Case presentation A 61-year-old man with pseudoaneurysm of the common hepatic artery post hepatectomy treated with a stent-graft. The patient was asymptomatic and the pseudoaneurysm appeared incidentally on follow-up. Selective catheterization of the common hepatic artery showed a pseudo-aneurysm close to its origin. Covered stent was deployed in the main hepatic artery. Completion angiography showed no residual spasm and adequate patency of the common hepatic artery, with complete exclusion of the pseudoaneurysm. Discussion Using stentgraft for pseudoaneurysm management has multiple advantages when compared to other traditional techniques. However, stent placement has its own complications. Conclusion Stent graft placement post hepatic artery pseudo-aneurysm is safe and effective; however its complications should be evaluated with multidisciplinary team.
Collapse
Affiliation(s)
- Charbel Aoun
- General Surgery Resident, Saint Georges Hospital University Medical Center, Faculty of Medicine, University of Balamand, Beirut, Lebanon.
| | - Ziad El Rassi
- Professor of Clinical Surgery, General and Digestive Surgery-Oncologic Surgery, Saint Georges Hospital University Medical Center, Faculty of Medicine, University of Balamand, Beirut, Lebanon
| |
Collapse
|
7
|
Regarding "Effectiveness and outcome of endovascular therapy for late-onset postpancreatectomy hemorrhage using covered stents and embolization". J Vasc Surg 2017; 65:1244. [PMID: 28342518 DOI: 10.1016/j.jvs.2016.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/17/2016] [Indexed: 11/23/2022]
|
8
|
deFreitas D, Phade S, Stoner M, Bogey W, Powell CS, Parker F. Endovascular Stent Exclusion of a Hepatic Artery Pseudoaneurysm. Vasc Endovascular Surg 2016; 41:161-4. [PMID: 17463211 DOI: 10.1177/1538574406298517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Presented is a patient with an iatrogenic hepatic artery pseudoaneurysm that was treated by endovascular stent grafting. Endovascular stent grafting of a hepatic artery pseudoaneurysm offers a safe and potentially less morbid alternative to an open repair. The report stresses the necessity of careful preoperative evaluation with angiography to determine the feasibility of the procedure. An aggressive approach to treating hepatic artery pseudoaneurysms is advocated because of the poor correlation between size and their tendency to rupture. With an increasing rate of diagnosis of visceral artery aneurysms in elderly, debilitated patients, endovascular repair is anticipated to have an increasing role and should be considered a first-line therapy in anatomically suitable candidates.
Collapse
Affiliation(s)
- Dorian deFreitas
- Section of Vascular and Endovascular Surgery, East Carolina University, Greenville, North Carolina 27834, USA
| | | | | | | | | | | |
Collapse
|
9
|
Luckhurst CM, Perez C, Collinsworth AL, Trevino JG. Atypical presentation of a hepatic artery pseudoaneurysm: A case report and review of the literature. World J Hepatol 2016; 8:779-784. [PMID: 27366305 PMCID: PMC4921800 DOI: 10.4254/wjh.v8.i18.779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/25/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
Classically, hepatic artery pseudoaneurysms (HAPs) arise secondary to trauma or iatrogenic causes. With an increasing prevalence of laparoscopic procedures of the hepatobiliary system the risk of inadvertent injury to arterial vessels is increased. Pseudoaneurysm formation post injury can lead to serious consequences of rupture and subsequent hemorrhage, therefore intervention in all identified visceral pseudoaneurysms has been advocated. A variety of interventional methods have been proposed, with surgical management becoming the last step intervention when minimally invasive therapies have failed. The authors present a case of a HAP in a 56-year-old female presenting with jaundice and pruritis suggestive of a Klatskin’s tumor. This presentation of HAP in a patient without any significant past medical or surgical intervention is atypical when considering that the majority of HAP cases present secondary to iatrogenic causes or trauma. Multiple minimally invasive approaches were employed in an attempt to alleviate the symptomology which included jaundice and associated inflammatory changes. Ultimately, a right hepatic trisegmentectomy was required to adequately relieve the mass effect on biliary outflow obstruction and definitively address the HAP. The presentation of a HAP masquerading as a malignancy with jaundice and pruritis, rather than the classic symptoms of abdominal pain, anemia, and melena, is unique. This presentation is only further complicated by the absent history of either trauma or instrumentation. It is important to be aware of HAPs as a potential cause of jaundice in addition to the more commonly thought of etiologies. Furthermore, given the morbidity and mortality associated with pseudoaneurysm rupture, intervention in identifiable cases, either by minimally invasive or surgical interventions, is recommended.
