Endovascular management of bleeding events following robotic pancreaticobiliary surgery

Diagn Interv Radiol. 2012 Jan-Feb;18(1):121-6. doi: 10.4261/1305-3825.DIR.4260-11.1. Epub 2011 Sep 27.

Abstract

Purpose: To describe the utility, safety, and efficacy of endovascular intervention for treating bleeding events after robotic pancreaticobiliary surgery.

Materials and methods: In this retrospective study, six patients (male/female, 3/3; mean age, 64 years) with histories of robotic pancreaticobiliary resection were referred for endovascular management of delayed postoperative intra-abdominal hemorrhage. Visceral angiography was performed, and the sites of suspected arterial hemorrhage were interrogated with selective microcatheter arteriography. The visualized bleeding sources were treated using catheter-directed embolotherapy with metallic coils, bare metal or covered stent insertion, or a combination of the two. The measured outcomes included the technical success of the angiographic occlusion, procedure safety, and procedure efficacy.

Results: Pseudoaneurysms resulted in bleeding in six cases (100%). The endovascular interventions included coil embolization in three cases (50%), covered stent exclusion in two cases (33%), and bare metal stent-assisted coil embolization in one case (17%). The technical success was 100%, with complete cessation of bleeding in all cases. No immediate or delayed procedure-related complications were encountered in any of the patients. The efficacy of the endovascular therapy was 100% in this series, with no recurrent hemorrhage during the mean clinical follow-up period of 262 days (range, 67-446 days).

Conclusion: Endovascular therapy provides a minimally invasive, safe, and effective method for managing hemorrhagic events after complicated pancreaticobiliary surgery.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biliary Tract Surgical Procedures*
  • Endovascular Procedures*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pancreas / surgery*
  • Postoperative Hemorrhage / surgery*
  • Retrospective Studies
  • Robotics*