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Da Silva D, Moyne T, De Ponthaud C, Marchese U, Barrat M, Dautry R, Conticchio M, Rousseau G, Ronde-Roupie C, Wagner M, Roux C, Soyer P, Dohan A, Scatton O, Fuks D, Gaujoux S, Tzedakis S. Validation of a computed tomography-based model for early prediction of postpancreatectomy hemorrhage risk. J Gastrointest Surg 2025; 29:102078. [PMID: 40348008 DOI: 10.1016/j.gassur.2025.102078] [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: 02/08/2025] [Revised: 04/16/2025] [Accepted: 05/02/2025] [Indexed: 05/14/2025]
Abstract
BACKGROUND Identification of early predictors of postoperative pancreatic fistula (POPF) related postpancreatectomy hemorrhage (PPH) on contrast-enhanced computed tomography (CT) may help tailor management after pancreaticoduodenectomy (PD). However, no model has been validated yet. METHODS A bicentric analysis of consecutive PDs performed between 2017 and 2022 was conducted. The recently reported CT-based prediction score (CTS) was externally validated. Sensitivity refinements were proposed using a modified CTS, which was internally (development cohort [n = 182]) and externally (validation cohort [n = 62]) validated. Bootstrap-corrected areas under the curve (AUCs), sensitivity, and positive predictive value (PPV) were used to evaluate and compare the 2 scores. RESULTS A total of 244 patients (55.1% were women; median age, 68 years [IQR, 58.0-75.0]; clinically relevant (cr)-POPF, 25.4%; cr-PPH, 13.9%) were included. CTS accurately predicted the cr-PPH, with an AUC of 0.83 (1000 bootstrap 95% CI, 0.76-0.89). The modified CTS, which is available online (https://stylianostzedakis.shinyapps.io/pph_risk_calculator/), included CTS with 2 supplementary variables selected from a multivariable backward stepwise regression: perianastomotic air bubbles, posterosuperior pancreaticojejunal (PJ) anastomosis collection, posterior PJ defect, PJ collection in contact with a hepatic or gastroduodenal artery stump, and arterial wall irregularities. When compared with the CTS, although modified CTS AUCs were similar in the validation cohort (0.81 [95% CI, 0.62-0.95] vs 0.87 [95% CI, 0.56-0.96]; DeLong P = .7), sensitivity and PPV for early PPH detection were significantly higher (0.82 [95% CI, 0.75-0.92] vs 0.71 [95% CI, 0.35-0.75] and 0.95 [95% CI, 0.83-0.99] vs 0.33 [95% CI, 0.12-0.62]; McNemar P = .03). CONCLUSION With a robust prediction model, early CT scan after PD seems a valid tool for the early identification of high-risk patients with cr-PPH.
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Affiliation(s)
- Doris Da Silva
- Department of Digestive, Pancreatic, Hepatobiliary, and Endocrine Surgery, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Université Paris Cité, Paris, France
| | - Thibault Moyne
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Université Paris Cité, Paris, France
| | - Charles De Ponthaud
- Department of Digestive, Hepatobiliary, and Pancreatic Surgery and Liver Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France
| | - Ugo Marchese
- Department of Digestive, Pancreatic, Hepatobiliary, and Endocrine Surgery, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Université Paris Cité, Paris, France
| | - Maxime Barrat
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Université Paris Cité, Paris, France
| | - Raphael Dautry
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Université Paris Cité, Paris, France
| | - Maria Conticchio
- Department of Digestive, Pancreatic, Hepatobiliary, and Endocrine Surgery, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Université Paris Cité, Paris, France
| | - Géraldine Rousseau
- Department of Digestive, Hepatobiliary, and Pancreatic Surgery and Liver Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France
| | - Charlotte Ronde-Roupie
- Department of Digestive, Pancreatic, Hepatobiliary, and Endocrine Surgery, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Université Paris Cité, Paris, France
| | - Mathilde Wagner
- Department of Advanced Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France
| | - Charles Roux
- Department of Advanced Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France
| | - Philippe Soyer
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Université Paris Cité, Paris, France
| | - Anthony Dohan
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Université Paris Cité, Paris, France
| | - Olivier Scatton
- Department of Digestive, Hepatobiliary, and Pancreatic Surgery and Liver Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France
| | - David Fuks
- Department of Digestive, Pancreatic, Hepatobiliary, and Endocrine Surgery, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Université Paris Cité, Paris, France
| | - Sebastien Gaujoux
- Department of Digestive, Hepatobiliary, and Pancreatic Surgery and Liver Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France
| | - Stylianos Tzedakis
- Department of Digestive, Pancreatic, Hepatobiliary, and Endocrine Surgery, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Université Paris Cité, Paris, France; Équipe HeKA, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1138, Centre de Recherche des Cordeliers, Centre Inria de Paris, Paris, France.
