Department of Visceral, Thoracic and Vascular Surgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Institute for Diagnostic and Interventional Radiology, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
Cardiovasc Intervent Radiol. 2020 Sep;43(9):1342-1352. doi: 10.1007/s00270-020-02509-2. Epub 2020 May 20.
Postpancreatectomy hemorrhage (PPH) is one of the leading causes of mortality after pancreatic resection. Late onset PPH is most often treated using a transarterial approach. The aim of this study was to analyze risk factors for in-hospital mortality after endovascular treatment.
Between 2012 and 2017, patients who were treated endovascular due to PPH were identified from a retrospective analysis of a database. Risk factors for mortality were identified by univariate analysis.
In total, 52 of the 622 patients (8.4%) underwent endovascular treatment due to PPH. The primary technical success achieved was 90.4%. In 59.6% of patients, bleeding control was achieved by placing a stent graft and in 40.4% by coil embolization. The primary 30-day and 1-year patency of the placed covered stents was 89.3% and 71.4%, respectively. The 60-day mortality was 34.6%. The reintervention rate was higher after stent graft placement compared to coiling (39.3% vs. 21.1%, P = 0.012). In the univariate analysis the need for reintervention was associated with a higher in-hospital mortality (21.2% vs. 7.7%, P = 0.049). The use of an antiplatelet agent was associated with a decreased in-hospital mortality in the univariate (11.5% vs. 25%, P = 0.024) and multivariate analysis (HR 3.1, 95% CI 1.1-9, P = 0.034), but did not increase the risk of rebleeding.
Endovascular management of delayed PPH has a high technical success rate. Stent graft placement showed a higher reintervention rate. The need for reintervention was associated with a higher in-hospital mortality but did not differ between coiling and stent graft placement.
胰十二指肠切除术后出血（PPH）是胰腺切除术后死亡的主要原因之一。迟发性 PPH 多采用经动脉途径治疗。本研究旨在分析血管内治疗后院内死亡的危险因素。
回顾性分析数据库，2012 年至 2017 年间，因 PPH 接受血管内治疗的患者被确定为研究对象。采用单因素分析确定死亡的危险因素。
622 例患者中，52 例（8.4%）因 PPH 接受血管内治疗。主要技术成功率为 90.4%。59.6%的患者通过放置支架移植物，40.4%的患者通过线圈栓塞达到止血效果。放置的覆膜支架 30 天和 1 年的通畅率分别为 89.3%和 71.4%。60 天死亡率为 34.6%。支架移植物放置后的再干预率高于线圈栓塞（39.3%比 21.1%，P=0.012）。单因素分析显示，需要再次干预与院内死亡率较高相关（21.2%比 7.7%，P=0.049）。抗血小板药物的使用与单因素（11.5%比 25%，P=0.024）和多因素分析（HR 3.1，95%CI 1.1-9，P=0.034）中的院内死亡率降低相关，但不会增加再出血的风险。
延迟性 PPH 的血管内治疗具有较高的技术成功率。支架移植物的放置显示出更高的再干预率。需要再次干预与较高的院内死亡率相关，但在线圈栓塞和支架移植物放置之间没有差异。
