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Endovascular intervention for delayed post-pancreaticoduodenectomy hemorrhage: clinical features and outcomes of transcatheter arterial embolization and covered stent placement.

Delayed post-pancreaticoduodenectomy hemorrhage (PPH) is a rare but life threatening complication with high mortality. In this retrospective study, we aimed to evaluate the safety, efficacy and utility of interventional treatment of delayed PPH. From January 2008 to December 2013, 357 patients underwent pancreaticoduodenectomy (PD). 21 patients (5.9%) suffered from the delayed PPH. 18 patients underwent diagnostic angiography and endovascular treatment, either transcatheter arterial embolization (TAE, n = 10) or covered stent placement (CSP, n = 8), and 3 patients underwent laparotomy. The mean time of hemorrhage was 21.4 days. In 10 patients received TAE treatments, 3 got liver damage and 2 presented liver abscesses with 1 died of severe infection and multi-organ failure. Re-bleeding was occurred in 4 of 10 TAE patients. 8 patients received CSP got thoroughly bleeding control and without any ischemic or re-bleeding complications. 2 of 3 laporotomy patients presented hemorrhage recurrence. In all 6 re-bleeding patients, 2 were saved by CSP, while the other 4 died (TAE in 3 and conservative treatment in 1). Early intervention plays an important role of saving patients from delayed PPH. The CSP is considered a fist-line treatment for delayed PPH and an appropriate solution for hemorrhage recurrence. TAE only could be performed in whom placing a covered stent is technically difficult.