Hepatic artery stenting with Viabahn

The effect of vessel morphology on the technical success and patency of Viabahn stent-grafts in treating postoperative arterial injuries and bleeding (AIB) after hepatopancreatobiliary surgery is not well understood. Difficulties in stent insertion persist despite using stiff guidewires to straighten tortuous vessels. This study aimed to identify vessel morphologies linked to technical success and short-term patency and to explore effective management strategies.

This retrospective study examined 12 consecutive cases of hepatic artery stenting in 11 patients, using Viabahn grafts for postoperative AIB from 2017 to 2024. Patient data, angiographic outcomes, and stent placement details were reviewed. Different types of guidewires, including stiff and soft guidewires, were utilized to facilitate stent deployment. Vessel tortuosity and vessel narrowing before stent placement were evaluated both qualitatively and quantitatively. Outcomes measured included technical and clinical success rates, stent patency at one month, and the time from surgery to stent placement.

Final technical and clinical success was achieved in all cases (100%). Vessel tortuosity often led to the emergence of accordion-like appearances upon vessel straightening, necessitating additional technical adaptations due to the formation of steps (p = 0.005). One-month stent patency was observed in 10/12 cases (83%). Among cases with severe vessel narrowing distal to the bleeding point, 2/3 (67%) experienced stent occlusion, significantly higher than those with less severe narrowing (p = 0.045). All occluded cases involved the extension of stent length by overlapping stent-grafts.

Steps created by the accordion-like appearance in the hepatic artery resulting from the straightening of tortuous vessels can complicate stent insertion, and severe narrowing distal to the bleeding point increases the risk of short-term occlusion.