Hepatic artery pseudoaneurysm after pancreaticoduodenectomy treated with coil embolization in combination with portomesenteric venous stenting
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Delayed massive hemorrhage after pancreaticoduodenectomy is known as a fatal complication, frequently caused by gastroduodenal artery stump bleeding or hepatic artery pseudoaneurysm. Transarterial hepatic artery embolization is one of the treatment options in such cases. However, hepatic artery embolization can also result in ischemic complications of the liver, even fatal sometimes. We report a case of a 70-year-old male patient with distal common bile duct cancer who underwent pancreaticoduodenectomy. After three weeks, there was a bloody drain component accompanied with a decreased hemoglobin level. The immediate computed tomography scan and subsequent angiography demonstrated a hepatic artery pseudoaneurysm (1.8 cm in size) with segmental narrowing of the portal vein and superior mesenteric vein. The pseudoaneurysm and common hepatic artery were embolized using microcoils, following percutaneous portomesenteric stenting. There was no such ischemic complication as hepatic infarction after the procedure, and the patient was well tolerable. We suggest that the simultaneous portomesenteric stenting prior to hepatic artery embolization may be helpful to reduce the risk of hepatic infarction/failure in a patient with hepatic artery pseudoaneurysm accompanying portomesenteric vein stenosis after pancreaticoduodenectomy.
Abstract
Delayed massive hemorrhage after pancreaticoduodenectomy is known as a fatal complication, frequently caused by gastroduodenal artery stump bleeding or hepatic artery pseudoaneurysm. Transarterial hepatic artery embolization is one of the treatment options in such cases. However, hepatic artery embolization can also result in ischemic complications of the liver, even fatal sometimes. We report a case of a 70-year-old male patient with distal common bile duct cancer who underwent pancreaticoduodenectomy. After three weeks, there was a bloody drain component accompanied with a decreased hemoglobin level. The immediate computed tomography scan and subsequent angiography demonstrated a hepatic artery pseudoaneurysm (1.8 cm in size) with segmental narrowing of the portal vein and superior mesenteric vein. The pseudoaneurysm and common hepatic artery were embolized using microcoils, following percutaneous portomesenteric stenting. There was no such ischemic complication as hepatic infarction after the procedure, and the patient was well tolerable. We suggest that the simultaneous portomesenteric stenting prior to hepatic artery embolization may be helpful to reduce the risk of hepatic infarction/failure in a patient with hepatic artery pseudoaneurysm accompanying portomesenteric vein stenosis after pancreaticoduodenectomy.
참고문헌 (17)
- Sato N, "Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy : the importance of early angiography", Arch Surg, 133, pp.1099~1102 (1998)
- Blanc T, "Hemorrhage after pancreaticoduodenectomy: when is surgery still indicated?", Am J Surg, 194, pp.3~9 (2007)
- Tajima Y, "Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery", World J Gastroenterol, 13, pp.408~413 (2007)
- Miura F, "Management of postoperative arterial hemorrhage after pancreato-biliary surgery according to the site of bleeding : re-laparotomy or interventional radiology", J Hepatobiliary Pancreat Surg, 16, pp.56~63 (2009)
- Cho SK, "Ischemic liver injuries after hepatic artery embolization in patients with delayed postoperative hemorrhage following hepatobiliary pancreatic surgery", Acta Radiol, 52, pp.393~400 (2011)
- Mine T, "Contribution of extrahepatic collaterals to liver parenchymal circulation after proper hepatic artery embolization", J Gastroenterol Hepatol, 29, pp.1515~1521 (2014)
- Hasegawa T, "Endovascular treatment of hepatic artery pseudoaneurysm after pancreaticoduodenectomy : risk factors associated with mortality and complications", J Vasc Interv Radiol, 28, pp.50~59.e5 (2017)
- Sato A, "The fatal risk in hepatic artery embolization for hemostasis after pancreatic and hepatic surgery : importance of collateral arterial pathways", J Vasc Interv Radiol, 22, pp.287~293 (2011)
- Okuno A, "Nonsurgical management of ruptured pseudoaneurysm in patients with hepatobiliary pancreatic diseases", Am J Gastroenterol, 96, pp.1067~1071 (2001)
- Stoupis C, "Stent grafting of acute hepatic artery bleeding following pancreatic head resection", Eur Radiol, 17, pp.401~408 (2007)
- Limongelli P, "Management of delayed postoperative hemorrhage after pancreaticoduodenectomy : a metaanalysis", Arch Surg, 143, pp.1001~1007 (2008)
- Hankins D, "Covered stents for late postoperative arterial hemorrhage after pancreaticoduodenectomy", J Vasc Interv Radiol, 20, pp.407~409 (2009)
- Kang MJ, "Portal vein patency after pancreatoduodenectomy for periampullary cancer", Br J Surg, 102, pp.77~84 (2015)
- Kim KR, "Percutaneous transhepatic stent placement in the management of portal venous stenosis after curative surgery for pancreatic and biliary neoplasms", AJR Am J Roentgenol, 196, pp.W446~50 (2011)
- Shibata T, "Transcatheter microcoil embolotherapy for ruptured pseudoaneurysm following pancreatic and biliary surgery", Cardiovasc Intervent Radiol, 25, pp.180~185 (2002)
- Ohgi K, "Benign portal vein stenosis after pancreaticoduodenectomy", World J Surg, 43, pp.2623~2630 (2019)
- Brodsky JT, "Arterial hemorrhage after pancreatoduodenectomy. The ‘sentinel bleed'", Arch Surg, 126, pp.1037~1040 (1991)