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Riegelbauer S, Mehdorn M, Struck MF, Tautenhahn HM, Scheuermann U, Ebel S, Denecke T, Meyer HJ. Prognostic relevance of CT-defined body composition in patients with acute bleeding undergoing endovascular embolization. Br J Radiol 2025; 98:571-577. [PMID: 39820679 DOI: 10.1093/bjr/tqaf011] [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: 06/01/2024] [Revised: 12/12/2024] [Accepted: 01/04/2025] [Indexed: 01/19/2025] Open
Abstract
OBJECTIVES Body composition assessment includes the parameter skeletal muscle mass, subcutaneous and visceral adipose tissue (SAT and VAT). The purpose of this study was to elucidate associations of body composition parameters with mortality in patients with acute bleeding undergoing transarterial embolization (TAE). METHODS A mixed cohort of patients from 2018 to 2022 with acute bleeding requiring treatment with a TAE was retrospectively evaluated. In every case, the triphasic CT to diagnose the source of bleeding was used to calculate the body composition parameters. RESULTS A total of 251 patients (93 female, 37.1%) with a mean age of 65.5 ± 14.3 years, 30-d mortality of 40.2%, and 24-h mortality of 7.6% were included in the analysis. In the Cox regression analysis, no statistically significant correlations were found between the body composition parameters and 24-h or 30-day mortality. In the subgroup analysis of patients aged older than 65 years, skeletal muscle index was associated with short-term 24-h mortality HR of 0.95 (95% CI 0.90; 0.99, P = .035). CONCLUSIONS The present study demonstrated the prognostic impact of clinical, laboratory, aniography-related, and CT-defined body composition in patients with acute haemorrhage undergoing endovascular therapy. Although the overall effect of CT-defined body composition appears to be small, skeletal muscle index was a prognostic factor in the age group over 65 years. ADVANCES IN KNOWLEDGE This is a large single-centre study to investigate the prognostic relevance of CT-defined body composition in patients undergoing TAE. The effect is overall small but might be further investigated in older patients in further trials.
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Affiliation(s)
- Simon Riegelbauer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig 04103, Germany
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, University of Leipzig, Leipzig 04103, Germany
| | - Manuel Florian Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig 04103, Germany
| | - Hans-Michael Tautenhahn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, University of Leipzig, Leipzig 04103, Germany
| | - Uwe Scheuermann
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, University of Leipzig, Leipzig 04103, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig 04103, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig 04103, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig 04103, Germany
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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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Yao Z, Zhao G, Luo S, Chen K, Tian W, Xu X, Huang Q, Zhao R. Comparative efficacy of sequential treatment and open abdomen approaches for corrosive abdominal hemorrhage due to inadequate drainage of duodenal leakage: a cohort study. Surg Endosc 2024; 38:85-96. [PMID: 37914952 DOI: 10.1007/s00464-023-10525-9] [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: 04/02/2023] [Accepted: 10/08/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Intra-abdominal bleeding resulting from inadequate drainage of duodenal leakage (DL) is typically caused by the corrosiveness of duodenal fluid. Open abdomen (OA) treatment addresses both the drainage and bleeding simultaneously. However, a sequential treatment (ST) approach involving hemostasis through transcatheter arterial embolization (TAE) followed by percutaneous drainage of source control has emerged as an alternative method. This study aimed to evaluate the prognosis of ST in cases of DL-induced intra-abdominal bleeding. METHODS This retrospective cohort study included 151 participants diagnosed with DL-induced intra-abdominal bleeding from January 2004 to December 2010, and January 2013 to December 2021. The ST and OA groups were established based on the treatment method applied. Propensity score-matching (PSM) matched patients in the ST group with those in the OA group. RESULTS Among the 151 patients, 61 (40.4%) died within 90 days after the bleeding episode. ST was associated with a lower mortality rate (28.2% vs. 51.3% adjusted odds ratio [OR] = 0.34; 95% confidence interval [CI] 0.17-0.68; P = 0.003) compared to OA. Following PSM, ST remained the only factor associated with reduced mortality (OR = 0.32; 95% CI 0.13-0.75; P = 0.009). Moreover, ST demonstrated a higher rate of initial hemostasis success before (90.1% [64/71] vs. 77.5% [62/80]; adjusted OR = 2.84; 95% CI 1.07-7.60; P = 0.04) and after PSM (94.4% [51/54] vs. 77.8% [42/54], adjusted OR = 3.85; 95% CI 2.15-16.82; P = 0.04). Additionally, ST was associated with a lower incidence of rebleeding within 90 days after the initial bleeding, before (7 vs. 23; adjusted OR 0.41; 95% CI 0.18-0.92; P = 0.03) and after PSM (5 vs. 14; adjusted OR 0.37; 95% CI 0.15-0.93; P = 0.03). CONCLUSIONS Applying ST involving TAE and subsequent percutaneous drainage might be superior to OA in lowering the mortality in DL-induced intra-abdominal hemorrhage.
