Delayed hepatic arterial hemorrhage after pancreaticoduodenectomy (PD) is not a common but a fatal complication, occurring in 7% of all patients. Its ideal management remains unclear and controversial.
A research article published on August 7, 2010 in the World Journal of Gastroenterology addresses this question. The authors reported the clinical outcome of 9 patients with life-threatening hemorrhage from a ruptured hepatic artery pseudoaneurysm after PD after treatment with a new interventional technique, namely placement of stent-grafts. This technique provides a good alternative option for the control of hemorrhage from ruptured hepatic artery pseudoaneurysm after PD, especially in those who cannot undergo embolization. Although the number of patients was small, the procedure demonstrated a lower mortality than conventional surgical intervention.
Based on their results, placement of stent-grafts for acute lifethreatening bleeding from hepatic artery pseudoaneurysm is a valuable alternative to embolization and surgical intervention. If technically possible, this technique should be considered the first-line treatment for bleeding from the common and proper hepatic artery, particularly in patients with a non-portal vein. Further data are required to evaluate its technical success rate, complications, and long-term outcome in a larger number of patients.
Reference: Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Fan QS. Stentgrafts placement for treatment of massive hemorrhage from ruptured hepatic artery after pancreaticoduodenectomy. World J Gastroenterol 2010; 16(29): 3716-3722
Correspondence to: Mao-Qiang Wang, MD, Professor, Director, Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, China. firstname.lastname@example.org
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About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2009 IF: 2.092. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.