Role of interventional endovascular therapy for delayed hemorrhage after pancreaticoduodenectomy

Background Delayed massive hemorrhage (DMH) after pancreaticoduodenectomy (PD) is a sedous complication and one of the most common causes of mortality after PD. Its ideal management remains unclear. This paper is to present our experience in the endovascular treatment of patients with DMH after PD u...

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Veröffentlicht in:Chinese medical journal 2010-11, Vol.123 (21), p.3110-3117
Hauptverfasser: Wang, Zhi-Jun, Wang, Mao-Qiang, Liu, Feng-Yong, Duan, Feng, Song, Peng, Fan, Qing-Sheng
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container_end_page 3117
container_issue 21
container_start_page 3110
container_title Chinese medical journal
container_volume 123
creator Wang, Zhi-Jun
Wang, Mao-Qiang
Liu, Feng-Yong
Duan, Feng
Song, Peng
Fan, Qing-Sheng
description Background Delayed massive hemorrhage (DMH) after pancreaticoduodenectomy (PD) is a sedous complication and one of the most common causes of mortality after PD. Its ideal management remains unclear. This paper is to present our experience in the endovascular treatment of patients with DMH after PD using different techniques and materials.Methods During a seven years period, 19 patients (fifteen men, four women) with DMH arter PD were treated with endovascular procedures, including transcatheter arterial embolization (TAE) with coils embolization in eight cases, with coils plus N-butyl-2-cyanoacrylate (NBCA)-Lipiodol mixture in six cases, and stent-graft placement in five cases. The mean age of the patients was 58.2 years. Follow-up, including clinical condition, liver function tests, and Doppler ultrasound examinations, was documented.Results The immediate technical success rate was 84.2% (16/19). There were no significant procedure-related complications. Hemostasis was not achieved with interventional procedures in three patients: one died of uncontrolled bleeding four days after the second TAE, and two patients required emergency laparotomy without re-angiography because of worsening clinical status. Among the 16 patients with successfully stopped bleeding who became hemodynamically stable after the procedure without evidence of further bleeding, two patients died during the peri-interventional procedure period because of multiple organ failure, and fourteen patients survived to hospital discharge. The mean length of follow-up was 14.6 months. Recurrent bleeding after discharge did not occur in any of these cases. Clinical and laboratory follow-up findings were unremarkable. Doppler ultrasound examinatation verified patency of the hepatic artery in the four patients with stent-graft placement during the follow-up period (5 months-29 months; mean, 15.3 months).Conclusions Interventional endovascular procedure is a safe and technically feasible solution to control DMH. The first-line treatment for the bleeding is TAE. Stent-graft placement with preservation of the organ arterial flow, if technicallypossible, is a valuable alternative to TAE and surgical intervention for management of DMH.
doi_str_mv 10.3760/cma.j.issn.0366-6999.2010.21.029
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Its ideal management remains unclear. This paper is to present our experience in the endovascular treatment of patients with DMH after PD using different techniques and materials.Methods During a seven years period, 19 patients (fifteen men, four women) with DMH arter PD were treated with endovascular procedures, including transcatheter arterial embolization (TAE) with coils embolization in eight cases, with coils plus N-butyl-2-cyanoacrylate (NBCA)-Lipiodol mixture in six cases, and stent-graft placement in five cases. The mean age of the patients was 58.2 years. Follow-up, including clinical condition, liver function tests, and Doppler ultrasound examinations, was documented.Results The immediate technical success rate was 84.2% (16/19). There were no significant procedure-related complications. Hemostasis was not achieved with interventional procedures in three patients: one died of uncontrolled bleeding four days after the second TAE, and two patients required emergency laparotomy without re-angiography because of worsening clinical status. Among the 16 patients with successfully stopped bleeding who became hemodynamically stable after the procedure without evidence of further bleeding, two patients died during the peri-interventional procedure period because of multiple organ failure, and fourteen patients survived to hospital discharge. The mean length of follow-up was 14.6 months. Recurrent bleeding after discharge did not occur in any of these cases. Clinical and laboratory follow-up findings were unremarkable. Doppler ultrasound examinatation verified patency of the hepatic artery in the four patients with stent-graft placement during the follow-up period (5 months-29 months; mean, 15.3 months).Conclusions Interventional endovascular procedure is a safe and technically feasible solution to control DMH. The first-line treatment for the bleeding is TAE. Stent-graft placement with preservation of the organ arterial flow, if technicallypossible, is a valuable alternative to TAE and surgical intervention for management of DMH.