Endovascular Treatment of Hepatic Artery Pseudoaneurysm after Pancreaticoduodenectomy: Risk Factors Associated with Mortality and Complications

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• 作者：Tetsuya Hasegawa ; MD ; PhD ; ^{te2ya.hase@gmail.com} ; Hideki Ota ; MD ; PhD ; Tomonori Matsuura ; MD ; PhD ; Kazumasa Seiji ; MD ; PhD ; Shunji Mugikura ; MD ; PhD ; Fuyuhiko Motoi ; MD ; PhD ; Michiaki Unno ; MD ; PhD ; Kei Takase ; MD ; PhD
• 关键词：aOR ; adjusted odds ratio ; CHA ; common hepatic artery ; CI ; confidence interval ; DIC ; disseminated intravascular coagulation ; EVT ; endovascular treatment ; GDA ; gastroduodenal artery ; IPA ; inferior phrenic artery ; NBCA ; n-butyl cyanoacrylate ; OR ; odds ratio ; PD ; pancreaticoduodenectomy
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：28
• 期：1
• 页码：50-59.e5
• 全文大小：2146 K
• 卷排序：28

文摘

To evaluate risk factors predicting death and complications of primary therapy for hepatic and gastric duodenal artery pseudoaneurysms following endovascular treatment (EVT) after pancreaticoduodenectomy (PD).Materials and MethodsBetween April 2004 and December 2014, 28 patients (mean age, 64.7 y) with post-PD hemorrhage underwent EVT. Prevention of hepatic artery blockage via stents or side-holed catheter grafts was stratified in cases without a replaced hepatic artery. Mortality and major hepatic complications following EVT were evaluated according to age; sex; surgery–EVT interval; presence of portal vein stenosis, shock, and coagulopathy at EVT onset; and post-EVT angiographic findings.ResultsAll hemorrhages were successfully treated with microcoils (n = 17; 61%), covered stents (n = 1; 3%), bare stent–assisted coil embolization (n = 5; 18%), or catheter grafts with coil embolization (n = 5; 18%). Hepatic arterial flow was observed after EVT in 18 patients (64%). Mortality and major hepatic complication rates were 28.6% and 32.1%, respectively. Hemorrhagic shock and coagulopathy at EVT onset (n = 8 each; odds ratio [OR], 27; 95% confidence interval [CI], 3.1–235.7; P < .01) were significantly associated with mortality. Coagulopathy at EVT onset (adjusted OR [aOR], 48.1; 95% CI, 3.2–2,931), portal vein stenosis (n = 16; aOR, 16.9; 95% CI, 1.3–721.9), and no visualization of hepatopetal flow through the hepatic arteries (n = 10; aOR, 29.5; 95% CI, 2.1–1,477) were significantly associated with major hepatic complications.ConclusionsEVT should be performed as soon as possible before the development of shock or coagulopathy. Hepatic arterial flow visualization decreases major hepatic complications.