Transcatheter Arterial Embolization for Postoperative Bleeding Following Abdominal Surgery

• Published in: Cardiovascular and interventional radiology Vol. 41; no. 9; pp. 1346 - 1355
• Main Authors: Chatani, Shohei, Inoue, Akitoshi, Ohta, Shinichi, Takaki, Kai, Sato, Shigetaka, Iwai, Takayasu, Murakami, Yoko, Watanabe, Shobu, Sonoda, Akinaga, Nitta, Norihisa, Maehira, Hiromitsu, Tani, Masaji, Murata, Kiyoshi
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2018; Springer Nature B.V
• Subjects: Abdomen; Abdomen - surgery; Abdominal surgery; Adult; Aged; Aged, 80 and over; Aneurysm, False - complications; Aneurysm, False - diagnostic imaging; Angiography; Arterial Interventions; ARTERIES; BIOMEDICAL RADIOGRAPHY; Bleeding; BLOOD PRESSURE; Cardiology; Clinical Investigation; Computed Tomography Angiography - methods; CONTRAST MEDIA; Embolization; Embolization, Therapeutic - methods; Extravasation; Female; Fistula; Fistulae; Follow-Up Studies; Heart rate; HEMORRHAGE; Humans; Imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; PANCREAS; Pancreatic Fistula - complications; Pancreatic Fistula - diagnostic imaging; PATIENTS; Postoperative Hemorrhage - complications; Postoperative Hemorrhage - diagnostic imaging; Postoperative Hemorrhage - therapy; Pseudoaneurysm; Radiography, Interventional - methods; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Retrospective Studies; Success; SURGERY; Treatment Outcome; Ultrasound; VASCULAR DISEASES; Arterial embolization; Postoperative hemorrhage; Hemorrhagic shock; Pancreatic fistula
• ISSN: 0174-1551; 1432-086X; 1432-086X
• DOI: 10.1007/s00270-018-2019-8

Purpose We aimed to estimate the usefulness of transcatheter arterial embolization (TAE) in patients with postoperative abdominal hemorrhage and to evaluate the effects of pancreatic fistula on clinical outcomes and angiographic findings. Materials and Methods We enrolled 22 patients (20 males and 2 females; mean age 63 years; range 25–86 years), who underwent transarterial angiography for postoperative hemorrhage after abdominal surgery. This group corresponded to 28 procedures. Technical and clinical success rates were calculated, and clinical findings and outcomes were compared between patients with and without a pancreatic fistula. Results Pre-interventional CT was performed in all patients before first angiography, and the location of the bleeding was identified in all but one patient. Active arterial bleeding, identified by extravasation of contrast agent ( n  = 12), pseudoaneurysm formation ( n  = 12), and arterial wall irregularity ( n  = 2) were detected in 28 angiographic procedures, and embolization was performed in 26 instances. Various embolization techniques such as isolation, packing, embolization, and stentgraft implantation were performed. The technical and clinical success rates were 96% (25/26 procedures) and 82% (18/22 patients), respectively. In hemodynamically unstable patients (shock index: heart rate/systolic blood pressure > 1), a 92% (12/13 cases) technical success rate was achieved. There were no significant differences in any evaluated parameters between patients with and without pancreatic fistula. Conclusion TAE is a safe and effective for treating postoperative hemorrhage even in patients with hemodynamic instability and pancreatic fistula. Additionally, pre-interventional CT is useful for effective, consecutive interventions.