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Affiliation(s)
- Zheng Yao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Guoping Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Shikun Luo
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Ke Chen
- Department of General Surgery, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China.
| | - Weiliang Tian
- Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China
| | - Xin Xu
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Qian Huang
- Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China
| | - Risheng Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China.
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Sindayigaya R, Barat M, Tzedakis S, Dautry R, Dohan A, Belle A, Coriat R, Soyer P, Fuks D, Marchese U. Modified Appleby procedure for locally advanced pancreatic carcinoma: A primer for the radiologist. Diagn Interv Imaging 2023; 104:455-464. [PMID: 37301694 DOI: 10.1016/j.diii.2023.05.008] [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: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the most prevalent pancreatic neoplasm accounting for more than 90% of pancreatic malignancies. Surgical resection with adequate lymphadenectomy remains the only available curative strategy for patients with PDAC. Despite improvements in both chemotherapy regimen and surgical care, body/neck PDAC still conveys a poor prognosis because of the vicinity of major vascular structures, including celiac trunk, which favors insidious disease spread at the time of diagnosis. Body/neck PDAC involving the celiac trunk is considered locally advanced PDAC in most guidelines and therefore not eligible for upfront resection. However, a more aggressive surgical approach (i.e., distal pancreatectomy with splenectomy and en-bloc celiac trunk resection [DP-CAR]) was recently proposed to offer hope for cure in selected patients with locally advanced body/neck PDAC responsive to induction therapy at the cost of higher morbidity. The so-called "modified Appleby procedure" is highly demanding and requires optimal preoperative staging as well as appropriate patient preparation for surgery (i.e., preoperative arterial embolization). Herein, we review current evidence regarding DP-CAR indications and outcomes as well as the critical role of diagnostic and interventional radiology in patient preparation before DP-CAR, and early identification and management of DP-CAR complications.
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Affiliation(s)
- Rémy Sindayigaya
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France.
