Background Delayed massive hemorrhage （DMH） after pancreaticoduodenectomy （PD） is a sedous complication and one of the most common causes of mortality after PD. Its ideal management remains unclear. This paper is ...Background Delayed massive hemorrhage （DMH） after pancreaticoduodenectomy （PD） is a sedous complication and one of the most common causes of mortality after PD. Its ideal management remains unclear. This paper is to present our experience in the endovascular treatment of patients with DMH after PD using different techniques and materials.Methods During a seven years period, 19 patients （fifteen men, four women） with DMH arter PD were treated with endovascular procedures, including transcatheter arterial embolization （TAE） with coils embolization in eight cases, with coils plus N-butyl-2-cyanoacrylate （NBCA）-Lipiodol mixture in six cases, and stent-graft placement in five cases. The mean age of the patients was 58.2 years. Follow-up, including clinical condition, liver function tests, and Doppler ultrasound examinations, was documented.Results The immediate technical success rate was 84.2% （16/19）. There were no significant procedure-related complications. Hemostasis was not achieved with interventional procedures in three patients： one died of uncontrolled bleeding four days after the second TAE, and two patients required emergency laparotomy without re-angiography because of worsening clinical status. Among the 16 patients with successfully stopped bleeding who became hemodynamically stable after the procedure without evidence of further bleeding, two patients died during the peri-interventional procedure period because of multiple organ failure, and fourteen patients survived to hospital discharge. The mean length of follow-up was 14.6 months. Recurrent bleeding after discharge did not occur in any of these cases. Clinical and laboratory follow-up findings were unremarkable. Doppler ultrasound examinatation verified patency of the hepatic artery in the four patients with stent-graft placement during the follow-up period （5 months-29 months; mean, 15.3 months）.Conclusions Interventional endovascular procedure is a safe and technically feasible solution to control DMH. The first-line treatment for the bleeding is TAE. Stent-graft placement with preservation of the organ arterial flow, if technicallypossible, is a valuable alternative to TAE and surgical intervention for management of DMH.展开更多
Gastric artery aneurysm is a rare and lethal condition,and is caused by inflammatory or degenerative vasculopathies.We describe herein the clinical course of a patient with a ruptured gastric artery aneurysm associate...Gastric artery aneurysm is a rare and lethal condition,and is caused by inflammatory or degenerative vasculopathies.We describe herein the clinical course of a patient with a ruptured gastric artery aneurysm associated with microscopic polyangiitis.Absence of vasculitic changes in the aneurysm resected and negative results of autoantibodies interfered with our diagnostic process.We should have adopted an interventional radiology and initiated steroid therapy promptly to rescue the patient.展开更多
Hepatic artery pseudoaneurysm is a rare complication of liver directed procedures. Several strategies for treatment of pseudoaneurysms have been described. We describe a challenging case in which a small bleeding hepa...Hepatic artery pseudoaneurysm is a rare complication of liver directed procedures. Several strategies for treatment of pseudoaneurysms have been described. We describe a challenging case in which a small bleeding hepatic artery pseudoaneurysm is complicated by a proximal hepatic arterial occlusion, preventing transcatheter access. The aneurysm was too small to be seen on ultrasound. Using combined angiographic and fluoroscopic guidance, however, the aneurysm was triangulated and successfully treated with percutaneous direct thrombin injection. Combined angiography and fluoroscopy guided percutaneous thrombin injection of intrahepatic pseudoaneurysms can be a valuable treatment approach, particularly when other methods are not feasible or have failed.展开更多
文摘Background Delayed massive hemorrhage （DMH） after pancreaticoduodenectomy （PD） is a sedous complication and one of the most common causes of mortality after PD. Its ideal management remains unclear. This paper is to present our experience in the endovascular treatment of patients with DMH after PD using different techniques and materials.Methods During a seven years period, 19 patients （fifteen men, four women） with DMH arter PD were treated with endovascular procedures, including transcatheter arterial embolization （TAE） with coils embolization in eight cases, with coils plus N-butyl-2-cyanoacrylate （NBCA）-Lipiodol mixture in six cases, and stent-graft placement in five cases. The mean age of the patients was 58.2 years. Follow-up, including clinical condition, liver function tests, and Doppler ultrasound examinations, was documented.Results The immediate technical success rate was 84.2% （16/19）. There were no significant procedure-related complications. Hemostasis was not achieved with interventional procedures in three patients： one died of uncontrolled bleeding four days after the second TAE, and two patients required emergency laparotomy without re-angiography because of worsening clinical status. Among the 16 patients with successfully stopped bleeding who became hemodynamically stable after the procedure without evidence of further bleeding, two patients died during the peri-interventional procedure period because of multiple organ failure, and fourteen patients survived to hospital discharge. The mean length of follow-up was 14.6 months. Recurrent bleeding after discharge did not occur in any of these cases. Clinical and laboratory follow-up findings were unremarkable. Doppler ultrasound examinatation verified patency of the hepatic artery in the four patients with stent-graft placement during the follow-up period （5 months-29 months; mean, 15.3 months）.Conclusions Interventional endovascular procedure is a safe and technically feasible solution to control DMH. The first-line treatment for the bleeding is TAE. Stent-graft placement with preservation of the organ arterial flow, if technicallypossible, is a valuable alternative to TAE and surgical intervention for management of DMH.
文摘Gastric artery aneurysm is a rare and lethal condition,and is caused by inflammatory or degenerative vasculopathies.We describe herein the clinical course of a patient with a ruptured gastric artery aneurysm associated with microscopic polyangiitis.Absence of vasculitic changes in the aneurysm resected and negative results of autoantibodies interfered with our diagnostic process.We should have adopted an interventional radiology and initiated steroid therapy promptly to rescue the patient.
文摘Hepatic artery pseudoaneurysm is a rare complication of liver directed procedures. Several strategies for treatment of pseudoaneurysms have been described. We describe a challenging case in which a small bleeding hepatic artery pseudoaneurysm is complicated by a proximal hepatic arterial occlusion, preventing transcatheter access. The aneurysm was too small to be seen on ultrasound. Using combined angiographic and fluoroscopic guidance, however, the aneurysm was triangulated and successfully treated with percutaneous direct thrombin injection. Combined angiography and fluoroscopy guided percutaneous thrombin injection of intrahepatic pseudoaneurysms can be a valuable treatment approach, particularly when other methods are not feasible or have failed.
