Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy. The importance of early angiography

Norihiro Sato, Koji Yamaguchi, Shuji Shimizu, Takashi Morisaki, Kazunori Yokohata, Kazuo Chijiiwa, Masao Tanaka

Research output: Contribution to journalArticle

153 Citations (Scopus)

Abstract

Objective: To evaluate the efficacy of early angiography in the diagnosis and treatment of delayed arterial hemorrhage as a significant complication following pancreatectomy. Design: Retrospective case series. Setting: University hospital; 6-year period between January 1992 and December 1997. Patients and Intervention: Of a total of 81 patients undergoing pancreatic head resection, 10 (12%) developed massive arterial hemorrhage after surgery. All 10 patients underwent an emergency angiography and 8 of these were managed by transcatheter arterial embolization. Results: Before onset of major bleeding, 9 patients (90%) had developed intra-abdominal abscess resulting from pancreatic fistula or other anastomotic leak, and all 10 patients had had preliminary minor bleeding. The angiogram demonstrated an exact site of bleeding as a pseudoaneurysm in all 10 patients. Transcatheter arterial embolization achieved temporary control of bleeding in all 8 patients for whom embolization was attempted and complete hemostasis in 5 of the 8 subsequently, yielding a success rate of 63%. Overall, 4 patients (40%) died of complications related directly to the major hemorrhage or the transcatheter arterial embolization technique. Conclusions: An emergency angiography should be considered in all patients who develop either a sentinel or massive gastrointestinal bleed following pancreatectomy irrespective of suspected intra-abdominal sepsis. Transcatheter arterial embolization allows temporary control of massive hemorrhage and hemodynamic stabilization in most cases, and prevents the need for high-risk emergency surgery.

Original languageEnglish
Pages (from-to)1099-1102
Number of pages4
JournalArchives of Surgery
Volume133
Issue number10
DOIs
Publication statusPublished - Oct 1 1998

All Science Journal Classification (ASJC) codes

  • Surgery

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