Collapse
|
10
|
Covered Stents and Coil Embolization for Treatment of Postpancreatectomy Arterial Hemorrhage. J Vasc Interv Radiol 2016; 27:73-9. [DOI: 10.1016/j.jvir.2015.09.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 09/18/2015] [Accepted: 09/26/2015] [Indexed: 12/12/2022] Open
|
11
|
Ischemic Liver Injury After Complete Occlusion of Hepatic Artery in the Treatment of Delayed Postoperative Arterial Bleeding. J Gastrointest Surg 2015; 19:2235-42. [PMID: 26334251 DOI: 10.1007/s11605-015-2930-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/19/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Delayed postoperative arterial bleeding is rare and may be life-threatening. When the bleeding source is the hepatic artery, complete ligation or embolization from the proximal to the distal area of the ruptured lesion usually results in complete occlusion of hepatic arterial flow. METHODS To evaluate the frequency and severity of ischemic liver injury following complete hepatic artery occlusion, a retrospective study was conducted. Patients who underwent complete hepatic artery occlusion in the treatment of delayed postoperative arterial bleeding between January 2007 and December 2014 in our institution were reviewed. Changes of hepatic function and rates of associated complications and prognosis were analyzed. RESULTS A total of 24 patients experienced 26 episodes of bleeding. Nineteen experienced transient liver enzyme elevation alone. There were no signs of acute liver failure after complete hepatic artery occlusion. The rates of liver infarction and liver abscess were 23.8 % (5/21) and 19 % (4/21), respectively. The 30-day mortality rate was 8.3 % (2/24). CONCLUSION Complete occlusion of the hepatic artery does not always result in severe hepatic ischemic injury. As a common cause of delayed postoperative bleeding, intra-abdominal infection may be fatal when it is not controlled successfully.
Collapse
|
12
|
Hemmati H, Karimian M, Moradi H, Farid Marandi K, Haghdoost A. Endovascular Treatment of a Huge Hepatic Artery Aneurysm by Coil Embolization Method: A Case Report. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e5200. [PMID: 26528386 PMCID: PMC4623773 DOI: 10.5812/iranjradiol.5200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/23/2013] [Accepted: 11/30/2013] [Indexed: 11/16/2022]
Abstract
Hepatic artery aneurysms are rare but potentially life threatening. We describe a novel case of a successful endovascular coil embolization of a huge hepatic artery aneurysm. A 67-year-old woman presented with recent abdominal pain that had begun from 2 weeks before referring to our hospital. Sonographic and computerized tomographic (CT) findings revealed a huge hepatic artery aneurysm with 95 mm × 83 mm diameter. The patient underwent an endovascular technique. In aortic angiography, the celiac artery orifice and superior mesenteric artery were so narrow, so sonography was used in order to determine the exact position of the catheter in the celiac artery orifice. The aneurysm was thrombosed using coil embolization. Pulsation of the aneurysm immediately disappeared. Huge hepatic artery aneurysm can be safely treated using coil embolization.
Collapse
Affiliation(s)
- Hossein Hemmati
- Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Hossein Hemmati, Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9133045924, Fax: +98-1333542460, E-mail:
| | - Mehdi Karimian
- Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Habibollah Moradi
- Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Kambiz Farid Marandi
- Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Afrooz Haghdoost
- Student Research Committee, Department of Research and Technology, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
13
|
Tiwari C, Sandlas G, Jayaswal S, Shah H. WITHDRAWN: Idiopathic Pancreatitis with Splenic Artery Pseudoaneurysm in a Child: A Rare Presentation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
14
|
Endovascular Management of Severe Bleeding After Major Abdominal Surgery. Ann Vasc Surg 2013; 27:1098-104. [DOI: 10.1016/j.avsg.2012.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 10/12/2012] [Accepted: 10/17/2012] [Indexed: 12/19/2022]
|
15
|
Yoshida RDA, Vieira PRB, Yoshida WB, Sobreira ML, Jaldin RG, Zuppardo RL, Moura R. Endovascular Treatment of Hepatic Artery Pseudoaneurysm secondary to an Erosion and Liver Block of Perforated Peptic Ulcer. J Vasc Bras 2013. [DOI: 10.1590/s1677-54492013000200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
16
|
Dardik H. Postpancreatectomy hemorrhage. J Am Coll Surg 2013; 216:508-9. [PMID: 23415407 DOI: 10.1016/j.jamcollsurg.2012.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 12/10/2012] [Indexed: 11/18/2022]
|
17
|
Dissecting pseudoaneurysm of the proper hepatic artery repaired by primary anastomosis: a case report. Case Rep Surg 2012. [PMID: 23198251 PMCID: PMC3502830 DOI: 10.1155/2012/804919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background. Although rare, visceral artery pseudoaneurysms often present as surgical emergencies with a specific mortality rate as high as 35% related to aneurysmal rupture. Risk factors for the development of iatrogenic pseudoaneurysms include anticoagulation, female gender, obesity, and vessel calcification. Case Report. We present a case of an elderly female who developed a dissecting pseudoaneurysm of the proper hepatic artery after undergoing routine surgery to resect a large duodenal adenoma. Surgical repair comprised of resection and primary anastomosis was employed resulting in a favourable outcome. Discussion/Conclusion. Surgical management reduces the risk of hepatic ischemia, biliary complications, and abscess formation. Although stenting, coil embolization, and thrombin injection are all plausible options for management, we propose that surgical reconstruction be considered seriously as a treatment for such spontaneous pseudoaneurysms.
