J Korean Soc Radiol.  2021 May;82(3):600-612. 10.3348/jlsr.2020.0144.

Long-Term Clinical and Radiologic Outcomes after Stent-Graft Placement for the Treatment of Late-Onset PostPancreaticoduodenectomy Arterial Hemorrhage

• Kim WJ
• Jeon CH
• Kwon H
• Kim JH
• Jeon UB
• Kim S
• Seo HI
• Kim CW

• KMID: 2516113
• DOI: http://doi.org/10.3348/jlsr.2020.0144

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. Stentgraft 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.

Keyword

Embolization; Therapeutic; Liver Function Tests; Pancreaticoduodenectomy; Postoperative Hemorrhage; Stent