| | - Maxime Barat
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Stylianos Tzedakis
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Raphael Dautry
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anthony Dohan
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Arthur Belle
- Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Romain Coriat
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Philippe Soyer
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - David Fuks
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Ugo Marchese
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
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Takata H, Hirakata A, Makino H, Yokoyama T, Furuki H, Mizutani S, Katsuno A, Taniai N, Yoshida H. Two synchronous pseudoaneurysms after bile duct resection for distal cholangiocarcinoma. Clin J Gastroenterol 2022; 15:1151-1157. [DOI: 10.1007/s12328-022-01711-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/26/2022] [Indexed: 11/27/2022]
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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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Wang X, He C, Li H, Huang J, Ge N, Yang Y. Endovascular treatment for delayed post-pancreaticoduodenectomy hemorrhage of unusual origin (splenic artery branch). J Vasc Surg Cases Innov Tech 2022; 8:865-871. [PMID: 36568956 PMCID: PMC9768243 DOI: 10.1016/j.jvscit.2022.09.013] [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: 06/29/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022] Open
Abstract
Objective The objective of this study was to investigate the method, efficacy, and safety of endovascular treatment (EVT) of delayed splenic artery branch (SAB) hemorrhage after pancreaticoduodenectomy. Methods From March 2019 to January 2022, all patients underwent EVT of SAB for delayed post-pancreaticoduodenectomy hemorrhage were included. Demographic, laboratory, angiographic, and clinical follow-up data were collected and analyzed. Results A total of eight patients were enrolled. In two patients, celiac axis angiography alone failed, but selective splenic artery (SA) angiography demonstrated the SAB bleeding; SAB erosions in four patients with recurrent bleeding were successfully detected by a second angiography; four patients underwent balloon catheter placement at the SA for temporary hemostasis and to further confirm the SAB bleeding before the subsequent EVT. Superselective embolization was performed in only one patient (12.5%; 1/8); covered stent implantation at the SA was performed in two patients (25%; 2/8); Embolization of the SA was performed in the remaining five patients (62.5%; 5/8). The technical success rate, clinical success rate, and in-hospital mortality were 100.0%, 87.5%, and 25%, respectively. No severe complications related to EVT occurred. Conclusions EVT of SAB for delayed post-pancreaticoduodenectomy hemorrhage is effective and safe. An awareness of the SAB as a potential bleeding source, together with appropriate endovascular procedures including selective SA angiography, repeat angiography, balloon catheter placement at the SA, and applicable hemostasis protocol, could achieve a high success rate of managing SAB hemorrhage.
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Affiliation(s)
| | | | | | | | - Naijian Ge
- Correspondence: Naijian Ge, MD, Department of Interventional Radiology, 700 Moyu North Road, Shanghai, 200438, China
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Reitano E, de'Angelis N, Bianchi G, Laera L, Spiliopoulos S, Calbi R, Memeo R, Inchingolo R. Current trends and perspectives in interventional radiology for gastrointestinal cancers. World J Radiol 2021; 13:314-326. [PMID: 34786187 PMCID: PMC8567440 DOI: 10.4329/wjr.v13.i10.314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/12/2021] [Accepted: 10/09/2021] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal (GI) cancers often require a multidisciplinary approach involving surgeons, endoscopists, oncologists, and interventional radiologists to diagnose and treat primitive cancers, metastases, and related complications. In this context, interventional radiology (IR) represents a useful minimally-invasive tool allowing to reach lesions that are not easily approachable with other techniques. In the last years, through the development of new devices, IR has become increasingly relevant in the context of a more comprehensive management of the oncologic patient. Arterial embolization, ablative techniques, and gene therapy represent useful and innovative IR tools in GI cancer treatment. Moreover, IR can be useful for the management of GI cancer-related complications, such as bleeding, abscesses, GI obstructions, and neurological pain. The aim of this study is to show the principal IR techniques for the diagnosis and treatment of GI cancers and related complications, as well as to describe the future perspectives of IR in this oncologic field.
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Affiliation(s)
- Elisa Reitano
- Division of General Surgery, Department of Translational Medicine, University of Eastern Piedmont, Novara 28100, Italy
| | - Nicola de'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Giorgio Bianchi
- Unit of Minimally Invasive and Robotic Digestive Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Letizia Laera
- Department of Oncology, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Athens 12461, Greece
| | - Roberto Calbi
- Department of Radiology, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70124, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
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10
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Fontana F, Piacentino F, Ossola C, Coppola A, Curti M, Macchi E, De Marchi G, Floridi C, Ierardi AM, Carrafiello G, Segato S, Carcano G, Venturini M. Transcatheter Arterial Embolization in Acute Non-Variceal Gastrointestinal Bleedings: A Ten-Year Single-Center Experience in 91 Patients and Review of the Literature. J Clin Med 2021; 10:jcm10214979. [PMID: 34768505 PMCID: PMC8584454 DOI: 10.3390/jcm10214979] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 12/13/2022] Open
Abstract
Objective: To report the safety and efficacy of trans-arterial embolization (TAE) for upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB) due to different etiologies in 91 patients for ten years. Methods: A retrospective analysis of GIB treated between January 2010 and December 2020 was performed. TAE was performed using different embolic agents (coils, particles, glue, gelatin sponge, and EVOH-based agents). Technical success, secondary technical success, clinical success, and complications were evaluated. Results: Technical success was achieved in 74/91 (81.32%) patients. Seventeen patients (18.68%) required re-intervention. Secondary technical success was achieved in all cases (100.0%). Clinical success was achieved in 81/91 patients (89.01%). No major complications were recorded; overall, minor complications occurred in 20/91 patients. Conclusions: TAE is a technically feasible and safe therapeutic option for patients with GIB from a known or blind anatomic source where endoscopic therapy has failed or is deemed unfeasible.
