Abstract:

Objective

To evaluate the efficacy and safety of the interventional techniques for treatment of postoperative massive hemorrhage on pancreatic diseases.

Methods

Twenty patients with postoperative hemorrhage were treated with endovascular interventional techniques，and 18 of them with only superselective arterial embolization，1 of them combined with stent placement and one combined with regional perfusion through SMA approach.The embolization devices were microcoils in 14 cases and standard stainless steel coils in 2 cases，associated with polyvinyl alcohol particles（PVA）in 6 cases and with gelfoams in 4 cases.

Results

Selective angiogram revealed the pseudoaneurysm in 13 cases，contrast media extravasation in 3 cases，pseudo aneurysm combined with contrast media extravasation in 3 cases.The technical success rate was 90.00%（18/20），and 2 died of massive hemorrhage associated with stress ulcer.Recurrent bleeding rate was 11.11%（2/18）.Angiography demonstrated complete obliteration of relative vessels after embolization，and patency with stable blood flow of the hepatic artery after stent placement，18 patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms.Two patients with pancreatic fistula and intra-abdominal abscess recurred bleeding in two weeks and died of hemorrhagic shock.The other 16 patents didn't occur bleeding in the following 2 weeks to 24 months.ALT occurred temporary increase in 4 patients with proper hepatic arterial embolization.Other complications，such as intestinal and pancreatic necrosis were not cbserved.

Conclusions

Transcatheter endovascular techniques are safe and effective to treat postoperative massive hemorrhage on pancreatic diseases.

Key words: Pancreatic diseases, Postoperative complications, Massive hemorrhage, Interventional treatment