Collapse
|
18
|
Lu NN, Huang Q, Wang JF, Wei BJ, Gao K, Zhai RY. Treatment of post-liver transplant hepatic artery pseudoaneurysm with balloon angioplasty after failed stent graft placement. Clin Res Hepatol Gastroenterol 2012; 36:e109-13. [PMID: 22766148 DOI: 10.1016/j.clinre.2012.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 05/10/2012] [Accepted: 05/21/2012] [Indexed: 02/04/2023]
Abstract
Hepatic artery pseudoaneurysm is a rare complication following liver transplantation but can lead to life threatening hemorrhage if not treated effectively and in a timely manner. We describe a hepatic artery pseudoaneurysm that occurred after liver transplantation in a 53-year-old woman. The pseudoaneurysm was initially treated by implantation of a balloon-expandable covered stent-graft, but an endoleak was observed 6 days later. The endoleak was successfully resolved by further balloon angioplasty, which expanded the cylindrical stent to a conical stent, matching the anatomy of the anastomotic hepatic artery. Follow-up ultrasound examinations demonstrated patent hepatic arteries, with no evidence of pseudoaneurysm. Balloon-expandable covered stent-graft may be utilized to treat hepatic artery pseudoaneurysm following liver transplantation, due to the remodeling ability of stent-grafts, enabling them to fit the diseased vessels.
Collapse
Affiliation(s)
- Ning-Ning Lu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongren Tiyuchang Nan Road, Chaoyang District, Beijing 100020, China
| | | | | | | | | | | |
Collapse
|
19
|
Asai K, Watanabe M, Kusachi S, Matsukiyo H, Saito T, Kodama H, Enomoto T, Nakamura Y, Okamoto Y, Saida Y, Iijima R, Nagao J. Successful treatment of a common hepatic artery pseudoaneurysm using a coronary covered stent following pancreatoduodenectomy: report of a case. Surg Today 2012; 44:160-5. [PMID: 22932840 DOI: 10.1007/s00595-012-0314-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 06/07/2012] [Indexed: 12/18/2022]
Abstract
This report presents the case of a common hepatic artery (CHA) pseudoaneurysm secondary to postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD), which was successfully treated using a coronary covered stent. A 70-year-old female underwent subtotal stomach-preserving PD for middle cholangiocarcinoma. POPF was identified on postoperative day (POD) 7, and the patient suddenly lost 500 ml of blood via the abdominal drain on POD 19. Urgent celiac arteriography revealed a CHA pseudoaneurysm. A coronary covered stent was placed to prevent rupture of the pseudoaneurysm and to maintain hepatic arterial flow, instead of performing transarterial embolization. No vascular adverse events were encountered during or after the procedure. Computed tomography and angiography showed a patent stent graft and good hepatic arterial flow 9 months after placement of the stent. Endovascular stent-graft placement not only treated the pseudoaneurysm, but also preserved the arterial blood flow. This report describes the placement of a covered stent graft for delayed hemorrhage after PD.
Collapse
Affiliation(s)
- Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Lee JH, Hwang DW, Lee SY, Hwang JW, Song DK, Gwon DI, Shin JH, Ko GY, Park KM, Lee YJ. Clinical features and management of pseudoaneurysmal bleeding after pancreatoduodenectomy. Am Surg 2012. [PMID: 22524769 DOI: 10.1177/000313481207800339] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A ruptured pseudoaneurysm is the most serious and life-threatening cause of postpancreatoduodenectomy (PD) hemorrhages. We have evaluated the clinical course and management of pseudoaneurysms after PD. Of 586 patients who underwent PD for periampullary tumors in Asan Medical Center between March 2003 and March 2011, 27 experienced pseudoaneurysmal bleeding. Bleeding developed at a median of 21 days (range, 8 to 45 days) after surgery, including 9 patients who developed bleeding more than 4 weeks after surgery. Before development of bleeding, 26 patients showed pancreatic fistula. Bleeding was developed from the gastroduodenal artery stump in 12 patients, the common hepatic artery in eight, the proper hepatic artery in five, and the left hepatic artery in two. Of the angiographic group, 21 patients underwent with microcoil embolization, four underwent stent insertion, and one experienced technical failure. Only one patient required emergent laparotomy without angiography. Of 25 patients with angiographic procedures, all patients achieved hemostasis. The mortality rate was 22.2 per cent (6 patients). Delayed hemorrhage after PD is closely associated with pancreatic fistula and carried a significantly higher mortality rate. The patients with pancreatic fistula should be carefully monitored, even more than 4 weeks after surgery. Selective microcoil embolization or stent graft is effective for pseudoaneurysmal bleeding.
