Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Rd. (No.2), Shanghai, 200025, People's Republic of China.
Department of Interventional Radiology, Luwan Branch of Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 149 Chongqing Rd. (S), Shanghai, 200020, People's Republic of China.
Eur Radiol. 2023 Mar;33(3):1779-1791. doi: 10.1007/s00330-022-09134-2. Epub 2022 Sep 23.
To explore the risk factors for recurrence of arterial complications after pancreatectomy during the period of covered stent implantation and to provide some opinions on peri-stent implantation management.
Data on patients implanted with covered stents due to arterial complications after pancreatectomy between January 2017 and December 2021 were analyzed retrospectively. Technical success, clinical success, recurrence, and survival were evaluated to elucidate the practicability of covered stents. Wilson score, Random Forest, logistic regression, and Pearson's chi-square test with bootstrap aggregation were performed for determining the perioperative risk factors for recurrence.
Among all fifty-five patients, success stent implantation (technical success) was achieved 100%. Patients who were hemodynamically stabilized without further treatment for artery complications in situ (clinical success) accounted for 89.1%. Based on statistical analysis, pre-stent implantation pancreatic fistula was identified as a robust recurrence-related risk factor for preoperative assessment (p = 0.02, OR = 4.5, 95% CI [1.2, 16.9]; p = 0.02). Post-stent implantation pancreatic fistula (p = 0.01, OR 4.5, 95% CI [1.4, 14.6]; p < 0.05) and SMA branches or GDA stumps (p = 0.02, OR 3.4, 95% CI [1.1, 10.3]) were relevant to recurrence. The survival rate during hospitalization was 87.3%. All survivors were free from recurrence during the subsequent follow-up. Vasospasm and stent occlusion were observed as short-term and long-term complications, respectively.
A covered stent implantation is a feasible and effective treatment option for post-pancreatectomy arterial complications. Rigorous management of pancreatic fistula, timely detection of problems, sensible strategies during stent implantation, and reasonable anticoagulation therapy are necessary for a better prognosis.
• A covered stent is feasible for various artery-related complications after pancreatectomy and has an ideal therapeutic effect. • Pancreatic fistula during the perioperative period of the covered stent is an independent risk factor for recurrent arterial complications and SMA branches or GDA stumps are prone to be recurrent offending arteries. • Rigorous management of pancreatic fistula, timely detection of problems, sensible strategies during stent implantation, and reasonable anticoagulation therapy are necessary for a better prognosis.
探讨覆膜支架植入期间胰切除术后动脉并发症复发的危险因素，并为支架植入围手术期管理提供一些意见。
回顾性分析 2017 年 1 月至 2021 年 12 月因动脉并发症接受覆膜支架植入的患者资料。评估技术成功率、临床成功率、复发和生存情况，以阐明覆膜支架的实用性。采用 Wilson 评分、随机森林、逻辑回归和 Pearson 卡方检验（带 bootstrap 聚集）确定与复发相关的围手术期危险因素。
55 例患者中，支架植入术（技术成功率）成功率为 100%。无需进一步治疗原位动脉并发症而血流动力学稳定的患者（临床成功率）占 89.1%。基于统计分析，支架植入术前胰瘘被确定为术前评估的一个强有力的复发相关危险因素（p=0.02，OR=4.5，95%CI[1.2,16.9]；p=0.02）。支架植入术后胰瘘（p=0.01，OR=4.5，95%CI[1.4,14.6]；p<0.05）和 SMA 分支或 GDA 残端（p=0.02，OR=3.4，95%CI[1.1,10.3]）与复发相关。住院期间的生存率为 87.3%。所有幸存者在随后的随访中均无复发。血管痉挛和支架闭塞分别为短期和长期并发症。
覆膜支架植入术是治疗胰切除术后动脉并发症的一种可行且有效的治疗选择。严格管理胰瘘，及时发现问题，在支架植入过程中采取明智的策略，以及合理的抗凝治疗，对改善预后至关重要。
覆膜支架对于胰切除术后各种与动脉相关的并发症是可行的，具有理想的治疗效果。
覆膜支架围手术期的胰瘘是动脉性并发症复发的独立危险因素，SMA 分支或 GDA 残端是易复发的责任动脉。
严格管理胰瘘，及时发现问题，在支架植入过程中采取明智的策略，以及合理的抗凝治疗，对改善预后至关重要。
