Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Long-Term Clinical and Radiologic Outcomes after Stent-Graft Placement for the Treatment of Late-Onset Post-Pancreaticoduodenectomy Arterial Hemorrhage

췌십이지장절제술 후 발생한 후기 출혈에서 스텐트-그라프트를 이용한 치료의 장기적 임상, 영상의학적 결과

  • Woo Jin Kim (Department of Radiology, Pusan National University Hospital) ;
  • Chang Ho Jeon (Department of Radiology, Pusan National University Hospital) ;
  • Hoon Kwon (Department of Radiology, Pusan National University Hospital) ;
  • Jin Hyeok Kim (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Ung Bae Jeon (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Suk Kim (Department of Radiology, Pusan National University Hospital) ;
  • Hyung Il Seo (Department of Surgery, Pusan National University Hospital) ;
  • Chang Won Kim (Department of Radiology, Pusan National University Hospital)
  • 김우진 (부산대학교병원 영상의학과) ;
  • 전창호 (부산대학교병원 영상의학과) ;
  • 권훈 (부산대학교병원 영상의학과) ;
  • 김진혁 (양산부산대학교병원 영상의학과) ;
  • 전웅배 (양산부산대학교병원 영상의학과) ;
  • 김석 (부산대학교병원 영상의학과) ;
  • 서형일 (부산대학교병원 ) ;
  • 김창원 (부산대학교병원 영상의학과)
  • Received : 2020.08.03
  • Accepted : 2020.09.16
  • Published : 2021.05.01
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Abstract

Purpose To evaluate the long-term radiologic and clinical outcomes of stent-graft placement for the treatment of post-pancreaticoduodenectomy arterial hemorrhage (PPAH) based on the imaging findings of stent-graft patency and results of liver function tests. Materials and Methods We retrospectively reviewed the medical records of nine consecutive patients who underwent stent-graft placement for PPAH between June 2012 and May 2017. We analyzed the immediate technical and clinical outcomes and liver function test results. Stent-graft patency was evaluated using serial CT angiography images. Results All stent-grafts were deployed in the intended position for the immediate cessation of arterial hemorrhage and preservation of hepatic arterial blood flow. Technical success was achieved in all nine patients. Eight patients survived after discharge, and one patient died on postoperative day 28. The median follow-up duration was 781 days (range: 28-1766 days). Follow-up CT angiography revealed stent-graft occlusion in all patients. However, serum aspartate aminotransferase or alanine aminotransferase levels in all patients were well below those observed in hepatic infarction cases. Conclusion Stent-graft placement is a safe and effective treatment method for acute life-threatening PPAH. Liver function and distal hepatic arterial blood flow were maintained postoperatively despite the high incidence of stent-graft occlusion observed on follow-up CT.

목적 간 기능 검사와 영상 소견을 기반으로 하여 췌십이지장절제술 후 발생한 후기 출혈에서 스텐트-그라프트를 이용한 치료의 장기적 영상의학적, 임상적 경과를 보고자 한다. 대상과 방법 2012년 6월부터 2017년 5월까지 췌십이지장절제술 후 발생한 후기 출혈로 스텐트-그라프트 삽입술을 받은 9명의 환자를 후향적으로 분석하였다. 저자들은 시술 직후 술기적, 임상적 결과와 간 기능 검사를 검토하였다. 스텐트-그라프트의 개통성은 CT angiography를 이용하여 평가하였다. 결과 모든 스텐트-그라프트는 즉각적인 동맥 출혈을 멈추면서 간동맥 혈류를 유지할 수 있도록 의도했던 위치에 배치되었다. 기술적 성공은 모든 9명의 환자에게서 이루어졌다. 8명의 환자는 시술 후 생존하여 퇴원하였으며 한 명의 환자는 시술 28일 후 사망하였다. 평균 추적 관찰 기간은 781일이었다(범위: 28~1766일). 추적관찰 CT angiography에서 모든 환자의 스텐트-그라프트는 폐쇄되었다. 그러나 모든 환자들에서 간 경색을 시사할 만한 혈중 아스파르테이트아미노전달효소나 알라닌아미노전달효소 수치의 증가를 보이지 않았다. 결론 스텐트-그라프트 삽입술은 췌십이지장절제술 후 발생한 생명을 위협하는 후기 출혈의 안전하고 효과적인 치료이다. 간 기능과 간 말단부 동맥혈 공급은 추적관찰 CT상 스텐트-그라프트가 높은 확률로 막힘에도 불구하고 유지된다.

