Ann Surg Treat Res.  2019 May;96(5):237-249. 10.4174/astr.2019.96.5.237.

Long-term clinical outcomes after endovascular management of ruptured pseudoaneurysm in patients undergoing pancreaticoduodenectomy

• You Y
• Choi SH
• Choi DW
• Heo JS
• Han IW
• Han S
• Shin SW
• Park KB
• Park HS
• Cho SK
• Han SH

• KMID: 2443587
• DOI: http://doi.org/10.4174/astr.2019.96.5.237

Abstract

PURPOSE
Recent studies have analyzed the short-term clinical outcomes of ndovascular management. However, the long-term outcomes are unknown. This study aimed to investigate clinical outcomes after endovascular management for ruptured pseudoaneurysm in patients after pancreaticoduodenectomy (PD).
METHODS
The medical records of 2,783 patients who underwent PD were retrospectively reviewed at a single center. Of 62 patients who received intervention after pseudonaeurysm rupture, 57 patients (91.9%) experienced eventual success of hemostasis. The patients were composed as follows: (embolization only [EMB], n = 30), (stent-graft placement only [STENT], n = 19) and (both embolization and stent-graft placement simultaneously or different times [EMB + STENT], n = 8). Long-term complications were defined as events that occur more than 30 days after the last successful endovascular treatment.
RESULTS
Among 57 patients, short-term stent-graft related complications developed in 3 patients (5.3%) and clinical complication developed in 18 patients (31.5%). Nine (15.8%) had long-term stent-graft related complications, which involved partial thrombosis in 5 cases, occlusion in 3 cases and migration in 1 case. Except for 1 death, the remaining 8 cases did not experience clinical complications. The stent graft primary patency rate was 88.9% after 1 month, 84.2% after 1 year, and 63.2% after 2 years. Of 57 patients, 30 days mortality occurred in 8 patients (14.0%).
CONCLUSION
After recovery from initial complication, most of patients did not experience fatal clinical complication during long-term follow-up. Endovascular management is an effective and safe management of pseudoaneurysm rupture after PD in terms of long-term safety.

Keyword

Stents; Therapeutic embolization; Pseudoaneurysm; Pancreaticoduodenectomy

MeSH Terms

Aneurysm, False*
Blood Vessel Prosthesis
Embolization, Therapeutic
Follow-Up Studies
Hemostasis
Humans
Medical Records
Mortality
Pancreaticoduodenectomy*
Retrospective Studies
Rupture
Stents
Thrombosis

Figure

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  Fig. 1 Patients selection. PD, pancreaticoduodenectomy. a)Percent-age of patients who received intervention. b)Success rate among 62 patients who underwent intervention.

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  Fig. 2 Endpoints and follow-up.

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  Fig. 3 (A) Short-term primary endpoint. (B) Long-term primary endpoint. EMB, embolization only; STENT, stent-graft placement only. a)Number of cases that both procedures were done simultaneously or different times. b)Number of patients except those who died due to short-term complications.

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  Fig. 4 Patient data. A series of images in cases of long-term stent occlusion. This example is from a 62-year-old woman with pancreatic cancer who underwent pylorus-preserving pancreaticoduodenectomy. (A) Celiac angiography demonstrated a pseudoaneurysm at broad segment of artery along the proper hepatic artery and common hepatic artery (red arrows) on postoperative day 20. (B) Completion angiogram after placement of the stent-graft (white arrows) showed complete exclusion of ruptured site without remnant bleeding. The left hepatic artery received blood flow (black head of arrows) from intraheapatic collateral (red head of arrows) and left gastric artery (LGA, yellow head of arrows). (C) Follow-up CT scan taken 4 days after intervention demonstrated normal liver parenchymal perfusion due to collateral from the LGA (red arrows). (D) Twenty-one months after intervention, the stent occlusion (red arrows) was found on follow-up CT scan. The most part of liver parenchyma was normal.

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  Fig. 5 Primary patency rate of stent-grafts.

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