Abstract
Objective To explore the role of interventional radiology (IR) in the management of late postpancreaticoduodenectomy hemorrhage (PPH). Materials and Methods Patients who had late PPH (occurring >24 h after index operation) managed by the IR procedure in our institution between 2013 and 2018 were retrospectively analyzed. Result Hired patients who were diagnosed with grade B (n = 10) and C (n = 22) late PPH underwent 40 transcatheter arterial angiographies (TAA). The overall positive rate of angiography was 45.0% (18/40). Eighteen transcatheter arterial embolizations (TAEs) were performed, and the technical success rate was 88.89% (16/18). The rebleeding rate after embolization was 18.8% (3/16), and no severe procedure-related complications were recorded. The overall mortality of late PPH was 25.0% (8/32). Conclusion Nearly half of hemorrhagic sites in late PPH could be identified by TAA. TAE is an effective and safe method for the hemostasia of late PPH in patients with positive angiography results.
Highlights
Hemorrhage is a less frequent but potentially fatal complication following pancreaticoduodenectomy (PD)
Ten patients were diagnosed with grade B post-PD hemorrhage (PPH) and interventional radiology (IR) treatment was performed immediately after failing in conservative therapy, and 22 patients were diagnosed with grade C PPH and IR treatment was performed as soon as the diagnosis was established
The incidence of post-PD hemorrhage has been declining [13, 16], late PPH remains a severe complication that is responsible for a substantial increase in perioperative mortality [17]
Summary
Hemorrhage is a less frequent but potentially fatal complication following pancreaticoduodenectomy (PD). The reported incidence of post-PD hemorrhage (PPH) ranges from 1.5% to 15% [1,2,3,4], while it accounts for 10% to 38% of overall mortality [5, 6]. The International Study Group for Pancreatic Surgery (ISGPS) classifies PPH as early or late, according to its onset [7]. PPH occurs less than 24 h after PD, and late PPH occurs more than 24 h after the index operation. The mortality rate of late PPH is nearly 50%, and it is among the most devastating of the post-PD morbidities [11, 12]
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