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Endovascular management for postpancreatectomy or pancreatitis-related hemorrhage: efficacy and clinical outcomes
JVIR
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Scientific Session
Sunday
4:12 PM
Abstract No. 79
Empiric transcatheter gastroduodenal artery embolization for massive duodenal ulcer bleeding with negative angiography compared with selective embolization with positive angiography K. Kim1, C. Burke1, R. Dixon1, J. Stavas1; 1University of North Carolina, Chapel Hill, NC Purpose: To evaluate the relative efficacy and safety of empiric gastroduodenal artery (GDA) embolization in patients with massive duodenal ulcer bleeding and negative angiography compared with selective embolization in patients with positive angiography. Materials: Data were retrospectively collected for consecutive patients who had catheter angiography for failed endoscopic hemostasis of massive duodenal ulcer bleeding from February 2000 to July 2015 (n ¼ 57, 39 males, age 17-87 y, median 62). The patients were divided into two groups according to angiographic findings: the site of bleeding was not identified on catheter angiography (group 1, n ¼ 44) and catheter angiography demonstrated a site of bleeding (group 2, n ¼ 13). Group 1 patients underwent empiric GDA embolization, and group 2 patients underwent selective embolization of bleeding GDA branches. Median follow-up was 5 months (mean 19 months, range: 1 day–139 months). Results: The initial embolization procedures were technically successful in all patients in both groups. The used embolic agents were coils (38/44 group 1 and 13/13 group 2), coils and Gelfoam (3/44 group 1), and coils and particles (3/44 group 1). The recurrent bleeding rate after embolization was 13/44 (30%) in group 1 and 3/13 (23%) in group 2. The 30-day mortality rate was 7/44 (16%) in group 1, and 5/13 (38%) in group 2. There was no statistically significant difference of recurrent bleeding or 30-day mortality rates in both groups. Out of 16 patients with recurrent bleeding, 5 underwent successful repeat embolization (3 empiric and 2 selective embolization), 9 underwent repeat endoscopic hemostasis, and 2 patients received conservative treatment due to unstable vital signs. Repeat endoscopic hemostasis was failed in 3 out of 9 patients; two underwent surgery, and the remaining one died of hypovolemic shock. No late recurrent bleeding occurred. Conclusions: Empiric GDA embolization in patients with massive duodenal ulcer bleeding with negative angiography appears to be a safe and effective treatment, comparable
S37
recurrent bleeding and 30-day mortality rates with selective GDA embolization with positive angiography.Survival depends on underlying conditions.
4:21 PM
Abstract No. 80
Endovascular management for postpancreatectomy or pancreatitis-related hemorrhage: efficacy and clinical outcomes P. Lee1, K. Kobayashi2, D. Zhang3, M. Jawed4, A. Jain5, D. Kittur5, M. Karmel6; 1State University of New York Upstate Medical University, Brooklyn, NY; 2SUNY Upstate Medical University, Syracuse, NY; 3SUNY Upstate Medical University, Indianapolis, IN; 4SUNY Upstate, Syracuse, NY; 5State University of New York Upstate Medical University, Syracuse, NY; 6Upstate Medical University, Syracuse, NY Purpose: To determine the efficacy, safety, and clinical outcomes of endovascular management (EM) of postpancreatectomy (PP) or pancreatitis-related (PR) hemorrhage. Materials: Query of our PACS database between December 2005 and March 2016 identified 24 patients (17 men, mean age: 59) who underwent EM of PP (n ¼ 13) or PR (n ¼ 11) hemorrhage. Medical records and imaging studies were reviewed to record clinical presentation, angiographic findings, technical details, clinical outcomes, and complications. Results: In total, 14 patients presented with clinical signs of hemorrhage, such as gastrointestinal bleeding, while 10 patients were asymptomatic, but had abnormal imaging findings. Median onset of hemorrhage following surgery was 36 days (range: 5-416). Angiography showed a pseudoaneurysm in 17 patients, active extravasation in 2, and none of these findings in 5. The site of bleeding included the splenic artery (n ¼ 10), gastroduodenal artery (GDA)/stump or its branches (n ¼ 9), and others (n ¼ 5). Stent-graft was placed in the celiac (n ¼ 1) or common/proper/right hepatic arteries (n ¼ 5). Embolization with coils (n ¼ 16), Gelfoam (n ¼ 2), NBCA glue (n ¼ 1) was performed in the splenic artery (n ¼ 10), GDA (n ¼ 4), and others (n ¼ 4). Post-EM angiograms showed exclusion of pseudoaneurysms or extravasation in all 19 patients. During the follow-up period (mean: 54 days), rebleeding rate was 8.3% and occurred following splenic artery embolization in 2 PR patients. Rebleeding was surgically treated. The 30-day and 6-month mortality rates were 4.3% (n ¼ 1) and 13.0% (n ¼ 3) respectively. Cause of death was sepsis (n ¼ 2) and cancer progression (n ¼ 1). Two patients treated with embolization (n ¼ 1) or stent-graft (n ¼ 1) in the common/proper hepatic artery developed hepatic abscesses. 5 patients had splenic infarction, with 450% in 2 and o50% in 3; 1 developed splenic abscess. Stent-graft became occluded in 2 patients (33%) at 103 and 976 days; 1 developed hepatic abscesses requiring drainage. Conclusions: Endovascular management was effective in controlling PP or PR hemorrhage with relatively rare recurrence. Stent-graft occlusion and splenic infarction were relatively common.
SUNDAY: Scientific Sessions
that received CTA prior to their therapeutic embolization for NVGIB to the patients that did not receive a pre-embolization CTA, there was an overall reduction of 20 minutes of procedural time. Conclusions: CTA is an accurate diagnostic modality in detecting NVGIB. Performing abdomen and pelvis CTA before TAE improves the localization of gastrointestinal bleeding and facilitates embolization by reducing the overall procedural time. Impact of pre-angiography CTA on reducing the overall number of imaging studies, amount of contrast administered, and overall mortality and morbidity needs to be further investigated.
’
’
Scientific Session
Sunday
4:12 PM
Abstract No. 79
Empiric transcatheter gastroduodenal artery embolization for massive duodenal ulcer bleeding with negative angiography compared with selective embolization with positive angiography K. Kim1, C. Burke1, R. Dixon1, J. Stavas1; 1University of North Carolina, Chapel Hill, NC Purpose: To evaluate the relative efficacy and safety of empiric gastroduodenal artery (GDA) embolization in patients with massive duodenal ulcer bleeding and negative angiography compared with selective embolization in patients with positive angiography. Materials: Data were retrospectively collected for consecutive patients who had catheter angiography for failed endoscopic hemostasis of massive duodenal ulcer bleeding from February 2000 to July 2015 (n ¼ 57, 39 males, age 17-87 y, median 62). The patients were divided into two groups according to angiographic findings: the site of bleeding was not identified on catheter angiography (group 1, n ¼ 44) and catheter angiography demonstrated a site of bleeding (group 2, n ¼ 13). Group 1 patients underwent empiric GDA embolization, and group 2 patients underwent selective embolization of bleeding GDA branches. Median follow-up was 5 months (mean 19 months, range: 1 day–139 months). Results: The initial embolization procedures were technically successful in all patients in both groups. The used embolic agents were coils (38/44 group 1 and 13/13 group 2), coils and Gelfoam (3/44 group 1), and coils and particles (3/44 group 1). The recurrent bleeding rate after embolization was 13/44 (30%) in group 1 and 3/13 (23%) in group 2. The 30-day mortality rate was 7/44 (16%) in group 1, and 5/13 (38%) in group 2. There was no statistically significant difference of recurrent bleeding or 30-day mortality rates in both groups. Out of 16 patients with recurrent bleeding, 5 underwent successful repeat embolization (3 empiric and 2 selective embolization), 9 underwent repeat endoscopic hemostasis, and 2 patients received conservative treatment due to unstable vital signs. Repeat endoscopic hemostasis was failed in 3 out of 9 patients; two underwent surgery, and the remaining one died of hypovolemic shock. No late recurrent bleeding occurred. Conclusions: Empiric GDA embolization in patients with massive duodenal ulcer bleeding with negative angiography appears to be a safe and effective treatment, comparable
S37
recurrent bleeding and 30-day mortality rates with selective GDA embolization with positive angiography.Survival depends on underlying conditions.