</description><identifier>ISSN: 0366-6999</identifier><identifier>EISSN: 2542-5641</identifier><identifier>DOI: 10.3760/cma.j.issn.0366-6999.2010.21.029</identifier><identifier>PMID: 21162965</identifier><language>eng</language><publisher>China: Department of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China</publisher><subject>Adult ; Aged ; Embolization, Therapeutic - adverse effects ; Embolization, Therapeutic - methods ; Endovascular Procedures - adverse effects ; Endovascular Procedures - methods ; Female ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy - adverse effects ; Pancreaticoduodenectomy - methods ; Postoperative Hemorrhage - prevention &amp; control ; Treatment Outcome ; Young Adult ; 切除术 ; 十二指肠 ; 多普勒超声 ; 大出血 ; 手术治疗 ; 治疗程序</subject><ispartof>Chinese medical journal, 2010-11, Vol.123 (21), p.3110-3117</ispartof><rights>Copyright © Wanfang Data Co. Ltd. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Uhttp://image.cqvip.com/vip1000/qk/85656X/85656X.jpg</thumbnail><link.rule.ids>314,776,780,860,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21162965$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wang, Zhi-Jun</creatorcontrib><creatorcontrib>Wang, Mao-Qiang</creatorcontrib><creatorcontrib>Liu, Feng-Yong</creatorcontrib><creatorcontrib>Duan, Feng</creatorcontrib><creatorcontrib>Song, Peng</creatorcontrib><creatorcontrib>Fan, Qing-Sheng</creatorcontrib><title>Role of interventional endovascular therapy for delayed hemorrhage after pancreaticoduodenectomy</title><title>Chinese medical journal</title><addtitle>Chinese Medical Journal</addtitle><description>Background Delayed massive hemorrhage (DMH) after pancreaticoduodenectomy (PD) is a sedous complication and one of the most common causes of mortality after PD. Its ideal management remains unclear. This paper is to present our experience in the endovascular treatment of patients with DMH after PD using different techniques and materials.Methods During a seven years period, 19 patients (fifteen men, four women) with DMH arter PD were treated with endovascular procedures, including transcatheter arterial embolization (TAE) with coils embolization in eight cases, with coils plus N-butyl-2-cyanoacrylate (NBCA)-Lipiodol mixture in six cases, and stent-graft placement in five cases. The mean age of the patients was 58.2 years. Follow-up, including clinical condition, liver function tests, and Doppler ultrasound examinations, was documented.Results The immediate technical success rate was 84.2% (16/19). There were no significant procedure-related complications. Hemostasis was not achieved with interventional procedures in three patients: one died of uncontrolled bleeding four days after the second TAE, and two patients required emergency laparotomy without re-angiography because of worsening clinical status. Among the 16 patients with successfully stopped bleeding who became hemodynamically stable after the procedure without evidence of further bleeding, two patients died during the peri-interventional procedure period because of multiple organ failure, and fourteen patients survived to hospital discharge. The mean length of follow-up was 14.6 months. Recurrent bleeding after discharge did not occur in any of these cases. Clinical and laboratory follow-up findings were unremarkable. Doppler ultrasound examinatation verified patency of the hepatic artery in the four patients with stent-graft placement during the follow-up period (5 months-29 months; mean, 15.3 months).Conclusions Interventional endovascular procedure is a safe and technically feasible solution to control DMH. The first-line treatment for the bleeding is TAE. Stent-graft placement with preservation of the organ arterial flow, if technicallypossible, is a valuable alternative to TAE and surgical intervention for management of DMH.</description><subject>Adult</subject><subject>Aged</subject><subject>Embolization, Therapeutic - adverse effects</subject><subject>Embolization, Therapeutic - methods</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pancreaticoduodenectomy - adverse effects</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Postoperative Hemorrhage - prevention &amp; control</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><subject>切除术</subject><subject>十二指肠</subject><subject>多普勒超声</subject><subject>大出血</subject><subject>手术治疗</subject><subject>治疗程序</subject><issn>0366-6999</issn><issn>2542-5641</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo90FFv1DAMAOAIgdht8BdQxQPw0pKkjZs-omkwpElICJ6LmzjXHm1yS9qh49cTdAPJkh_82ZbN2DvBq7oF_t4sWB2qKSVf8RqghK7rKslzWYqKy-4J20nVyFJBI56y3X9zwS5TOnAulWrhObuQQoDsQO3Yj69hpiK4YvIrxQfy6xQ8zgV5Gx4wmW3GWKwjRTyeChdiYWnGE9lipCXEOOKeCnS5tTiiN5FwnUywW7DkyaxhOb1gzxzOiV4-5iv2_ePNt-vb8u7Lp8_XH-5KI0GvpdOKo7UWHXZaKKeUFIScUy4TaGUF8tpZDQKgdWqAxgxSNyClHkStVX3F3pzn_kLv0O_7Q9hiviT1v0ezHP4-SeboMnx7hscY7jdKa79MydA8o6ewpV4LDU3dyjbLV49yGxay_TFOC8ZT_-97Gbw-AzMGv7-f8tYBzU83zdTXSktQCuo_GCyC4g</recordid><startdate>20101105</startdate><enddate>20101105</enddate><creator>Wang, Zhi-Jun</creator><creator>Wang, Mao-Qiang</creator><creator>Liu, Feng-Yong</creator><creator>Duan, Feng</creator><creator>Song, Peng</creator><creator>Fan, Qing-Sheng</creator><general>Department of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China</general><scope>2RA</scope><scope>92L</scope><scope>CQIGP</scope><scope>W95</scope><scope>~WA</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope><scope>2B.