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Affiliation(s)
- Federico Fontana
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy; (F.F.); (F.P.); (A.C.); (E.M.); (G.D.M.); (M.V.)
- School of Medicine and Surgery, Università degli Studi dell’Insubria, 21100 Varese, Italy; (M.C.); (G.C.)
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy; (F.F.); (F.P.); (A.C.); (E.M.); (G.D.M.); (M.V.)
- School of Medicine and Surgery, Università degli Studi dell’Insubria, 21100 Varese, Italy; (M.C.); (G.C.)
| | - Christian Ossola
- School of Medicine and Surgery, Università degli Studi dell’Insubria, 21100 Varese, Italy; (M.C.); (G.C.)
- Correspondence: ; Tel.: +39-0332-393609
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy; (F.F.); (F.P.); (A.C.); (E.M.); (G.D.M.); (M.V.)
| | - Marco Curti
- School of Medicine and Surgery, Università degli Studi dell’Insubria, 21100 Varese, Italy; (M.C.); (G.C.)
| | - Edoardo Macchi
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy; (F.F.); (F.P.); (A.C.); (E.M.); (G.D.M.); (M.V.)
| | - Giuseppe De Marchi
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy; (F.F.); (F.P.); (A.C.); (E.M.); (G.D.M.); (M.V.)
| | - Chiara Floridi
- Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60100 Ancona, Italy;
| | - Anna Maria Ierardi
- Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy; (A.M.I.); (G.C.)
| | - Gianpaolo Carrafiello
- Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy; (A.M.I.); (G.C.)
| | - Sergio Segato
- Gastroenterology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy;
| | - Giulio Carcano
- School of Medicine and Surgery, Università degli Studi dell’Insubria, 21100 Varese, Italy; (M.C.); (G.C.)
- Surgery Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy; (F.F.); (F.P.); (A.C.); (E.M.); (G.D.M.); (M.V.)
- School of Medicine and Surgery, Università degli Studi dell’Insubria, 21100 Varese, Italy; (M.C.); (G.C.)
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11
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Alekyan BG, Lusnikov VP, Varava AB, Kriger AG. [Endovascular treatment of arterial bleeding after pancreatic surgery]. Khirurgiia (Mosk) 2021:76-83. [PMID: 34363449 DOI: 10.17116/hirurgia202108176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pancreatic surgery is complex and associated with a risk of complications including bleeding. Bleeding after pancreatic surgery is rare, but characterized by high mortality. This review is devoted to classification, diagnosis and treatment strategies for bleeding after pancreatic surgery. Methods and results of endovascular surgery are of special attention.
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Affiliation(s)
- B G Alekyan
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - V P Lusnikov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A B Varava
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A G Kriger
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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12
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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: 1.3] [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.
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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
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13
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Empiric Transcatheter Embolization for Acute Arterial Upper Gastrointestinal Bleeding: A Meta-Analysis. AJR Am J Roentgenol 2021; 216:880-893. [PMID: 33566631 DOI: 10.2214/ajr.20.23151] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE. The purpose of this study was to conduct a meta-analysis to assess the safety and efficacy of empiric embolization compared with targeted embolization in the treatment of acute upper gastrointestinal bleeding (UGIB). MATERIALS AND METHODS. We searched the PubMed and Cochrane Library databases for studies performed without language restrictions from January 2000 to November 2019. Only clinical studies with a sample size of five or more were included. Clinical success, rebleeding and complication rates, survival rates, bleeding cause, embolic materials, and vessels embolized were recorded. Empiric embolization and targeted embolization (i.e., embolization performed based on angiographic evidence of ongoing bleeding) were compared when possible. Meta-analysis was performed. RESULTS. Among 13 included studies (12 retrospective and 1 prospective), a total of 357 of 725 patients (49.2%) underwent empiric embolization for UGIB. The clinical success rate of empiric embolization was 74.7% (95% CI, 63.1-86.3%) among the 13 studies, and the survival rate was 80.9% (95% CI, 73.8-88.0%) for 10 studies. On the basis of comparative studies, no statistically significant difference was observed between empiric and targeted embolization in terms of rebleeding rate in 111 studies (36.5% vs 29.6%; odds ratio [OR], 1.13; 95% CI, 0.77-1.65; p = .53), mortality in eight studies (23.3% vs 18.0%; OR, 1.44; 95% CI, 0.89-2.33; p = .14), and need for surgery to control rebleeding in four studies (17.8% vs 13.4%; OR, 1.34; 95% CI, 0.58-3.07; p = .49). The pooled embolization-specific complications were 1.9% (empiric) and 2.4% (targeted). CONCLUSION. According to all available published evidence, empiric embolization assessed with endoscopic or preprocedural imaging findings (or both) appears to be as effective as targeted embolization in preventing rebleeding and mortality in patients with angiographically negative acute UGIB. Because of its favorable safety profile, empiric embolization should be considered for patients in this clinical scenario.