Collapse
Affiliation(s)
- Jae Hoon Lee
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Barge JU, Lopera JE. Vascular complications of pancreatitis: role of interventional therapy. Korean J Radiol 2012; 13 Suppl 1:S45-55. [PMID: 22563287 PMCID: PMC3341460 DOI: 10.3348/kjr.2012.13.s1.s45] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/05/2011] [Indexed: 12/12/2022] Open
Abstract
Major vascular complications related to pancreatitis can cause life-threatening hemorrhage and have to be dealt with as an emergency, utilizing a multidisciplinary approach of angiography, endoscopy or surgery. These may occur secondary to direct vascular injuries, which result in the formation of splanchnic pseudoaneurysms, gastrointestinal etiologies such as peptic ulcer disease and gastroesophageal varices, and post-operative bleeding related to pancreatic surgery. In this review article, we discuss the pathophysiologic mechanisms, diagnostic modalities, and treatment of pancreatic vascular complications, with a focus on the role of minimally-invasive interventional therapies such as angioembolization, endovascular stenting, and ultrasound-guided percutaneous thrombin injection in their management.
Collapse
Affiliation(s)
- Jaideep U Barge
- Diagnostic and Interventional Radiology at University of Texas Health Science Center at San Antonio, San Antonio, TX 78249, USA.
| | | |
Collapse
|
22
|
Ferlini M, Quaretti P, Cascella T, Cionfoli N, Ferrario M, Bramucci E. Percutaneous hepatic pseudoaneurysm exclusion using a pericardium covered stent. J Cardiovasc Med (Hagerstown) 2012; 14:472-3. [PMID: 22499003 DOI: 10.2459/jcm.0b013e3283536aff] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Visceral artery pseudoaneurysms (PA) are a rare complication of abdominal surgery. Their natural history is generally unknown and unpredictable, so a repair is recommended. We report the case of a 77-year-old male with a huge PA of the hepatic artery diagnosed by computed tomography (CT) and treated successfully with percutaneous exclusion using a pericardium-covered stent. A staged CT confirmed the good result of the procedure.
Collapse
Affiliation(s)
- Marco Ferlini
- UO Cardiologia, Laboratorio di Emodinamica, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy.
| | | | | | | | | | | |
Collapse
|
23
|
Adkisson CD, Sibulesky L, Collis GN, McLaughlin DW, Oldenburg WA, Nguyen JH. Aneurysmectomy and revascularization of a large hepatic artery aneurysm. Ann Vasc Surg 2011; 25:556.e11-5. [PMID: 21549927 DOI: 10.1016/j.avsg.2010.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022]
Abstract
Aneurysms of the hepatic artery are rare, but are associated with significant mortality because of their lack of symptoms at presentation and risk of rupture. We report a case of an enlarging 4-cm hepatic artery aneurysm involving the proximal common hepatic artery to the bifurcation of the right and left hepatic arteries which was found incidentally on ultrasound examination. Endovascular treatment with a stent was considered, but because of the location of the aneurysm as well as the presence of significant thrombosis involving the right and left hepatic arteries, aneurysmectomy and revascularization using saphenous vein was performed. Doppler ultrasound measurements demonstrated good flow through the graft postoperatively and at 1-month follow-up. Although a variety of endovascular techniques exist to treat hepatic artery aneurysms, our results indicate that open excision and revascularization may be required and can have a good outcome.
Collapse
|
24
|
Therapeutic management of hemorrhage from visceral artery pseudoaneurysms after pancreatic surgery. J Gastrointest Surg 2011; 15:1417-25. [PMID: 21584822 DOI: 10.1007/s11605-011-1561-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/02/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Hemorrhage from pseudoaneurysms after pancreatic surgery is a rare but life-threatening and complicated complication. The study presents our experience to provide therapeutic management for this rare condition. METHODS Between February 1994 and January 2011, 35 patients experienced hemorrhage from pseudoaneurysms in our hospital. Medical data of this rare complication were analyzed retrospectively. RESULTS The prevalence of hemorrhage from pseudoaneurysms was 3.2% (35/1,102). Sixteen patients (45.7%) experienced sentinel bleeding. Pancreatic fistula (74.3%) and intra-abdominal abscess (57.1%) were two common complications prior to hemorrhage. Of 35 patients, 20 underwent endovascular intervention, 14 received surgical re-laparotomy, and bleeding stopped spontaneously in one. The overall mortality rate was 22.9%. Technical success rate of endovascular treatment was 87%. There were significant differences in the mortality rate (10.0% vs 42.9%), operation time (72.8 vs 123.9 min), estimated blood loss (1,835 vs 3,000 ml), and intensive care unit stay (3.6 vs 8.6 days) between endovascular and surgical treatment. Mean follow-up was 19.2 ± 17.0 (range, 5-63 months). CONCLUSION Endovascular intervention represents the first-line treatment for hemorrhage from pseudoaneurysms after pancreatic surgery. Endovascular embolization or stent-graft placement should be selected individually depending on the involved artery and its vascular anatomy.
