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Outcomes of Arterial Embolization vs Covered Stents for Delayed Massive Hemorrhage After Pancreatic or Biliary

Yukihiro Watanabe1, Ken Nakazawa2, Kenichiro Takase3

  • 1Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, 1397-1 Yamane350-1298, Japan. watanb@saitama-med.ac.jp.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|January 29, 2022
PubMed

Insights

Covered stent placement (CSP) is a superior endovascular treatment for delayed massive hemorrhage (DMH) after pancreatic or biliary surgery. CSP significantly reduces major hepatic complications and mortality compared to arterial embolization (AE).

Area of Science:

  • Interventional Radiology
  • Vascular Surgery
  • Hepatobiliary Surgery

Background:

  • Delayed massive hemorrhage (DMH) is a serious complication following pancreatic or biliary surgery.
  • Covered stent placement (CSP) is increasingly used for DMH management, but its benefits require further evaluation.
  • Conflicting results exist regarding the efficacy of CSP versus traditional methods.

Purpose of the Study:

  • To compare the short- and medium-term outcomes of arterial embolization (AE) and CSP for managing DMH.
  • To assess the effectiveness of endovascular treatments for hepatic artery hemorrhage post-pancreaticobiliary surgery.

Main Methods:

  • Retrospective analysis of patients treated with AE (n=50) or CSP (n=20) for DMH from January 2009 to December 2019.
  • Evaluation of major hepatic complications, in-hospital mortality, and 1-year mortality.
  • Analysis of factors including age, sex, reintervention, arterial variants, and portal vein stenosis.

Main Results:

  • CSP demonstrated no in-hospital mortality versus 32% for AE (p=0.003).
  • CSP showed significantly lower rates of major hepatic complications (10% vs. 44%, p=0.011) and 1-year mortality (25% vs. 54%, p=0.035) compared to AE.
  • Technical success and reintervention rates were similar between CSP and AE.

Conclusions:

  • Covered stent placement is superior to arterial embolization for managing delayed massive hemorrhage from hepatic arteries.
  • CSP significantly reduces major hepatic complications and mortality in this patient population.
  • CSP offers improved outcomes for patients experiencing DMH after pancreatic or biliary surgery.
Abstract

Keywords:
Covered stent placementEndovascular treatmentHemorrhagePancreatic or biliary surgeryTherapeutic embolization

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