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14
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Alhazemi AA, Park S, Shin JH, Cho YC, Kim Y, Lee J, Kim PH, Kim JW, Chu HH. Safety and efficacy of transarterial embolisation for treatment of dorsal pancreatic artery haemorrhage. Clin Radiol 2020; 76:314.e9-314.e15. [PMID: 33334554 DOI: 10.1016/j.crad.2020.11.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/12/2020] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the safety and efficacy of transarterial embolisation (TAE) of dorsal pancreatic artery (DPA) haemorrhage. MATERIALS AND METHODS Nineteen consecutive patients (M:F = 16:3, mean age 59.6 years) who underwent TAE of DPA in three tertiary medical centres between January 2001 to January 2020 were reviewed retrospectively. Angiographic features and the technical and clinical outcomes of TAE were analysed. RESULTS The clinical presentations were a bloody drain from the Jackson-Pratt drainage tube (n=8), melaena (n=7), abdominal pain (n=4), and haematochezia (n=3). Angiographic findings included pseudoaneurysm (n=14), contrast media extravasation (n=4), or abrupt cut-off of the arterial branch (n=1). The NBCA (N-butyl-cyanoacrylate; n=4), microcoils (n=4), and a combination of these agents (n=7) were used as embolic agents. The most common origin of the DPA in the present study cohort was the splenic artery (n=7), followed by the coeliac trunk (n=4), common hepatic artery (n=4), and superior mesenteric artery (n=4). Technical and clinical success rates were 100% and 84.2% (16/19), respectively. Of the three clinically unsuccessful cases, two patients were revealed to have newly developed bleeding from another artery. The other patient expired 1 day after the TAE procedure due to a progression of hepatic failure. In one patient, an asymptomatic non-target embolisation occurred in the right posterior tibial artery as a procedure-related complication. No major complications were observed. CONCLUSION TAE is safe and effective for the management of bleeding from the DPA. It is important to be aware of the DPA as a potential bleeding source, including the relevant clinical characteristics.