Collapse
|
25
|
Burke CT, Park J. Portal vein pseudoaneurysm with portoenteric fistula: an unusual cause for massive gastrointestinal hemorrhage. Semin Intervent Radiol 2011; 24:341-5. [PMID: 21326482 DOI: 10.1055/s-2007-985748] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pancreaticoduodenectomy (Whipple's procedure) is a commonly performed procedure for the treatment of pancreatic malignancies. Postoperative bleeding from adjacent arteries is a well-established complication of this procedure. This article describes an unusual case of massive gastrointestinal bleeding following pancreaticoduodenectomy due to the development of a portal vein pseudoaneurysm with a portoenteric fistula. The diagnosis was confirmed with multidetector computed tomography angiography; the different endovascular treatment options are discussed.
Collapse
Affiliation(s)
- Charles T Burke
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | |
Collapse
|
26
|
Hur S, Yoon CJ, Kang SG, Dixon R, Han HS, Yoon YS, Cho JY. Transcatheter arterial embolization of gastroduodenal artery stump pseudoaneurysms after pancreaticoduodenectomy: safety and efficacy of two embolization techniques. J Vasc Interv Radiol 2011; 22:294-301. [PMID: 21353982 DOI: 10.1016/j.jvir.2010.11.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 10/28/2010] [Accepted: 11/09/2010] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of two transcatheter arterial embolization (TAE) techniques used to treat pseudoaneurysms of the gastroduodenal artery (GDA) stump after pancreaticoduodenectomy. MATERIALS AND METHODS Between March 2003 and March 2008, 16 patients were treated with TAE for pseudoaneurysms of the GDA stump after pancreaticoduodenectomy. Two embolization techniques were employed: endovascular trapping of the hepatic artery (embolization of the hepatic artery proximal and distal to GDA stump; group A; n = 13) and selective embolization of the GDA stump and/or pseudoaneurysm sparing hepatic arterial flow (group B; n = 3). Technical success, initial hemostasis, recurrence of bleeding, and complications were compared between the two groups retrospectively. RESULTS All TAE procedures were technically successful and immediate hemostasis was achieved in all patients. There was no recurrent bleeding in group A; however, all three patients in group B experienced recurrent bleeding after initial hemostasis (P = .002), and these patients required subsequent embolization with the endovascular trapping technique. Two patients died of multiple organ failure (one patient in each group) despite successful hemostasis. Three patients experienced subsegmental (n = 1, group A) and multisegmental (n = 2, group B) liver infarction, which were successfully managed with conservative treatment. There was a higher incidence of major complications in group B (15.4% vs 100%; P = .018). CONCLUSIONS Endovascular trapping of the hepatic artery is a safe and effective treatment of pseudoaneurysms of the GDA stump after pancreaticoduodenectomy. Hepatic ischemic complications are not rare, but can be conservatively managed. Selective embolization of the GDA stump and/or pseudoaneurysm is frequently associated with recurrence of bleeding, which eventually leads to major complications.
Collapse
Affiliation(s)
- Saebeom Hur
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea
| | | | | | | | | | | | | |
Collapse
|
27
|
Christie AB, Christie DB, Nakayama DK, Solis MM. Hepatic Artery Aneurysms: Evolution from Open to Endovascular Repair Techniques. Am Surg 2011. [DOI: 10.1177/000313481107700522] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
With the development of endovascular therapy, treatment for hepatic artery aneurysm (HAA) has evolved from open excision and repair to include endovascular approaches. We reviewed our recent experience with HAA to help define the treatment of HAA. From 2002 to 2010, five patients underwent treatment of HAA, all men with a median age of 63.2 years (range, 41-75). The median diameter of HAA was 5.8 cm (range, 2.4 cm-11 cm). Four lesions involved the extrahepatic portion of the hepatic artery, and one was an intrahepatic HAA that involved the right hepatic artery. Three were true aneurysms and two were pseudoaneurysms associated with trauma. Four of the five HAA patients were symptomatic, three with nonspecific abdominal pain, and one with free hemorrhage from a ruptured intrahepatic pseudoaneurysm. All five underwent computed tomography and selective arteriography. Two patients underwent open surgical aneurysmectomy and revascularization because of aneurysm location and concerns of the potential lack of collateral flow. Three patients underwent an endovascular coil embolization because obliteration of a saccular aneurysm could be achieved without compromising arterial flow of the native hepatic vessel. Re-embolization was necessary in the intrahepatic aneurysm because of recanalization of a feeding vessel. Endovascular embolization is an important minimally invasive approach in the treatment of HAA. Depending on HAA location and the adequacy of collateral arterial flow around the lesion, open aneurysmectomy and revascularization may be required.
