Delayed visceral arterial hemorrhage following Whipple's procedure: Minimally invasive treatment with covered stents

Heiss, Peter and Bachthaler, Maike and Hamer, Okka Wilkea and Piso, Pompiliu and Herold, Thomas and Schlitt, Hans Juergen and Feuerbach, Stefan and Zorger, Niels (2008) Delayed visceral arterial hemorrhage following Whipple's procedure: Minimally invasive treatment with covered stents. ANNALS OF SURGICAL ONCOLOGY, 15 (3). pp. 824-832. ISSN 1068-9265,

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Abstract

Background: Delayed visceral arterial hemorrhage caused by inflammatory vessel erosion represents a rare but life-threatening complication after pancreatic head resection. Therapeutic options include reoperation or endovascular minimally invasive techniques such as embolization or stent graft placement. The present article describes our experiences with implantation of newly developed low-profile stent grafts. Methods: The findings of four patients with delayed visceral arterial hemorrhage are described. All patients were treated with placement of low-profile stent grafts. The patients' medical records, radiological reports, and images were retrospectively reviewed. Technical success was defined as immediate cessation of hemorrhage. Clinical success was defined as hemodynamic stability. Results: A total of seven stent grafts were implanted in four arteries. In detail, one stent graft was placed in the splenic artery of the first and second patients. In the third patient one stent graft was initially implanted in the common hepatic artery. The patient developed recurrent hemorrhages of the common hepatic artery, treated one time surgically and two times by deployment of a second and third stent graft. In the fourth patient two stent grafts were placed in the proper hepatic artery. Technical and clinical success was achieved at every procedure. Apart from recurrent hemorrhage of patient No. 3 there were no major complications. Conclusions: Minimally invasive therapy using low-profile stent grafts is an effective and safe procedure for the treatment of delayed visceral arterial hemorrhage following Whipple's procedure. The technique is a promising alternative to standard procedures such as surgical repair or embolization.

Item Type: Article
Uncontrolled Keywords: INTERNATIONAL STUDY-GROUP; POSTPANCREATECTOMY HEMORRHAGE; PANCREATIC SURGERY; PANCREATICODUODENECTOMY; EMBOLIZATION; MANAGEMENT; ANEURYSMS; GRAFT; DEFINITION; FISTULA; pancreatic resection; inflammatory erosion hemorrhage; minimally invasive therapy; stent graft
Subjects: 600 Technology > 610 Medical sciences Medicine
Divisions: Medicine > Lehrstuhl für Chirurgie
Medicine > Lehrstuhl für Röntgendiagnostik
Depositing User: Dr. Gernot Deinzer
Date Deposited: 05 Nov 2020 12:16
Last Modified: 05 Nov 2020 12:16
URI: https://pred.uni-regensburg.de/id/eprint/31193

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