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Affiliation(s)
- A A Alhazemi
- Department of Radiology, King Fahd Central Hospital, Jazan 45196, Saudi Arabia
| | - S Park
- Department of Radiology, Gil Medical Centre, Gachon University College of Medicine, Incheon, Republic of Korea
| | - J H Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Y C Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y Kim
- Department of Radiology Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - J Lee
- Department of Radiology Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - P H Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J W Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H H Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
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15
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Muglia R, Lanza E, Poretti D, D'Antuono F, Gennaro N, Gavazzi F, Zerbi A, Chiti A, Pedicini V. Emergency endovascular treatments for delayed hemorrhage after pancreaticobiliary surgery: indications, outcomes, and follow-up of a retrospective cohort. Abdom Radiol (NY) 2020; 45:2593-2602. [PMID: 32172410 DOI: 10.1007/s00261-020-02480-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the outcomes of emergency endovascular treatments for delayed bleeding after pancreaticobiliary surgery. METHODS We retrospectively evaluated 21 patients (M:F = 13:8, median age = 64 years) undergoing 23 endovascular treatments, performed from 2010 to 2017 in a single center. Data collected were patient characteristics; surgery; pathology; incidence of postoperative pancreatic fistulas (POPF); bleeding signs on CT and angiography; damaged artery; endovascular tools used; technical and clinical success; intervals between surgery, endovascular treatment, and discharge; survival rates. RESULTS Sixteen patients had pancreatoduodenectomy, three hepaticojejunostomy, two distal pancreatectomy. Indications for surgery were mainly biliary (33%), pancreatic (19%), or duodenal (10%) malignancies. Seventeen patients had "grade C" POPF, three suffered a biliary leak, one had no POPF. Active bleeding was present in 17/23 CTs and in 22/23 angiographies, mostly from hepatic (43%), gastroduodenal (22%), and splenic (13%) arteries. The endovascular treatments were performed with coils (26%), glue (22%), stent-graft (22%), and their combinations (30%). Sixteen patients had a single endovascular treatment, one underwent a second embolization, three had subsequent surgery, one had repeat embolization followed by surgery. Relaparotomy rate was 19%. Median hospital stay was 37 days (range 12-75); median intervals among pancreaticobiliary surgery, endovascular treatment, and discharge were 21 (2-36) and 12 (8-47) days, respectively. We observed 4/21 intrahospital deaths (median: 31 days from endovascular treatment, 4-53); 1-year survival rate of discharged patients was 71%. CONCLUSIONS Endovascular treatment using embolization and/or stent-graft placement is a useful first-line intervention to halt postoperative hemorrhage after pancreaticobiliary surgery and decreases the need for urgent relaparotomy.
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Affiliation(s)
- Riccardo Muglia
- Training School in Radiology, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milano, Italy.
| | - Ezio Lanza
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Via A. Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Dario Poretti
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Via A. Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Felice D'Antuono
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Via A. Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Nicolò Gennaro
- Training School in Radiology, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milano, Italy
| | - Francesca Gavazzi
- Department of General Surgery, Humanitas Research Hospital, Via A. Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Alessandro Zerbi
- Department of General Surgery, Humanitas Research Hospital, Via A. Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milano, Italy
| | - Vittorio Pedicini
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Via A. Manzoni 56, 20089, Rozzano, Milano, Italy
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16
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Yao Z, Tian W, Xu X, Zhao R, Huang M, Zhao Y, Chen X. Transcatheter Arterial Embolization in the Treatment of Abdominal Bleeding in Patients Being Treated with Open Abdomen Due to Duodenal Fistula. World J Surg 2020; 44:2562-2571. [PMID: 32274535 DOI: 10.1007/s00268-020-05504-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study aimed to investigate the transcatheter arterial embolization (TAE) in treatment of abdominal bleeding in patients being treated with open abdomen due to duodenal fistula. METHODS This was a retrospective study performed at our center. From January 2005 to November 2010, all patients with abdominal bleeding were treated with surgical hemostasis (SH) and included in SH group. From January 2012 to December 2018, all patients with a bleeding were treated with TAE and included in the TAE group. Clinical data were reviewed and compared between the two groups. The effect of TAE in the management of abdominal bleeding was evaluated. RESULTS A total of 131 patients were enrolled, and there were 64 in the SH group and 67 in the TAE group. The success rate of hemostasis was higher in the TAE group (89.55% vs. 73.44%, adjusted OR = 4.065, 95% CI 1.336-12.336, P = 0.013). Moreover, the recognition rate of hemorrhagic vessels in the TAE group was higher (91.04 vs. 51.56; P < 0.001). The re-bleeding occurred in 20 patients, 7(11.67%) in the TAE group and 13(27.66%) in the SH group. The re-bleeding rate in SH group was higher (adjusted HR = 2.564, 95% CI 1.023-6.428, P = 0.045) CONCLUSIONS: TAE is an effective method in treatment of abdominal bleeding in patients being treated with open abdomen due to duodenal fistula.
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Affiliation(s)
- Zheng Yao
- Department of General Surgery, Nanjing Jiangning Hospital, Nanjing, Jiangsu, 211100, China
| | - Weiliang Tian
- Department of General Surgery, Nanjing Jinling Hospital, Nanjing, Jiangsu, 21002, China
| | - Xin Xu
- Department of General Surgery, Nanjing Jiangning Hospital, Nanjing, Jiangsu, 211100, China
| | - Risheng Zhao
- Department of General Surgery, Nanjing Jiangning Hospital, Nanjing, Jiangsu, 211100, China.
| | - Ming Huang
- Department of General Surgery, Nanjing Jiangning Hospital, Nanjing, Jiangsu, 211100, China
| | - Yunzhao Zhao
- Department of General Surgery, Nanjing Jiangning Hospital, Nanjing, Jiangsu, 211100, China.
