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Emergency endovascular treatments for delayed hemorrhage after pancreaticobiliary surgery: indications, outcomes, and follow-up of a retrospective cohort

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

A Correction to this article was published on 09 September 2020

This article has been updated

Abstract

Purpose

To evaluate the outcomes of emergency endovascular treatments for delayed bleeding after pancreaticobiliary surgery.

Methods

We retrospectively evaluated 21 patients (M:F = 13:8, median age = 64 years) undergoing 23 endovascular treatments, performed from 2010 to 2017 in a single center. Data collected were patient characteristics; surgery; pathology; incidence of postoperative pancreatic fistulas (POPF); bleeding signs on CT and angiography; damaged artery; endovascular tools used; technical and clinical success; intervals between surgery, endovascular treatment, and discharge; survival rates.

Results

Sixteen patients had pancreatoduodenectomy, three hepaticojejunostomy, two distal pancreatectomy. Indications for surgery were mainly biliary (33%), pancreatic (19%), or duodenal (10%) malignancies. Seventeen patients had “grade C” POPF, three suffered a biliary leak, one had no POPF. Active bleeding was present in 17/23 CTs and in 22/23 angiographies, mostly from hepatic (43%), gastroduodenal (22%), and splenic (13%) arteries. The endovascular treatments were performed with coils (26%), glue (22%), stent-graft (22%), and their combinations (30%). Sixteen patients had a single endovascular treatment, one underwent a second embolization, three had subsequent surgery, one had repeat embolization followed by surgery. Relaparotomy rate was 19%. Median hospital stay was 37 days (range 12–75); median intervals among pancreaticobiliary surgery, endovascular treatment, and discharge were 21 (2–36) and 12 (8–47) days, respectively.

We observed 4/21 intrahospital deaths (median: 31 days from endovascular treatment, 4–53); 1-year survival rate of discharged patients was 71%.

Conclusions

Endovascular treatment using embolization and/or stent-graft placement is a useful first-line intervention to halt postoperative hemorrhage after pancreaticobiliary surgery and decreases the need for urgent relaparotomy.

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Change history

  • 09 September 2020

    The original version of this article has an error in the affiliations of all the authors. The authors affiliations are corrected.

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Authors and Affiliations

  1. Training School in Radiology, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milano, Italy

    Riccardo Muglia & Nicolò Gennaro

  2. Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Via A. Manzoni 56, 20089, Rozzano, Milano, Italy

    Ezio Lanza, Dario Poretti, Felice D’Antuono & Vittorio Pedicini

  3. Department of General Surgery, Humanitas Research Hospital, Via A. Manzoni 56, 20089, Rozzano, Milano, Italy

    Francesca Gavazzi & Alessandro Zerbi

  4. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milano, Italy

    Arturo Chiti

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  1. Riccardo Muglia
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Correspondence to Riccardo Muglia.

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Muglia, R., Lanza, E., Poretti, D. et al. Emergency endovascular treatments for delayed hemorrhage after pancreaticobiliary surgery: indications, outcomes, and follow-up of a retrospective cohort. Abdom Radiol 45, 2593–2602 (2020). https://doi.org/10.1007/s00261-020-02480-z

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