13th Annual Global Embolization Symposium & Technologies
Purpose : The objective of our study was to analyse the technical and clinical outcomes
of endovascular treatment of patients with iatrogenic vascular complications after hepato-pancreato-biliary procedures.
Material and Methods : From September 2008 to December 2018, 44 patients were enrolled in this retrospective study who had undergone hepato-pancreato-biliary procedures and presented with post-procedure arterial hemorrhage. Arterial hemorrhage was seen in hepato-pancreato-biliary procedures that included Whipple’s pancreatico-duodectomy (n=8), pancreatojejunostomy (n=2), open and laparoscopic cholecystectomy (n=16), hepatectomy (n=1), Endoscopic sphincterotomy/ ampullectomy (n=4), endoscopic drainage of pancreatic collections (n=5) and image guided interventions (percutaneous transhepatic biliary drainage, abscess drainage and liver biopsy) (n=5). All patients presented with clinical symptoms ranging from pain, hematemesis, bleed through drain, hypotensive shock and multi-organ dysfunction. All patients underwent CT angiography to identify the etiology of hemorrhage in suspected arterial hemorrhage.
Results : The right hepatic artery (n=12) and gastro-duodenal artery (n=11) were most frequently involved and pseudoaneurysm (n=23) was the most common abnormality followed by contrast extravasation (n=20) and arterio-portal fistula (n=1). Coil embolization were performed in majority of the cases (n=39) including combination of coils and nBCA in n=4, nBCA was used alone in n=4 and stent-graft deployed in n=1. Technical success was achieved in 100% and clinical success in 93.1% (41/44) cases with re-bleeding occurring in one (2.2%) which was successfully coil embolized. Two patients (4.5%) expired due to ensuing comorbidities despite technically successful endovascular therapy. Procedural complication (n=1) included migration of a coil during deployment which was successfully snared.
Conclusions : Early detection of clinical deterioration and diagnosis of the underlying abnormality following hepato-pancreato-biliary procedures coupled with timely intervention through endovascular approach performed safely results in high technical and clinical success. Endovascular management is thus an effective treatment option for vascular complications.