- Department of General Surgery, Nanjing Jinling Hospital, Nanjing, Jiangsu, 21002, China.
| | - Xinhao Chen
- Department of General Surgery, Nanjing Jiangning Hospital, Nanjing, Jiangsu, 211100, China
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17
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Inoue A, Ohta S, Imai Y, Murakami Y, Tomozawa Y, Sonoda A, Nitta N. Naturally shrunk visceral artery aneurysms by stenting for the superior mesenteric artery occlusion. MINIM INVASIV THER 2020; 30:245-249. [PMID: 32100596 DOI: 10.1080/13645706.2020.1732426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 77-year-old woman who had experienced postprandial abdominal pain for four years was admitted to our institution presenting sudden and severe abdominal pain. Contrast-enhanced computed tomography (CECT) demonstrated complete short-segmented occlusion in the orifice of the superior mesenteric artery (SMA), and saccular aneurysms in the right hepatic artery and the anterior superior pancreaticoduodenal artery. She was diagnosed with abdominal angina due to occlusion of the SMA. The SMA was recanalized by stenting, and a CECT scan confirmed naturally shrunk aneurysms after eight months. The patency of the SMA was maintained at five years after endovascular treatment.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Shinichi Ohta
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Yugo Imai
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Yoko Murakami
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Yuki Tomozawa
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
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18
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Chang YC, Liu KL, Huang YC, Chen PT, Tien YW, Lin YH, Chang YC. Efficacy and hepatic complications of three endovascular treatment approaches for delayed postpancreatectomy hemorrhage: evolution over 15 years. CVIR Endovasc 2019; 2:33. [PMID: 32026015 PMCID: PMC6966415 DOI: 10.1186/s42155-019-0077-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/09/2019] [Indexed: 12/14/2022] Open
Abstract
Background Delayed postpancreatectomy hemorrhage (PPH) is a fatal complication caused by arterial erosion. This study reports a single-center experience of managing delayed PPH with different endovascular treatment approaches. Methods We reviewed the data of patients who had delayed PPH due to hepatic artery or gastroduodenal artery stump perforation and underwent endovascular treatment between 2003 and 2018. We categorized endovascular treatment approaches involving hepatic artery sacrifice, superselective pseudoaneurysm embolization with hepatic artery preservation, and covered stent placement. Technical success rates, hemorrhage recurrence rates, major and minor hepatic complication rates, and 30-day and 1-year mortality rates were assessed. Results A total of 18 patients were reviewed; 11 (61%), 4 (22%), and 3 (17%) delayed PPH cases were managed through hepatic artery sacrifice, superselective pseudoaneurysm embolization, and hepatic artery stenting, respectively. Multidetector computed tomography was performed in 14 (78%) patients. The technical success rate was 100%. The overall hemorrhage recurrence rate was 39%, with superselective pseudoaneurysm embolization having a 100% hemorrhage recurrence rate—much higher than that of hepatic artery sacrifice or stent graft placement. The overall major and minor hepatic complication rates were 56% and 83%, respectively. The overall 30-day and 1-year mortality rates were 11% and 25%, respectively. The 30-day and 1-year mortality rates and minor and major hepatic complication rates were similar in each group. Conclusion Hepatic artery sacrifice is more effective than superselective pseudoaneurysm embolization in the management of delayed PPH. Covered stent placement may be a reasonable alternative treatment to hepatic artery sacrifice.
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Affiliation(s)
- Yu-Chien Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Rd, Taipei, 100, Taiwan, Republic of China
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Rd, Taipei, 100, Taiwan, Republic of China.,Department of Medical Imaging, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China
| | - Yu-Cheng Huang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Rd, Taipei, 100, Taiwan, Republic of China
| | - Po-Ting Chen
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Rd, Taipei, 100, Taiwan, Republic of China
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China
| | - Yen-Heng Lin
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Rd, Taipei, 100, Taiwan, Republic of China.
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Rd, Taipei, 100, Taiwan, Republic of China
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