The incidence of liver abscesses after TAE for patients with postpancreatectomy hemorrhages

Abstract

Introduction: Pancreatobiliary surgery has been associated with high rates of mortality and morbidity. Recently, advances in interventional radiology (IVR) have reduced the postoperative mortality rates of complications such as pseudoaneurysms or postpancreatectomy hemorrhages related to pancreatic fistulas. However, transcatheter arterial embolization (TAE) sometimes results in liver abscess (LA). Therefore, this study aimed to assess the frequency and risk factors for LA after TAE for hepatic arteries. Method: We retrospectively reviewed the records of patients who underwent a pancreatoduodenectomy (PD) or bile duct resection (BDR) from January 2008 to December 2017. Preoperative, intraoperative, postoperative, and post-IVR factors were analyzed. Result: 339 patients underwent PD or BDR for pancreatobiliary disease, and 24 (7.1%) patients were performed TAE for the hepatic artery with postoperative hemorrhages (PPH) or pseudoaneurysms (PA). The median postoperative interval of performing TAE was 16 days (2-42). LA was observed in 7 cases (29.1%). The median interval in which LA occurred after TAE was 25 days (4-89). Multivariate analyses showed that diabetes mellitus (p<0.0001), bile leakage (p=0.002), pre-IVR max G-GTP>150 (p=0.003), pre-IVR max PT-INR>1.28 (p=0.006), and post-IVR max PT-INR>1.56 (p=0.019) were correlated with LA. Conclusion: The risk factors of LA after TAE for the hepatic artery are diabetes mellitus and bile leakage. High levels of pre-IVR G-GTP, PT-INR, and post-IVR PT-INR may be factors predicting the onset of LA after TAE for the hepatic artery.