Endovascular Management of Postoperative Hemorrhage after Pancreaticoduodenectomy

Objective The aim of the study was to assess the safety and efficacy of endovascular management for postpancreaticoduodenectomy hemorrhage.

Materials and Methods A retrospective analysis of patients who underwent endovascular management for hemorrhage after pancreatic surgery between January 2015 to December 2020 was performed. Patient demographics, clinical presentation, angiography findings, endovascular procedure, technical success, clinical success, and complications were assessed.

Results Seventeen patients, comprising 14 (82.4%) males and 3 (17.6%) females, aged 37 to 68 years underwent endovascular management for postpancreatectomy hemorrhage. Patients presented with hemorrhage on their postoperative days 4 to 22 (mean: 9.8th day; median: 8th day); the presentation was with extraluminal hemorrhage in 11 patients (64.7%) and intraluminal hemorrhage in 6 patients (35.2%). The gastroduodenal artery (GDA) stump (10 patients, 58.8%) was the most commonly involved artery. The majority of cases were treated using coils as embolizing agents (13/17 patients, 76.5%). The technical and clinical success rates were 100%. The complication rate was 5.9% (1/17) and the mortality rate was 11.8% (2/17). The relaparotomy rate was 23.5% (4/17); however, none of the relaparotomy was for hemorrhage.

Conclusion Endovascular treatment provides a minimally invasive, safe, and effective method for the management of pancreaticoduodenectomy hemorrhage.