Endovascular Hepatic Artery Stents in the Modern Management of Postpancreatectomy Hemorrhage

Abstract Background Delayed postpancreatectomy hemorrhage (PPH) is a fatal complication caused by arterial erosion. This study reports a single-center experience of managing delayed PPH with different endovascular treatment approaches. Methods We reviewed the data of patients who had delayed PPH due to hepatic artery or gastroduodenal artery stump perforation and underwent endovascular treatment between 2003 and 2018. We categorized endovascular treatment approaches involving hepatic artery sacrifice, superselective pseudoaneurysm embolization with hepatic artery preservation, and covered stent placement. Technical success rates, hemorrhage recurrence rates, major and minor hepatic complication rates, and 30-day and 1-year mortality rates were assessed. Results A total of 18 patients were reviewed; 11 (61%), 4 (22%), and 3 (17%) delayed PPH cases were managed through hepatic artery sacrifice, superselective pseudoaneurysm embolization, and hepatic artery stenting, respectively. Multidetector computed tomography was performed in 14 (78%) patients. The technical success rate was 100%. The overall hemorrhage recurrence rate was 39%, with superselective pseudoaneurysm embolization having a 100% hemorrhage recurrence rate—much higher than that of hepatic artery sacrifice or stent graft placement. The overall major and minor hepatic complication rates were 56% and 83%, respectively. The overall 30-day and 1-year mortality rates were 11% and 25%, respectively. The 30-day and 1-year mortality rates and minor and major hepatic complication rates were similar in each group. Conclusion Hepatic artery sacrifice is more effective than superselective pseudoaneurysm embolization in the management of delayed PPH. Covered stent placement may be a reasonable alternative treatment to hepatic artery sacrifice.

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Covered Stents Used for Late, Postpancreatectomy Hemorrhage in the Common Hepatic Artery

The American Surgeon ◽

10.1177/000313481107700231 ◽

2011 ◽

Vol 77 (2) ◽

pp. 236-238

Author(s):

Theodoros Kolokotronis ◽

Waldemar Hosch ◽

Jan Schmidt ◽

Boris Radeleff ◽

Jens Werner ◽

...

Keyword(s):

Hepatic Artery ◽

Common Hepatic Artery ◽

Covered Stents ◽

Postpancreatectomy Hemorrhage ◽

The Common

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Endovascular Hepatic Artery Stents in the Modern Management of Post-pancreatectomy Haemorrhage

HPB ◽

10.1016/j.hpb.2021.08.827 ◽

2021 ◽

Vol 23 ◽

pp. S885-S886

Author(s):

L. Finch ◽

S. Jegatheeswaran ◽

A. Siriwardena

Keyword(s):

Hepatic Artery ◽

Modern Management

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Multiple episodes of postpancreatectomy hemorrhage resolved by endoscopy and ultrasound-guided percutaneous thrombin injection into a common hepatic artery aneurysm: a case report

Journal of International Medical Research ◽

10.1177/03000605211067395 ◽

2021 ◽

Vol 49 (12) ◽

pp. 030006052110673

Author(s):

Jun Lu ◽

Weijiang Zhou ◽

Kai Wang ◽

Chao Wang ◽

Xiao Xu ◽

...

Keyword(s):

Hepatic Artery ◽

Gastrointestinal Hemorrhage ◽

Artery Aneurysm ◽

Arterial Embolization ◽

Common Hepatic Artery ◽

Digestive Endoscopy ◽

Hepatic Artery Aneurysm ◽

Postpancreatectomy Hemorrhage ◽

Multiple Episodes ◽

Abdominal Hemorrhage

Postpancreatectomy hemorrhage (PPH) is one of the most common complications after pancreatoduodenectomy (PD). It mainly includes gastrointestinal hemorrhage and abdominal hemorrhage. With the development of digestive endoscopy and ultrasonic/radiological interventional technology, hemostasis can be effectively performed by minimally invasive methods in many patients with PPH. This report describes the successful treatment of multiple episodes of postoperative hemorrhage after PD. The patient developed anastomotic hemorrhage after PD and was successfully treated by endoscopic hemostasis. However, he also developed intra-abdominal hemorrhage after PD caused by a pseudoaneurysm that had formed next to the common hepatic artery. We effectively performed hemostasis by injecting lyophilized thrombin powder into the pseudoaneurysm with ultrasound guidance, which is a rarely used method. This case indicates that digestive endoscopy provides great advantages in the treatment of gastrointestinal hemorrhage after PD. For patients who develop PPH with a pseudoaneurysm, interventional ultrasonography is an option if transcatheter arterial embolization or covered stenting fails.

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The Glissonian Approach of the Hilum

Swiss Surgery ◽

10.1024/1023-9332.5.3.143 ◽

1999 ◽

Vol 5 (3) ◽

pp. 143-146 ◽

Cited By ~ 9

Author(s):

Launois ◽

Maddern ◽

Tay

Keyword(s):

Portal Vein ◽

Hepatic Artery ◽

Posterior Approach ◽

Hepatic Duct ◽

Rapid Evolution ◽

Hepatic Tissue ◽

Detailed Knowledge ◽

Porta Hepatis ◽

Liver Segment ◽

Glissonian Approach

The detailed knowledge of the segmental anatomy of the liver has led to a rapid evolution in resectional surgery based on the intrahepatic distribution of the portal trinity (the hepatic artery, hepatic duct and portal vein). The classical intrafascial or extrahepatic approach is to isolate the appropriate branch of the portal vein, hepatic artery and the hepatic duct, outside the liver substance. Another method, the extrafascial approach, is to dissect the whole sheath of the pedicle directly after division of a substantial amount of the hepatic tissue to reach the pedicle, which is surrounded by a sheath, derived from Glisson's capsule. This Glissonian sheath encloses the portal trinity. In the transfissural or intrahepatic approach, these sheaths can be approached either anteriorly (after division of the main, right or umbilical fissure) or posteriorly from behind the porta hepatis. We describe the technique for approaching the Glissonian sheath and hence the hepatic pedicle structures and their branches by the intrahepatic posterior approach that allows early delineation of the liver segment without the need for ancillary techniques. In addition, the indications for the use of this technique in the technical and oncologic settings are also discussed.

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