经导管动脉栓塞术治疗胰十二指肠切除术后胃十二指肠动脉残端假性动脉瘤：两种栓塞技术的安全性和有效性。

Transcatheter arterial embolization of gastroduodenal artery stump pseudoaneurysms after pancreaticoduodenectomy: safety and efficacy of two embolization techniques.

机构信息

Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea.

出版信息

J Vasc Interv Radiol. 2011 Mar;22(3):294-301. doi: 10.1016/j.jvir.2010.11.020.

DOI:10.1016/j.jvir.2010.11.020

PMID:21353982

Abstract

PURPOSE

To evaluate the safety and efficacy of two transcatheter arterial embolization (TAE) techniques used to treat pseudoaneurysms of the gastroduodenal artery (GDA) stump after pancreaticoduodenectomy.

MATERIALS AND METHODS

Between March 2003 and March 2008, 16 patients were treated with TAE for pseudoaneurysms of the GDA stump after pancreaticoduodenectomy. Two embolization techniques were employed: endovascular trapping of the hepatic artery (embolization of the hepatic artery proximal and distal to GDA stump; group A; n = 13) and selective embolization of the GDA stump and/or pseudoaneurysm sparing hepatic arterial flow (group B; n = 3). Technical success, initial hemostasis, recurrence of bleeding, and complications were compared between the two groups retrospectively.

RESULTS

All TAE procedures were technically successful and immediate hemostasis was achieved in all patients. There was no recurrent bleeding in group A; however, all three patients in group B experienced recurrent bleeding after initial hemostasis (P = .002), and these patients required subsequent embolization with the endovascular trapping technique. Two patients died of multiple organ failure (one patient in each group) despite successful hemostasis. Three patients experienced subsegmental (n = 1, group A) and multisegmental (n = 2, group B) liver infarction, which were successfully managed with conservative treatment. There was a higher incidence of major complications in group B (15.4% vs 100%; P = .018).

CONCLUSIONS

Endovascular trapping of the hepatic artery is a safe and effective treatment of pseudoaneurysms of the GDA stump after pancreaticoduodenectomy. Hepatic ischemic complications are not rare, but can be conservatively managed. Selective embolization of the GDA stump and/or pseudoaneurysm is frequently associated with recurrence of bleeding, which eventually leads to major complications.

摘要

目的

评估两种经导管动脉栓塞（TAE）技术治疗胰十二指肠切除术后胃十二指肠动脉（GDA）残端假性动脉瘤的安全性和有效性。

材料与方法

2003 年 3 月至 2008 年 3 月，16 例胰十二指肠切除术后 GDA 残端假性动脉瘤患者接受 TAE 治疗。采用两种栓塞技术：肝动脉血管内夹闭（GDA 残端近端和远端肝动脉栓塞；A 组，n = 13）和选择性 GDA 残端和/或假性动脉瘤栓塞保留肝动脉血流（B 组，n = 3）。回顾性比较两组患者的技术成功率、即刻止血、再出血、并发症等。

结果

所有 TAE 操作均技术成功，所有患者即刻止血。A 组无再出血；但 B 组 3 例患者均在初始止血后再次出血（P =.002），随后采用血管内夹闭技术进行栓塞。尽管止血成功，但仍有 2 例患者死于多器官功能衰竭（每组 1 例）。3 例患者发生亚段性（n = 1，A 组）和多节段性（n = 2，B 组）肝梗死，均经保守治疗成功处理。B 组主要并发症发生率较高（15.4% vs 100%；P =.018）。