Collapse
Affiliation(s)
- Amy B. Christie
- Department of Surgery, Medical Center of Central Georgia, Macon, Georgia
| | | | - Don K. Nakayama
- Department of Surgery, Medical Center of Central Georgia, Macon, Georgia
| | - Maurice M. Solis
- Department of Surgery, Medical Center of Central Georgia, Macon, Georgia
| |
Collapse
|
28
|
Cho SK, Kim SS, Do YS, Park KB, Shin SW, Park HS, Choo SW, Choo IW. Ischemic liver injuries after hepatic artery embolization in patients with delayed postoperative hemorrhage following hepatobiliary pancreatic surgery. Acta Radiol 2011; 52:393-400. [PMID: 21498292 DOI: 10.1258/ar.2011.100414] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many collateral pathways to the liver are dissected during hepatobiliary pancreatic surgery and, if the arterial bleeding is massive and a hematoma becomes larger, the adjacent portal vein can be compressed with impairment of the portal venous flow. PURPOSE To evaluate the frequency and severity of ischemic liver injuries after hepatic artery embolization in patients with delayed postoperative arterial hemorrhage after hepatobiliary pancreatic surgery. MATERIAL AND METHODS Eighteen patients undergoing proper or common hepatic artery embolization for delayed postoperative arterial hemorrhage after hepatobiliary pancreatic surgery achieved hemostasis. To evaluate the frequency and severity of ischemic liver injuries, the liver enzyme levels and CT findings before and after hepatic artery embolization were retrospectively compared and the clinical outcomes after hepatic artery embolization were analyzed. Angiographic findings were also analyzed to reveal any association with development of ischemic liver injuries after hepatic artery embolization. RESULTS Ischemic liver injuries were observed in 15 (83%) of 18 patients undergoing hepatic artery embolization for postoperative hemorrhage. Injuries included hepatic infarction combined with abscess in one (5%) patient, hepatic infarction in 12 (67%) patients, and transient hepatic ischemia/dysfunction in two (11%). As for the extent of hepatic infarction, lobar infarction developed in two patients and subsegmental infarction in 11. One patient with right hepatic lobar infarction died of hepatic failure 11 days after hepatic artery embolization. In the other 14 patients with ischemic liver injuries, the elevated liver enzymes returned to baseline levels within two weeks. All of the four patients with portal vein stenosis, four patients with no hepatic arterial flow on post-embolization angiogram, and one patient with both had hepatic infarction after hepatic artery embolization. No ischemic liver injuries developed after hepatic artery embolization in three patients with no portal vein stenosis and bilobar hepatic arterial flow via the left hepatic artery aberrantly arising from the left gastric artery or from the common hepatic artery. CONCLUSION Ischemic liver injuries can develop in most patients undergoing hepatic artery embolization for postoperative arterial hemorrhage after hepatobiliary pancreatic surgery; hepatic infarction appears to be the most frequent type of ischemic liver injury. Hepatic artery embolization for postoperative arterial hemorrhage after hepatobiliary pancreatic surgery may carry a great risk of ischemic liver injury if a patient has portal vein stenosis or no aberrant hepatic artery.
Collapse
Affiliation(s)
- Sung Ki Cho
- Department of Radiology, Kangwon National University College of Medicine, Kangwon-do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sam Soo Kim
- Department of Radiology, Kangwon National University College of Medicine, Kangwon-do
| | - Young Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Wook Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Suk Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Wook Choo
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Wook Choo
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
29
|
Multimodal approach to the endovascular treatment of embolisation or exclusion of the renal arteries and their distal and/or polar branches: personal experience. Radiol Med 2011; 116:945-59. [PMID: 21509547 DOI: 10.1007/s11547-011-0684-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE This study reviews our experience over the last 10 years with procedures of embolisation and/or exclusion of the renal arteries, their parenchymal branches and the polar arteries [renal artery embolisation (RAE)]. MATERIALS AND METHODS Twenty-seven patients (19 men and eight women; age range 37-93 years; mean 74 years) underwent RAE. The indications were: symptomatic gross haematuria in nine patients (33.3%) (tumour-related in seven and iatrogenic in two), symptomatic inoperable renal tumour in five (18.5%), large subcapsular or perirenal haematoma in three (11.1%) and aneurysm of the main renal artery in two (7.4%). Eight patients (29.6%) scheduled for endovascular aneurysm repair (EVAR) of the abdominal aorta underwent prophylactic embolisation of the renal polar branch arising from the aneurysmal sac or the subrenal aortic neck to prevent the possible revascularisation of the sac. Different embolisation agents were used: coils (17 cases), embolisation particles (14 cases), glue (one case), coated stent (two cases) and mechanical occlusion devices (two cases). In 11 cases, two to three different embolisation agents were used together. RESULTS Technical success was achieved in 26/27 patients (96.3%); in one case, embolisation of a polar artery arising from the aneurysmal sac was not possible. One case of gross haematuria recurred 13 months after the procedure and was re-treated with success. There were no cases of major or minor complications. CONCLUSIONS RAE is an effective and minimally invasive procedure in the treatment of neoplastic/iatrogenic symptomatic gross haematuria and in the palliative treatment of inoperable renal tumours. One possible new indication is the prophylactic exclusion of the polar artery arising from the neck or the sac of an abdominal aortic aneurysm in patients who are candidates for EVAR. In our experience, we observed very low morbidity and a short hospital stay. This procedure requires the availability of various materials for performing embolisation and experience in their use.
