Emergency endovascular treatments for delayed hemorrhage after pancreaticobiliary surgery: indications, outcomes, and fo
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INTERVENTIONAL RADIOLOGY
Emergency endovascular treatments for delayed hemorrhage after pancreaticobiliary surgery: indications, outcomes, and follow‑up of a retrospective cohort Riccardo Muglia1 · Ezio Lanza2 · Dario Poretti2 · Felice D’Antuono2 · Nicolò Gennaro1 · Francesca Gavazzi3 · Alessandro Zerbi3 · Arturo Chiti4 · Vittorio Pedicini2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To evaluate the outcomes of emergency endovascular treatments for delayed bleeding after pancreaticobiliary surgery. Methods We retrospectively evaluated 21 patients (M:F = 13:8, median age = 64 years) undergoing 23 endovascular treatments, performed from 2010 to 2017 in a single center. Data collected were patient characteristics; surgery; pathology; incidence of postoperative pancreatic fistulas (POPF); bleeding signs on CT and angiography; damaged artery; endovascular tools used; technical and clinical success; intervals between surgery, endovascular treatment, and discharge; survival rates. Results Sixteen patients had pancreatoduodenectomy, three hepaticojejunostomy, two distal pancreatectomy. Indications for surgery were mainly biliary (33%), pancreatic (19%), or duodenal (10%) malignancies. Seventeen patients had “grade C” POPF, three suffered a biliary leak, one had no POPF. Active bleeding was present in 17/23 CTs and in 22/23 angiographies, mostly from hepatic (43%), gastroduodenal (22%), and splenic (13%) arteries. The endovascular treatments were performed with coils (26%), glue (22%), stent-graft (22%), and their combinations (30%). Sixteen patients had a single endovascular treatment, one underwent a second embolization, three had subsequent surgery, one had repeat embolization followed by surgery. Relaparotomy rate was 19%. Median hospital stay was 37 days (range 12–75); median intervals among pancreaticobiliary surgery, endovascular treatment, and discharge were 21 (2–36) and 12 (8–47) days, respectively. We observed 4/21 intrahospital deaths (median: 31 days from endovascular treatment, 4–53); 1-year survival rate of discharged patients was 71%. Conclusions Endovascular treatment using embolization and/or stent-graft placement is a useful first-line intervention to halt postoperative hemorrhage after pancreaticobiliary surgery and decreases the need for urgent relaparotomy. Keywords Emergency transarterial embolization · Delayed hemorrhage · Pancreaticobiliary surgery · Stent-graft · Bleeding
Introduction * Riccardo Muglia [email protected] 1
Training School in Radiology, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milano, Italy
2
Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Via A. Manzoni 56, 20089 Rozzano, Milano, Italy
3
Department of General Surgery, Humanitas Research Hospital, Via A. Manzoni 56, 20089 Rozzano, Milano, Italy
4
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milano, Italy
Postoperative hemorrhag
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