4:21 PM
Abstract No. 80
Endovascular management for postpancreatectomy or pancreatitis-related hemorrhage: efficacy and clinical outcomes P. Lee1, K. Kobayashi2, D. Zhang3, M. Jawed4, A. Jain5, D. Kittur5, M. Karmel6; 1State University of New York Upstate Medical University, Brooklyn, NY; 2SUNY Upstate Medical University, Syracuse, NY; 3SUNY Upstate Medical University, Indianapolis, IN; 4SUNY Upstate, Syracuse, NY; 5State University of New York Upstate Medical University, Syracuse, NY; 6Upstate Medical University, Syracuse, NY Purpose: To determine the efficacy, safety, and clinical outcomes of endovascular management (EM) of postpancreatectomy (PP) or pancreatitis-related (PR) hemorrhage. Materials: Query of our PACS database between December 2005 and March 2016 identified 24 patients (17 men, mean age: 59) who underwent EM of PP (n ¼ 13) or PR (n ¼ 11) hemorrhage. Medical records and imaging studies were reviewed to record clinical presentation, angiographic findings, technical details, clinical outcomes, and complications. Results: In total, 14 patients presented with clinical signs of hemorrhage, such as gastrointestinal bleeding, while 10 patients were asymptomatic, but had abnormal imaging findings. Median onset of hemorrhage following surgery was 36 days (range: 5-416). Angiography showed a pseudoaneurysm in 17 patients, active extravasation in 2, and none of these findings in 5. The site of bleeding included the splenic artery (n ¼ 10), gastroduodenal artery (GDA)/stump or its branches (n ¼ 9), and others (n ¼ 5). Stent-graft was placed in the celiac (n ¼ 1) or common/proper/right hepatic arteries (n ¼ 5). Embolization with coils (n ¼ 16), Gelfoam (n ¼ 2), NBCA glue (n ¼ 1) was performed in the splenic artery (n ¼ 10), GDA (n ¼ 4), and others (n ¼ 4). Post-EM angiograms showed exclusion of pseudoaneurysms or extravasation in all 19 patients. During the follow-up period (mean: 54 days), rebleeding rate was 8.3% and occurred following splenic artery embolization in 2 PR patients. Rebleeding was surgically treated. The 30-day and 6-month mortality rates were 4.3% (n ¼ 1) and 13.0% (n ¼ 3) respectively. Cause of death was sepsis (n ¼ 2) and cancer progression (n ¼ 1). Two patients treated with embolization (n ¼ 1) or stent-graft (n ¼ 1) in the common/proper hepatic artery developed hepatic abscesses. 5 patients had splenic infarction, with 450% in 2 and o50% in 3; 1 developed splenic abscess. Stent-graft became occluded in 2 patients (33%) at 103 and 976 days; 1 developed hepatic abscesses requiring drainage. Conclusions: Endovascular management was effective in controlling PP or PR hemorrhage with relatively rare recurrence. Stent-graft occlusion and splenic infarction were relatively common.
SUNDAY: Scientific Sessions
that received CTA prior to their therapeutic embolization for NVGIB to the patients that did not receive a pre-embolization CTA, there was an overall reduction of 20 minutes of procedural time. Conclusions: CTA is an accurate diagnostic modality in detecting NVGIB. Performing abdomen and pelvis CTA before TAE improves the localization of gastrointestinal bleeding and facilitates embolization by reducing the overall procedural time. Impact of pre-angiography CTA on reducing the overall number of imaging studies, amount of contrast administered, and overall mortality and morbidity needs to be further investigated.
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