Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Abdominal Surgery, University Hospitals KU Leuven, Leuven, Belgium.
Abdom Radiol (NY). 2023 Jul;48(7):2406-2414. doi: 10.1007/s00261-023-03906-0. Epub 2023 Apr 13.
To retrospectively evaluate the safety, efficacy, and late clinical outcome of coronary covered stent placement for the treatment of late-onset arterial complications after hepato-pancreato-biliary surgery.
Consecutive patients presenting with post-hepato-pancreato-biliary surgery-related arterial lesions and subsequently treated with a covered coronary stent in the authors institution between January 2012 and November 2021 were included. Primary endpoints were technical and clinical success; secondary endpoints were covered stent patency and end-organ perfusion of the affected artery.
The study included 22 patients (13 men and 9 women) with a mean age of 67 years ± 9.6 years. Initial surgery included pancreaticoduodenectomy (n = 15; 68%), liver transplantation (n = 2; 9%), left hepatectomy (n = 1; 5%), bile duct resection (n = 1; 5%), hepatogastrostomy (n = 1; 5%), and segmental enterectomy (n = 1; 5%). Technically, coronary covered stents were successfully placed in n = 22 patients (100%) without immediate complication. Definitive bleeding control was observed in n = 18 patients (81.1%) with recurrent bleeding within 30 days postintervention in n = 5 patients (23%). No ischemic liver or biliary complications occurred during the follow-up period. The 30-day mortality rate was 0%.
Coronary covered stents are a safe and efficient treatment option in most of the patients presenting with late-onset postoperative arterial injuries following hepato-pancreato-biliary surgery and are associated with an acceptable recurrent bleeding rate and no late, ischemic, parenchymal complications.
回顾性评估冠状动脉覆膜支架置入治疗肝胆胰手术后迟发性动脉并发症的安全性、疗效和晚期临床结果。
连续纳入 2012 年 1 月至 2021 年 11 月在作者所在机构因肝胆胰手术后相关动脉病变而接受覆膜冠状动脉支架治疗的患者。主要终点为技术和临床成功；次要终点为覆膜支架通畅性和受影响动脉的终末器官灌注。
该研究共纳入 22 例患者（男 13 例，女 9 例），平均年龄 67 岁±9.6 岁。初始手术包括胰十二指肠切除术（n=15；68%）、肝移植（n=2；9%）、左半肝切除术（n=1；5%）、胆管切除术（n=1；5%）、肝胃吻合术（n=1；5%）和节段性肠切除术（n=1；5%）。22 例患者（100%）的冠状动脉覆膜支架均成功放置，无即时并发症。18 例患者（81.1%）获得明确的出血控制，5 例患者（23%）在介入后 30 天内再次出现出血。在随访期间，无肝或胆道缺血性并发症发生。30 天死亡率为 0%。
对于大多数肝胆胰手术后迟发性术后动脉损伤的患者，冠状动脉覆膜支架是一种安全有效的治疗选择，其再出血率可接受，且无晚期缺血性实质并发症。
