Hepatic artery embolization for postoperative hemorrhage in upper abdominal surgery

The purpose of this study was to evaluate angiographic findings and radiologic and clinical results of transcatheter arterial embolization (TAE) of the hepatic artery for hemorrhage after upper abdominal surgery.

Ten patients (nine male, one female, mean age = 63.5 years) with postoperative hemorrhage underwent emergency hepatic artery embolization. We retrospectively analyzed the angiographic findings and the effectiveness of TAE.

Angiography demonstrated pseudoaneurysms (n = 6) and extravasation (n = 5). Portal veins were not compromised in any patient. The bleeding points were at the gastroduodenal artery (n = 3), proper hepatic artery (n = 3), right hepatic artery (n = 2), left hepatic artery (n = 1), and intrahepatic artery (n = 2). Embolization was performed at the extrahepatic site (n = 6) and intrahepatic site (n = 4). TAE was successful in eight patients. Hemostasis was achieved in eight patients. Two patients in whom TAE was not successful died of bleeding after TAE. In six patients whose collateral arteries were visualized at TAE, hypoxic hepatic failure was avoided and the patients had a favorable clinical course.

TAE is a useful treatment for postoperative hemorrhage, but the presence of collateral arteries at the time of TAE can affect the patients' prognoses.