Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Aug 7, 2010; 16(29): 3716-3722
Published online Aug 7, 2010. doi: 10.3748/wjg.v16.i29.3716
Stent-grafts placement for treatment of massive hemorrhage from ruptured hepatic artery after pancreaticoduodenectomy
Mao-Qiang Wang, Feng-Yong Liu, Feng Duan, Zhi-Jun Wang, Peng Song, Qing-Sheng Fan
Mao-Qiang Wang, Feng-Yong Liu, Feng Duan, Zhi-Jun Wang, Peng Song, Qing-Sheng Fan, Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Wang MQ and Liu FY designed the study; Wang MQ and Wang ZJ wrote the manuscript; Wang MQ, Wang ZJ, Liu FY and Duan F treated the patients; Wang ZJ and Song P collected the data; Wang MQ, Liu FY and Fan QS analyzed and interpreted the data; Wang MQ, Liu FY and Duan F sreached the literature; all authors read and approved the manuscript.
Supported by Chinese PLA Scientific Foundation of the Eleventh Five-Year Plan (06MA263)
Correspondence to: Mao-Qiang Wang, MD, Professor, Director, Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, China. wangmq@vip.sina.com
Telephone: +86-10-66936746 Fax: +86-10-66936327
Received: February 23, 2010
Revised: April 16, 2010
Accepted: April 23, 2010
Published online: August 7, 2010
Abstract

AIM: To present a series of cases with life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm after pancreaticoduodenectomy (PD) treated with placement of stent-grafts.

METHODS: Massive hemorrhage from ruptured hepatic artery pseudoaneurysm after PD in 9 patients (6 men, 3 women) at the age of 23-75 years (mean 48 years), were treated with placement of percutaneous endovascular balloon-expandable coronary stent-grafts. All patients were not suitable for embolization because of a non-patent portal vein. One or more stent-grafts, ranging 3-6 mm in diameter and 16-55 mm in length, were placed to exclude ruptured pseudoaneurysm. Follow-up data, including clinical condition, liver function tests, and Doppler ultrasound examination, were recorded at the outpatient clinic.

RESULTS: Immediate technical success was achieved in all the 9 patients. All stent-grafts were deployed in the intended position for immediate cessation of bleeding and preservation of satisfactory hepatic arterial blood flow. No significant procedure-related complications occurred. Recurrent bleeding occurred in 2 patients at 16 and 24 h, respectively, after placement of stent-grafts and treated with surgical revision. One patient died of sepsis 12 d after the interventional procedure. The remaining 6 patients were survived when they were discharged. The mean follow-up time was 10.5 mo (range 4-16 mo). No patient had recurrent bleeding after discharge. Doppler ultrasound examination verified the patency of hepatic artery and stent-grafts during the follow-up.

CONCLUSION: Placement of stent-grafts is an effective and safe procedure for acute life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm.

Keywords: Pancreaticoduodenectomy; Hemorrhage; Hepatic artery; Pseudoaneurysm; Stent-graft