</scope><scope>4A8</scope><scope>92I</scope><scope>93N</scope><scope>PSX</scope><scope>TCJ</scope></search><sort><creationdate>20101105</creationdate><title>Role of interventional endovascular therapy for delayed hemorrhage after pancreaticoduodenectomy</title><author>Wang, Zhi-Jun ; Wang, Mao-Qiang ; Liu, Feng-Yong ; Duan, Feng ; Song, Peng ; Fan, Qing-Sheng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c268t-f850adddafa9815f5521ea00ec26e685d1a03fd861667f5b64cb2846228b13853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Embolization, Therapeutic - adverse effects</topic><topic>Embolization, Therapeutic - methods</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pancreaticoduodenectomy - adverse effects</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Postoperative Hemorrhage - prevention &amp; control</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><topic>切除术</topic><topic>十二指肠</topic><topic>多普勒超声</topic><topic>大出血</topic><topic>手术治疗</topic><topic>治疗程序</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wang, Zhi-Jun</creatorcontrib><creatorcontrib>Wang, Mao-Qiang</creatorcontrib><creatorcontrib>Liu, Feng-Yong</creatorcontrib><creatorcontrib>Duan, Feng</creatorcontrib><creatorcontrib>Song, Peng</creatorcontrib><creatorcontrib>Fan, Qing-Sheng</creatorcontrib><collection>中文科技期刊数据库</collection><collection>中文科技期刊数据库-CALIS站点</collection><collection>中文科技期刊数据库-7.0平台</collection><collection>中文科技期刊数据库-农业科学</collection><collection>中文科技期刊数据库- 镜像站点</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><collection>Wanfang Data Journals - Hong Kong</collection><collection>WANFANG Data Centre</collection><collection>Wanfang Data Journals</collection><collection>万方数据期刊 - 香港版</collection><collection>China Online Journals (COJ)</collection><collection>China Online Journals (COJ)</collection><jtitle>Chinese medical journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wang, Zhi-Jun</au><au>Wang, Mao-Qiang</au><au>Liu, Feng-Yong</au><au>Duan, Feng</au><au>Song, Peng</au><au>Fan, Qing-Sheng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of interventional endovascular therapy for delayed hemorrhage after pancreaticoduodenectomy</atitle><jtitle>Chinese medical journal</jtitle><addtitle>Chinese Medical Journal</addtitle><date>2010-11-05</date><risdate>2010</risdate><volume>123</volume><issue>21</issue><spage>3110</spage><epage>3117</epage><pages>3110-3117</pages><issn>0366-6999</issn><eissn>2542-5641</eissn><abstract>Background Delayed massive hemorrhage (DMH) after pancreaticoduodenectomy (PD) is a sedous complication and one of the most common causes of mortality after PD. Its ideal management remains unclear. This paper is to present our experience in the endovascular treatment of patients with DMH after PD using different techniques and materials.Methods During a seven years period, 19 patients (fifteen men, four women) with DMH arter PD were treated with endovascular procedures, including transcatheter arterial embolization (TAE) with coils embolization in eight cases, with coils plus N-butyl-2-cyanoacrylate (NBCA)-Lipiodol mixture in six cases, and stent-graft placement in five cases. The mean age of the patients was 58.2 years. Follow-up, including clinical condition, liver function tests, and Doppler ultrasound examinations, was documented.Results The immediate technical success rate was 84.2% (16/19). There were no significant procedure-related complications. Hemostasis was not achieved with interventional procedures in three patients: one died of uncontrolled bleeding four days after the second TAE, and two patients required emergency laparotomy without re-angiography because of worsening clinical status. Among the 16 patients with successfully stopped bleeding who became hemodynamically stable after the procedure without evidence of further bleeding, two patients died during the peri-interventional procedure period because of multiple organ failure, and fourteen patients survived to hospital discharge. The mean length of follow-up was 14.6 months. Recurrent bleeding after discharge did not occur in any of these cases. Clinical and laboratory follow-up findings were unremarkable. Doppler ultrasound examinatation verified patency of the hepatic artery in the four patients with stent-graft placement during the follow-up period (5 months-29 months; mean, 15.3 months).Conclusions Interventional endovascular procedure is a safe and technically feasible solution to control DMH. The first-line treatment for the bleeding is TAE. Stent-graft placement with preservation of the organ arterial flow, if technicallypossible, is a valuable alternative to TAE and surgical intervention for management of DMH.</abstract><cop>China</cop><pub>Department of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China</pub><pmid>21162965</pmid><doi>10.3760/cma.j.issn.0366-6999.2010.21.029</doi><tpages>8</tpages></addata></record>
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subjects Adult
Aged
Embolization, Therapeutic - adverse effects
Embolization, Therapeutic - methods
Endovascular Procedures - adverse effects
Endovascular Procedures - methods
Female
Humans
Male
Middle Aged
Pancreaticoduodenectomy - adverse effects
Pancreaticoduodenectomy - methods
Postoperative Hemorrhage - prevention & control
Treatment Outcome
Young Adult
切除术
十二指肠
多普勒超声
大出血
手术治疗
治疗程序
title Role of interventional endovascular therapy for delayed hemorrhage after pancreaticoduodenectomy
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