To evaluate the effectiveness of DSA as an initial diagnostic tool for patients with sentinel hemorrhage after abdominal surgery and the clinical value of interventional therapy in such diseases.

The data of 45 patients with postoperative bleeding after abdominal surgery in our department from July 2018 to December 2020 were collected. The results of DSA and interventional therapy were analyzed retrospectively.

Among the 45 patients detected by DSA for the first time, the 14 patients showed negative angiography and the other 31 cases showed contrast extravasation (n = 20), pseudoaneurysm (n = 6), irregular arterial wall and disordered distal branches (n = 5), with a positive rate of 68.9% (31/45). Among the other 14 patients with negative angiography for the first time, the delayed hemorrhage occurred in 6 cases whose subsequent DSA showed contrast extravasation in 2 cases, pseudoaneurysm in 1 case, uneven arterial wall in 3 cases, and 8 cases without rebleeding were improved after conservative treatment. Among the 37 patients with signs of bleeding found by DSA, 4 patients underwent surgery because of abdominal infection, while the other 33 patients preferred endovascular treatment, of whom 2 cases were converted to surgery because of hemostasis difficulties during interventional operation, resulting ina technical success rate of 93.9% (31/33). Among the 31 patients, 24 patients achieved clinical success only by interventional therapy, with a clinical success rate of 77.4% (24/31). Rebleeding occurred in 7 patients after interventional therapy, of which 4 cases were successfully stopped by repeated embolization, and 3 failed cases were converted to surgery. The mortality rate was 17.6% (5/28) in the interventional therapy group, and 55.5% (5/9) in the surgical mortality, P = 0.041.

DSA can be used as a first-line diagnostic tool for patients with sentinel hemorrhage after abdominal surgery. Choosing appropriate interventional therapy on the basis of angiography has important clinical value in reducing the mortality of patients with delayed massive hemorrhage after abdominal surgery.