Keywords

Acknowledgement

This work was supported by a 2-year Research Grant of Pusan National University.

References

  1. Huo Y, Chi J, Zhang J, Liu W, Liu D, Li J, et al. Endovascular intervention for delayed post-pancreaticoduodenectomy hemorrhage: clinical features and outcomes of transcatheter arterial embolization and covered stent placement. Int J Clin Exp Med 2015;8:7457-7466 
  2. Khalsa BS, Imagawa DK, Chen JI, Dermirjian AN, Yim DB, Findeiss LK. Evolution in the treatment of delayed postpancreatectomy hemorrhage: surgery to interventional radiology. Pancreas 2015;44:953-958 
  3. Treckmann J, Paul A, Sotiropoulos GC, Lang H, Ozcelik A, Saner F, et al. Sentinel bleeding after pancreaticoduodenectomy: a disregarded sign. J Gastrointest Surg 2008;12:313-318 
  4. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007;142:20-25 
  5. De Castro SM, Kuhlmann KF, Busch OR, Van Delden OM, Lameris JS, Van Gulik TM, et al. Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? Ann Surg 2005;241:85-91 
  6. Miura F, Asano T, Amano H, Yoshida M, Toyota N, Wada K, et al. Management of postoperative arterial hemorrhage after pancreato-biliary surgery according to the site of bleeding: re-laparotomy or interventional radiology. J Hepatobiliary Pancreat Surg 2009;16:56-63 
  7. Gwon DI, Ko GY, Sung KB, Shin JH, Kim JH, Yoon HK. Endovascular management of extrahepatic artery hemorrhage after pancreatobiliary surgery: clinical features and outcomes of transcatheter arterial embolization and stent-graft placement. AJR Am J Roentgenol 2011;196:W627-W634 
  8. Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Fan QS. Stent-grafts placement for treatment of massive hemorrhage from ruptured hepatic artery after pancreaticoduodenectomy. World J Gastroenterol 2010;16:3716-3722 
  9. Ching KC, Santos E, McCluskey KM, Orons PD, Bandi R, Friend CJ, et al. Covered stents and coil embolization for treatment of postpancreatectomy arterial hemorrhage. J Vasc Interv Radiol 2016;27:73-79 
  10. Sanjay P, Kellner M, Tait IS. The role of interventional radiology in the management of surgical complications after pancreatoduodenectomy. HPB (Oxford) 2012;14:812-817 
  11. Sato A, Yamada T, Takase K, Matsuhashi T, Higano S, Kaneda T, et al. The fatal risk in hepatic artery embolization for hemostasis after pancreatic and hepatic surgery: importance of collateral arterial pathways. J Vasc Interv Radiol 2011;22:287-293 
  12. Chen AY, Laniado I Jr, Lin PH. Durability of the Viabahn stent graft after axillary artery pseudoaneurysm exclusion. J Vasc Surg Cases Innov Tech 2017;3:99-101 
  13. Ouchi T, Kato N, Nakajima K, Higashigawa T, Hashimoto T, Chino S, et al. Splenic artery aneurysm treated with endovascular stent grafting: a case report and review of literature. Vasc Endovascular Surg 2018;52:663-668 
  14. Zaghlool D, Franz R. Treatment of a high large extracranial carotid artery pseudoaneurysm from trauma using a Viabahn graft. Ann Vasc Surg 2015;29:837.e1-7 
  15. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003;14:S199-S202 
  16. Christensen T, Matsuoka L, Heestand G, Palmer S, Mateo R, Genyk Y, et al. Iatrogenic pseudoaneurysms of the extrahepatic arterial vasculature: management and outcome. HPB (Oxford) 2006;8:458-464 
  17. Biondetti P, Fumarola EM, Ierardi AM, Carrafiello G. Bleeding complications after pancreatic surgery: interventional radiology management. Gland Surg 2019;8:150-163 
  18. Zhang J, Qian HG, Leng JH, Qiu H, Wu JH, Liu BN, et al. Ischemic liver injury after complete occlusion of hepatic artery in the treatment of delayed postoperative arterial bleeding. J Gastrointest Surg 2015;19:2235-2242 
  19. You Y, Choi SH, Choi DW, Heo JS, Han IW, Han S, et al. Long-term clinical outcomes after endovascular management of ruptured pseudoaneurysm in patients undergoing pancreaticoduodenectomy. Ann Surg Treat Res 2019;96:237-249