Fatal arterial hemorrhage after pancreaticoduodenectomy:How do we simultaneously accomplish complete hemostasis and hepatic arterial flow?  

作　　者：Yasuyuki Kamada Tomohide Hori Hidekazu Yamamoto Hideki Harada Michihiro Yamamoto MasahiroYamada Takefumi Yazawa Ben Sasaki Masaki Tani Asahi Sato Hikotaro Katsura Ryotaro Tani RyuheiAoyama Yudai Sasaki Masaharu Okada Masazumi Zaima 

机构地区：[1]Department of Surgery,Shiga General Hospital,Moriyama 524-8524,Shiga,Japan [2]Department of Cardiovascular Medicine,Shiga General Hospital,Moriyama 524-8524,Shiga,Japan

出　　处：《World Journal of Hepatology》2021年第4期483-503,共21页世界肝病学杂志（英文版）（电子版）

摘　　要：BACKGROUND Although arterial hemorrhage after pancreaticoduodenectomy(PD)is not frequent,it is fatal.Arterial hemorrhage is caused by pseudoaneurysm rupture,and the gastroduodenal artery stump and hepatic artery(HA)are frequent culprit vessels.Diagnostic procedures and imaging modalities are associated with certain difficulties.Simultaneous accomplishment of complete hemostasis and HA flow preservation is difficult after PD.Although complete hemostasis may be obtained by endovascular treatment(EVT)or surgery,liver infarction caused by hepatic ischemia and/or liver abscesses caused by biliary ischemia may occur.We herein discuss therapeutic options for fatal arterial hemorrhage after PD.AIM To present our data here along with a discussion of therapeutic strategies for fatal arterial hemorrhage after PD.METHODS We retrospectively investigated 16 patients who developed arterial hemorrhage after PD.The patients’clinical characteristics,diagnostic procedures,actual treatments[transcatheter arterial embolization(TAE),stent-graft placement,or surgery],clinical courses,and outcomes were evaluated.RESULTS The frequency of arterial hemorrhage after PD was 5.5%.Pancreatic leakage was observed in 12 patients.The onset of hemorrhage occurred at a median of 18 d after PD.Sentinel bleeding was observed in five patients.The initial EVT procedures were stent-graft placement in seven patients,TAE in six patients,and combined therapy in two patients.The rate of technical success of the initial EVT was 75.0%,and additional EVTs were performed in four patients.Surgical approaches including arterioportal shunting were performed in eight patients.Liver infarction was observed in two patients after TAE.Two patients showed a poor outcome even after successful EVT.These four patients with poor clinical courses and outcomes had a poor clinical condition before EVT.Fourteen patients were successfully treated.CONCLUSION Transcatheter placement of a covered stent may be useful for simultaneous accomplishment of complete hemostasis and HA fl

关 键 词：PANCREATICODUODENECTOMY Endovascular treatment STENT-GRAFT Covered stent Transcatheter arterial embolization Arterioportal shunting 

分 类 号：R657.5[医药卫生—外科学] R656.64[医药卫生—临床医学]