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Diagn Interv Imaging. 2016 Nov;97(11):1071-1077. doi: 10.1016/j.diii.2016.08.003. Epub 2016 Aug 31.

Late postpancreatectomy hemorrhage: Predictive factors of morbidity and mortality after percutaneous endovascular treatment.

Author information

1
Department of radiology, hôpital la Timone, 264, rue Saint-Pierre, 13005 Marseille, France. Electronic address: c.gaudon@hopital-europeen.fr.
2
Department of radiology, hôpital Nord, 13015 Marseille, France.
3
Department of radiology, hôpital la Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
4
Department of surgery, hôpital Nord, 13015 Marseille, France.
5
Department of surgery, hôpital La Timone, 13005 Marseille, France.

Abstract

PURPOSE:

The objective of this study was to evaluate the effectiveness of endovascular treatment in patients presenting with late hemorrhage after pancreatectomy (LPPH).

MATERIAL AND METHOD:

Between 2008 and 2012, 53 percutaneous arterial procedures were performed in 42 patients with LPPH. There were 27 men and 15 women (mean age, 61.8 years±14.5 [SD]; range: 19-81 years). Clinical and technical success along with frequency of complications associated with the use of different endovascular techniques in patients with and without arterial anatomical variation were assessed.

RESULTS:

Clinical success was observed in 35/42 patients (85%). The technical success was 37.5% in patients with anatomical variation versus 82.8% for those with modal anatomy (P=0.003). Repeat bleeding (P=0.029), complications (P=0.013) and mortality (P=0.045) were more frequent in patients with variation of celiac artery than in those with modal anatomy. For hepatic and gastroduodenal artery stump bleeding, the rate of complications was higher (60%) in the group treated by hepatic artery embolization (P=0.028) by comparison with gastroduodenal artery stump selective embolisations or treatments by covered stent. A significant difference in mortality rate was found between patients with anatomical variations of celiac artery (36.4%) and those with normal anatomy (6.5%) (P=0.032).

CONCLUSION:

Percutaneous endovascular treatment is effective in patients presenting with LPPH. The presence of an anatomical variation of the celiac artery increases the rate of complications and mortality in patients with LPPH.

KEYWORDS:

Arterial embolization; Hemorrhage; Interventional imaging; Pancreaticoduodenectomy; Pseudoaneurysm

PMID:
27592120
DOI:
10.1016/j.diii.2016.08.003
[Indexed for MEDLINE]
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