Collapse
|
30
|
Sileikis A, Beisa V, Rutkauskaite D, Misonis N, Strupas K. Management of Bleeding Pseudoaneurysms in Complicated Pancreatitis. VISZERALMEDIZIN 2011. [DOI: 10.1159/000332931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
31
|
Zhu WH, Li S, Zhang DF, Peng JR, Jin ZT, Li GM, Wang FS, Zhu JY, Leng XS. Risk factors and outcome of pancreatic fistula after consecutive pancreaticoduodenectomy with pancreaticojejunostomy for patients with malignant tumor. Chin J Cancer Res 2010. [DOI: 10.1007/s11670-010-0032-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
32
|
Hashim A, Allaqaband S, Bajwa T. Leaking hepatic artery aneurysm successfully treated with covered stent. Catheter Cardiovasc Interv 2009; 74:500-5. [DOI: 10.1002/ccd.22012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
33
|
Results of non-operative therapy for delayed hemorrhage after pancreaticoduodenectomy. J Gastrointest Surg 2009; 13:922-8. [PMID: 19224299 DOI: 10.1007/s11605-009-0818-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 01/28/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Hemorrhage after pancreaticoduodenectomy is a life-threatening complication, which occurs in 4% to 16% of cases, even in experienced centers. Many diagnostic and therapeutic options exist but no one has yet established management guidelines. This study aimed to determine the role of conservative management in delayed hemorrhage. PATIENTS AND METHODS From January 2005 to August 2008, 87 patients underwent pancreaticoduodenectomy at our center. We reviewed, retrospectively, the medical charts of all patients who had experienced postoperative hemorrhage. RESULTS AND DISCUSSION Early hemorrhage occurred in one patient, who underwent successful reoperation. Nine patients presented with delayed hemorrhage (10.3%), including three with sentinel bleeding. Mean onset was 20 days post-surgery. We used the same initial management for each patient: all had an urgent contrast computed tomography scan. In every case, the bleeding site was arterial. Conservative treatment (embolization or covered stent) was successful in every case. We reoperated on two patients for gastrointestinal perforation, at 9 days and 2 months after embolization, respectively. We transferred seven patients to an intensive care unit, with an average stay of 8 days. Mean hospital stay was 43 days (33-60). All patients survived. CONCLUSION Conservative management, combining endovascular procedures and aggressive resuscitation, is appropriate for most cases of delayed hemorrhage after pancreaticoduodenectomy.
Collapse
|
34
|
Grotemeyer D, Duran M, Park EJ, Hoffmann N, Blondin D, Iskandar F, Balzer KM, Sandmann W. Visceral artery aneurysms—follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy. Langenbecks Arch Surg 2009; 394:1093-100. [DOI: 10.1007/s00423-009-0482-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 03/02/2009] [Indexed: 10/21/2022]
|
35
|
Hankins D, Chao S, Dolmatch BL, Jeyarajah RD. Covered Stents for Late Postoperative Arterial Hemorrhage after Pancreaticoduodenectomy. J Vasc Interv Radiol 2009; 20:407-9. [DOI: 10.1016/j.jvir.2008.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 11/14/2008] [Accepted: 11/24/2008] [Indexed: 01/01/2023] Open
|
36
|
|
37
|
Pasklinsky G, Gasparis AP, Labropoulos N, Pagan J, Tassiopoulos AK, Ferretti J, Ricotta JJ. Endovascular covered stenting for visceral artery pseudoaneurysm rupture: report of 2 cases and a summary of the disease process and treatment options. Vasc Endovascular Surg 2008; 42:601-6. [PMID: 18583306 DOI: 10.1177/1538574408318478] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present 2 cases of hemorrhage from a visceral artery pseudoaneurysm, managed successfully with endovascular covered stent placement. The first case was a 59-year-old man, 3 months after a laparoscopic distal pancreatectomy for adenoma, presenting with diffuse abdominal pain. The patient was evaluated with a computed tomography scan revealing a splenic artery pseudoaneurysm (PA) bleeding into a pancreatic pseudocyst. He was emergently taken to the angiography suite where a covered stent was deployed at the level of splenic artery PA. The second case was a 52-year-old woman with recurrent left retroperitoneal mass 5 years after distal pancreatectomy and splenectomy for a nonfunctional neuroendocrine tumor. She underwent resection of the mass in the left upper quadrant. Postoperative course was complicated by hematoma, abscess formation, reexploration, and repair of the duodenotomy and the portal vein. Subsequently, she was noted to have intermittent gastrointestinal hemorrhage, which prompted an angiogram revealing a hepatic artery PA that was repaired with a covered balloon-expandable stent. A completion angiogram was obtained in each case demonstrating exclusion of the PA. Our experience with these 2 cases supports the notion that endovascular covered stenting is a safe and effective therapy for exclusion of visceral artery aneurysm.
