Management of Massive Arterial Hemorrhage After Pancreatobiliary Surgery: Does Embolotherapy Contribute to Successful Outcome? |
| |
Authors: | Yoshiro Fujii Hiroshi Shimada Itaru Endo Ken-ichi Yoshida Ken-ichi Matsuo Kazuhisa Takeda Michio Ueda Daisuke Morioka Kuniya Tanaka Shinji Togo |
| |
Institution: | (1) Department of Gastroenterological Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan |
| |
Abstract: | Massive arterial hemorrhage is, although unusual, a life-threatening complication of major pancreatobiliary surgery. Records
of 351 patients who underwent major surgery for malignant pancreatobiliary disease were reviewed in this series. Thirteen
patients (3.7%) experienced massive hemorrhage after surgery. Complete hemostasis by transcatheter arterial embolization (TAE)
or re-laparotomy was achieved in five patients and one patient, respectively. However, 7 of 13 cases ended in fatality, which
is a 54% mortality rate. Among six survivors, one underwent selective TAE for a pseudoaneurysm of the right hepatic artery
(RHA). Three patients underwent TAE proximal to the proper hepatic artery (PHA): hepatic inflow was maintained by successful
TAE of the gastroduodenal artery in two and via a well-developed subphrenic artery in one. One patient had TAE of the celiac
axis for a pseudoaneurysm of the splenic artery (SPA), and hepatic inflow was maintained by the arcades around the pancreatic
head. One patient who experienced a pseudoaneurysm of the RHA after left hemihepatectomy successfully underwent re-laparotomy,
ligation of RHA, and creation of an ileocolic arterioportal shunt. In contrast, four of seven patients with fatal outcomes
experienced hepatic infarction following TAE proximal to the PHA or injury of the common hepatic artery during angiography.
One patient who underwent a major hepatectomy for hilar bile duct cancer had a recurrent hemorrhage after TAE of the gastroduodenal
artery and experienced hepatic failure. In the two patients with a pseudoaneurysm of the SPA or the superior mesenteric artery,
an emergency re-laparotomy was required to obtain hemostasis because of worsening clinical status. Selective TAE distal to
PHA or in the SPA is usually successful. TAE proximal to PHA must be restricted to cases where collateral hepatic blood flow
exists. Otherwise or for a pseudoaneurysm of the superior mesenteric artery, endovascular stenting, temporary creation of
an ileocolic arterioportal shunt, or vascular reconstruction by re-laparotomy is an alternative. |
| |
Keywords: | Hemorrhage Pseudoaneurysm Pancreato-biliary surgery Transcatheter arterial embolization |
本文献已被 SpringerLink 等数据库收录! |
|