Diagnosis and treatment of hemorrhage after pancreatoduodenectomy via digital subtraction angiography and transcatheter arterial embolization

Abstract

To evaluate the clinical diagnosis and treatment of hemorrhage after pancreatoduodenectomy via digital subtraction angiography (DSA) and transcatheter arterial embolization (TAE). The clinical and imaging data of 23 patients receiving DSA examination and TAE treatment due to hemorrhage after pancreatoduodenectomy at our interventional center from October 2012 to October 2014 were retrospectively reviewed. And the manifestations of DSA and therapeutic efficacies of TAE were summarized and analyzed. Among them, 16 patients showed positive signs of extravasation of contrast medium (n = 8), pseudoaneurysm formation (n = 3), ruptured pseudoaneurysm plus extravasation of contrast medium (n = 2) and local vascular spasm and non-smooth arterial intima (n = 3). And the remainder with negative signs (n = 7) underwent surgery. The 16 patients with positive signs underwent TAE with a technical success rate of 16/16. And clinical success was achieved in 12/16 patients. Among 4 rebleeders, two were successfully managed by surgery. And bleeding was caused by stress ulcer in gastrojejunal anastomosis (n = 1) and necrosis of pancreatic stump (n = 1). Another two on conservative treatment died from multiple organ failure. As first-line options, DSA and TAE are miniinvasive and accurate in the diagnosis and treatment of hemorrhage after pancreatoduodenectomy.