Risk Factors for In-hospital Mortality After Transarterial Intervention After Postpancreatectomy Hemorrhage
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CLINICAL INVESTIGATION
EMBOLISATION (ARTERIAL)
Risk Factors for In-hospital Mortality After Transarterial Intervention After Postpancreatectomy Hemorrhage Steffen Wolk1 • Christoph Georg Radosa2 • Marius Distler1 • Hanns-Christoph Held1 Jens-Peter Ku¨hn2 • Ju¨rgen Weitz1 • Thilo Welsch1 • Ralf-Thorsten Hoffmann2
•
Received: 3 February 2020 / Accepted: 28 April 2020 The Author(s) 2020
Abstract Purpose Postpancreatectomy hemorrhage (PPH) is one of the leading causes of mortality after pancreatic resection. Late onset PPH is most often treated using a transarterial approach. The aim of this study was to analyze risk factors for in-hospital mortality after endovascular treatment. Methods Between 2012 and 2017, patients who were treated endovascular due to PPH were identified from a retrospective analysis of a database. Risk factors for mortality were identified by univariate analysis. Results In total, 52 of the 622 patients (8.4%) underwent endovascular treatment due to PPH. The primary technical success achieved was 90.4%. In 59.6% of patients, bleeding control was achieved by placing a stent graft and in 40.4% by coil embolization. The primary 30-day and 1-year patency of the placed covered stents was 89.3% and 71.4%, respectively. The 60-day mortality was 34.6%. The reintervention rate was higher after stent graft placement compared to coiling (39.3% vs. 21.1%, P = 0.012). In the univariate analysis the need for reintervention was associated with a higher in-hospital mortality (21.2% vs. 7.7%,
Steffen Wolk and Christoph Georg Radosa contributed equally to this paper & Ralf-Thorsten Hoffmann [email protected] 1
Department of Visceral, Thoracic and Vascular Surgery, Medizinische Fakulta¨t Carl Gustav Carus, Technische Universita¨t Dresden, Dresden, Germany
2
Institute for Diagnostic and Interventional Radiology, Medizinische Fakulta¨t Carl Gustav Carus, Technische Universita¨t Dresden, Fetscherstr. 74, 01307 Dresden, Germany
P = 0.049). The use of an antiplatelet agent was associated with a decreased in-hospital mortality in the univariate (11.5% vs. 25%, P = 0.024) and multivariate analysis (HR 3.1, 95% CI 1.1-9, P = 0.034), but did not increase the risk of rebleeding. Conclusion Endovascular management of delayed PPH has a high technical success rate. Stent graft placement showed a higher reintervention rate. The need for reintervention was associated with a higher in-hospital mortality but did not differ between coiling and stent graft placement. Keywords Postpancreatectomy hemorrhage Interventional treatment Covered stents Stent graft Coils
Introduction Postpancreatectomy hemorrhage (PPH) is one of the leading causes of death after pancreatic surgery, with an associated mortality rate of up to 50% [1–4]. According to the definition of the International Study Group of Pancreatic Surgery (ISGPS), PPH can be classified as early (= / \ 24 h after operation) and late ([ 24 h after operation) onset [5]. Late onset PPH can occur from vessel erosion caused by anastomotic l
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