Collapse
Affiliation(s)
- Garri Pasklinsky
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, New York 11794-8191, USA
| | | | | | | | | | | | | |
Collapse
|
38
|
Luebke T, Heckenkamp J, Gawenda M, Beckurts KTE, Lackner K, Brunkwall J. Combined Endovascular–Open Surgical Procedure in a Great Hepatic Artery Aneurysm. Ann Vasc Surg 2007; 21:807-12. [PMID: 17703916 DOI: 10.1016/j.avsg.2007.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 04/21/2007] [Accepted: 06/28/2007] [Indexed: 10/21/2022]
Abstract
Visceral artery aneurysms are rare lesions. They involve the hepatic artery in approximately 20% of cases. Various therapeutic options are available for patients with hepatic artery aneurysms (HAAs). Dictated predominately by the need to maintain distal end-organ perfusion, potential therapies include traditional surgical techniques and laparoscopic surgery, endovascular methods of embolization, and stenting of the lesions. There is still a lack of studies demonstrating the comparative efficacy or inefficacy of any particular treatment, so there are currently no precise indications for determining which type of treatment should be used. In this paper, we present a case of great HAA in a 59-year-old man. He was preoperatively diagnosed and treated with a combined surgical and endovascular approach. The clinical presentation, management, and therapy of patients with HAAs are discussed. In addition to that, we reviewed the literature dealing with HAAs. This case report lays emphasis on the aspect that the treatment strategy in HAAs has to be determined individually in each case due to the high anatomic variability of the arterial supply of the liver. Treatment with a combined surgical and endovascular approach may reduce the risk of liver ischemia and morbidity.
Collapse
Affiliation(s)
- T Luebke
- Division of Vascular Surgery, University of Cologne, Cologne, Germany.
| | | | | | | | | | | |
Collapse
|
39
|
Blanc T, Cortes A, Goere D, Sibert A, Pessaux P, Belghiti J, Sauvanet A. Hemorrhage after pancreaticoduodenectomy: when is surgery still indicated? Am J Surg 2007; 194:3-9. [PMID: 17560900 DOI: 10.1016/j.amjsurg.2006.08.088] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Revised: 08/28/2006] [Accepted: 08/28/2006] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study analyzed presentation and management of hemorrhage after pancreaticoduodenectomy (PD) to determine the respective role of surgery and embolization. METHODS From January 1992 to March 2005, 411 patients underwent PD and were analyzed with regard to postoperative hemorrhage. RESULTS Hemorrhage occurred in 27 patients (7%), either within the first 3 postoperative days ("early" hemorrhage, n = 11) or after day 8 ("delayed" hemorrhage, n = 16, including 4 with "sentinel" bleeding). At the time of bleeding, 12 patients (44%) (all with delayed hemorrhage) had associated abdominal complications. Two patients had successful conservative treatment. Two stable patients with pseudoaneurysm, diagnosed by computed tomography scan, underwent successful embolization. Four patients with active bleeding underwent unsuccessful angiography. Overall, 23 patients were reoperated on without any completion pancreatectomy, 3 rebled, and 3 (11%) died (including 2 with delayed hemorrhage). CONCLUSIONS Both embolization and surgery have a role in the management of hemorrhage after PD. For early hemorrhage, reoperation is appropriate. In case of sentinel bleeding, pseudoaneurysms can be detected by computed tomography scan and treated by embolization. For delayed active hemorrhage, reoperation is still indicated.
Collapse
Affiliation(s)
- Thomas Blanc
- Department of Digestive Surgery, AP-HP, Hospital Beaujon, 100 Bd du Général Leclerc, 92118 Clichy-Cedex, France
| | | | | | | | | | | | | |
Collapse
|