Nadine Bellemann1, Christof-Matthias Sommer2, Theresa Mokry2, Nikolas Kortes2, Daniel Gnutzmann2, Theresa Gockner2, Anne Schmitz2, Jürgen Weitz3, Hans-Ulrich Kauczor2, Boris Radeleff2, Ulrike Stampfl2. 1. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany. Electronic address: nadine.bellemann@med.uni-heidelberg.de. 2. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany. 3. Department of Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany; Department for Visceral, Thoracic and Vascular Surgery at the University Hospital, Technical University Dresden, Germany.
Abstract
PURPOSE: We evaluated the technical success and clinical efficacy of stent-graft implantation for the emergency management of acute hepatic artery bleeding. METHODS: Between January 2010 and July 2013, 24 patients with hemorrhage from the hepatic artery were scheduled for emergency implantation of balloon expandable stent-grafts. The primary study endpoints were technical and clinical success, which were defined as successful stent-graft implantation with sealing of the bleeding site at the end of the procedure, and cessation of clinical signs of hemorrhage. The secondary study endpoints were complications during the procedure or at follow-up and 30-day mortality rate. RESULTS: In 23 patients, hemorrhage occurred after surgery, and in one patient hemorrhage occurred after trauma. Eight patients had sentinel bleeding. In most patients (n=16), one stent-graft was implanted. In six patients, two overlapping stent-grafts were implanted. The stent-grafts had a target diameter between 4mm and 7 mm. Overall technical success was 88%. The bleeding ceased after stent-graft implantation in 21 patients (88%). The mean follow-up was 137 ± 383 days. In two patients, re-bleeding from the hepatic artery occurred during follow-up after 4 and 29 days, respectively, which could be successfully treated by endovascular therapy. The complication rate was 21% (minor complication rate 4%, major complication rate 17%). The 30-day mortality rate was 21%. CONCLUSIONS: Implantation of stent-grafts in the hepatic artery is an effective emergency therapy and has a good technical success rate for patients with acute arterial hemorrhage.
PURPOSE: We evaluated the technical success and clinical efficacy of stent-graft implantation for the emergency management of acute hepatic artery bleeding. METHODS: Between January 2010 and July 2013, 24 patients with hemorrhage from the hepatic artery were scheduled for emergency implantation of balloon expandable stent-grafts. The primary study endpoints were technical and clinical success, which were defined as successful stent-graft implantation with sealing of the bleeding site at the end of the procedure, and cessation of clinical signs of hemorrhage. The secondary study endpoints were complications during the procedure or at follow-up and 30-day mortality rate. RESULTS: In 23 patients, hemorrhage occurred after surgery, and in one patienthemorrhage occurred after trauma. Eight patients had sentinel bleeding. In most patients (n=16), one stent-graft was implanted. In six patients, two overlapping stent-grafts were implanted. The stent-grafts had a target diameter between 4mm and 7 mm. Overall technical success was 88%. The bleeding ceased after stent-graft implantation in 21 patients (88%). The mean follow-up was 137 ± 383 days. In two patients, re-bleeding from the hepatic artery occurred during follow-up after 4 and 29 days, respectively, which could be successfully treated by endovascular therapy. The complication rate was 21% (minor complication rate 4%, major complication rate 17%). The 30-day mortality rate was 21%. CONCLUSIONS: Implantation of stent-grafts in the hepatic artery is an effective emergency therapy and has a good technical success rate for patients with acute arterial hemorrhage.
Authors: F Pedersoli; V Van den Bosch; P Sieben; E Barzakova; M Schulze-Hagen; P Isfort; S Keil; G Wiltberger; C K Kuhl; P Bruners Journal: Cardiovasc Intervent Radiol Date: 2021-11-03 Impact factor: 2.740