Diagnosis and interventional treatment value of digital subtraction angiography for post pancreatectomy hemorrhage

Abstract

Objective To investigate the diagnosis and treatment value of digital subtraction angiography (DSA) and transcatheter arterial embolization (TAE) for post pancreatectomy hemorrhage (PPH), and influencing factors of severity of PPH. Methods The retrospective case-control study was conducted. The clinicopathological data of 20 patients with PPH who were admitted to the Zhongshan Hospital of Fudan University from August 2009 to November 2016 were collected. Patients with PPH in the early stage underwent reoperations for hemostasis; patients with PPH in the later stage received conservative treatment, and then DSA and TAE were considered when patients had the stable vital signs. Observation indicators: (1) DSA situations: overall times, positive rate and bleeding sites; (2) TAE situations: successful rate of hemostasis, operating time and postoperative complications; (3) follow-up situations; (4) influencing factors analysis of severity of PPH. Follow-up using outpatient examination and telephone interview was performed to detect occurrence of complications after discharging from hospital up to April 2017. Measurement data with skewed distribution were described as M (range). Count data were evaluated by the ratio and proportion. The univariate analysis was done using the Fisher exact probability. Results (1) DSA situations: all the 20 patients underwent DSA, with overall times of 27. The direct sign was 18 times extravasation of the contrast medium, with a positive rate of 66.7% (18/27). Of 18 times positive DSA, clear bleeding sites were located in 5 times gastroduodenal artery (3 times with pseudoaneurysm of gastroduodenal artery stump), in 4 times common hepatic artery (3 times with pseudoaneurysm of common hepatic artery), in 3 times superior mesenteric artery, in 2 times splenic artery, in 1 time left gastric artery, in 1 time right gastric artery, in 1 time left hepatic artery (pseudoaneurysm of left hepatic artery) and in 1 time inferior mesenteric artery. (2) TAE situations: of patients with 18 times positive DSA, patients with 15 times positive DSA received TAE, with a successful rate of hemostasis of 13/15, and patients with 5 times positive DSA received successful hemostasis by reoperation. A median operating time of TAE for patients with 15 times positive DSA was 30 minutes. There was no occurrence of adverse reaction, including fever, abdominal pain, melena, elevated aminotransferase and liver abscess. One patient complicated with splenic abscess after transcatheter splenic arterial embolization underwent puncture drainage and then had a good recovery. Of patients with 9 times negative DSA, patients with 8 times negative DSA were cured by conservative treatment and patient with 1 time negative DSA received successful hemostasis by operation. All the 20 patients were cured and then discharged from hospital. (3) Follow-up situations: 20 patients were followed up for 4-92 months, with a median time of 24 months. During the follow-up, 20 patients recovered well, without long-term complications. (4) Influencing factors analysis of severity of PPH: the results of univariate analysis showed that gender, age, preoperative blood sugar, preoperative combined jaundice, preoperative albumin (Alb), preoperative prothrombin time (PT) extended, preserving pylorus, pancreatic duct stent placement, pancreatic operation time, volume of intraoperative blood loss, intraoperative blood transfusion, property of tumor, postoperative pancreatic fistula and time of PPH were not factors affecting the severity of PPH (P>0.05). Conclusion DSA is minimal-invasive in the diagnosis for PPH, and TAE is safe and effective for patients with positive DSA. Key words: Post pancreatectomy hemorrhage; Digital subtraction angiography; Transcatheter arterial embolization; Outcomes