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Stent-graft implantation for hepatic arterial bleeding: a systematic review and meta-analysis
Sinan Deniz1, Elif Öcal1, Muzaffer Reha Ümütlü1
1Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
Insights
Stent-graft implantation for hepatic artery bleeding shows high success rates. While stent-graft occlusion can occur, it is often asymptomatic due to collateral circulation.
Area of Science:
- Interventional Radiology
- Vascular Surgery
- Hepatobiliary Medicine
Background:
- Hepatic artery bleeding is a serious complication, often occurring post-surgery.
- Stent-graft implantation offers a minimally invasive option for managing hepatic artery hemorrhage.
Purpose of the Study:
- To evaluate the technical and clinical outcomes of stent-graft implantation for hepatic artery bleeding.
- To assess success rates, mortality, and stent-graft patency.
Main Methods:
- Systematic review and meta-analysis of studies published between 2000 and March 2025.
- Included 351 patients from 22 studies, assessing technical success, clinical success, early mortality, and stent-graft patency.
- Used modified Newcastle-Ottawa Scale for quality assessment and individual patient data meta-analysis.
Main Results:
- Technical success rate was 94.3% for stent-graft placement.
- Clinical success rate (no rebleeding) was 92.7%, with an early mortality rate of 15.6%.
- Stent-graft patency was 76.5% at follow-up; occlusions were mostly asymptomatic. Overlapping stent-grafts were a risk factor for occlusion.
Conclusions:
- Stent-graft implantation is effective for hepatic artery bleeding, achieving high technical and clinical success.
- While stent-graft occlusion is common, it is frequently asymptomatic, likely due to collateral vessel development.
- Overlapping stent-grafts increase the risk of occlusion.
Purpose:
The aim of this systematic review and meta-analysis was to identify the technical and clinical outcomes of stent-graft implantation in patients with hepatic artery bleeding.
Materials And Methods:
The PubMed database was searched for publications between 2000 and March 2025 evaluating patients treated with stent-graft implantation for hepatic arterial hemorrhage. The outcome measurements were technical (successful hemostasis with stent-grafts) and clinical success (no rebleeding from hepatic arteries), early mortality, and stent-graft patency during follow-up. A modified Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included publications. An individual patient data meta-analysis was performed using the chi-square test or Fischer exact test to identify predictors of stent-graft patency.
Results:
In total, 351 patients from 22 studies were included. The mean NOS score was 5.4 ± 0.95. Most patients (n = 323) had bleeding after surgery. The technical success rate of stent-graft placement was 94.3%. Patients with technical failure were managed either by surgery (n = 10) or coil embolization of the hepatic artery (n = 10). Rebleeding from hepatic arteries was seen in 24 patients with a clinical success rate of 92.7%. The early mortality rate was 15.6%. Follow-up showed stent-graft patency in 76.5% (202 of 264) of the cases. Most of the stent-graft occlusions (51/62, 82.2%) were asymptomatic. No significant difference was seen in the rate of stent-graft patency between patients receiving acetylsalicylic acid or not, or dual antiplatelet treatment or not. Overlapping stent-grafts (p = 0.009) were significant risk factors for stent-graft occlusion.
Conclusion:
Stent-graft implantation in hepatic arterial bleeding is associated with high technical and clinical success rates. Despite the considerable rate of stent-graft occlusion during follow-up, occlusion is mostly asymptomatic, probably due to collateral development.
