Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding

Left gastric artery embolization for recurrent massive intraluminal postoperative bleeding after revisional laparoscopic one anastomosis gastric bypass surgery

Laparoscopic one-anastomosis gastric bypass (LOAGB) has gained popularity as safe weight-reduction procedure. Bleeding is the common postoperative complication. We present a successful treatment of recurrent bleeding after LOAGB by embolization of the left gastric artery (LGA) and later development of necrotizing pancreatitis. A 41-year-old patient with previous bariatric surgeries undergone LOAGB surgery with development of massive intraluminal bleeding in the postoperative period. Attempts of unsuccessful endoscopic treatment were done and the bleeding was stopped by LGA embolization. In the post-embolization period, the patients developed necrotizing pancreatitis. Postoperative bleeding is the serious complications of the bariatric LOAGB procedure. Transcatheter Arterial Embolization (TAE) is the possible treatments after unsuccessful endoscopic attempts to stop the bleeding. The technical and clinical success rates of TAE in post-gastrectomy bleeding are 100 and 79%, respectively. TAE can be successfully used to stop obstinate recurrent postoperative bleeding after a LOAGB procedure.

Efficacy and safety of transcatheter arterial embolization for active arterial esophageal bleeding: a single-center experience

PURPOSE

The study aimed to evaluate the safety and clinical efficacy of transcatheter arterial embolization (TAE) for the treatment of arterial esophageal bleeding.

METHODS

Nine patients (8 male, 1 female; mean age, 62.3±7.5 years) who underwent TAE for arterial esophageal bleeding between January 2004 and January 2020 were included. Preceding endoscopic treatment was unsuccessful in five patients and was not attempted in four patients due to the non-cooperation of the patients in endoscopic treatment. The etiologies of bleeding were esophageal cancer (n=4), Mallory-Weiss syndrome (n=3), erosive esophagitis (n=1), and esophageal ulcer (n=1). Technical and clinical success, recurrent bleeding, procedure-related complications, and clinical outcomes were retrospectively reviewed.

RESULTS

The angiographic findings for bleeding were contrast media extravasation (n=8) or tumor staining without a definite bleeding focus (n=1). The bleeding focus at the distal esophagus (n=8) was the left gastric artery, whereas that at the middle esophagus (n=1) was the right bronchial artery. Technical success was achieved in all patients. The embolic agents were n-butyl cyanoacrylate (NBCA, n=5), gelatin sponge particles (n=2), microcoils (n=1), and NBCA with gelatin sponge particles (n=1). Clinical success was achieved in 77.8% of cases (7/9); two patients with recurrent bleeding one day after the first TAE showed culprit arteries different from the bleeding foci at the first TAE. One patient who underwent embolization of both the left and short gastric arteries died of gastric infract/perforation one month after TAE.

CONCLUSION

TAE can be an alternative to the treatment of arterial esophageal bleeding. TAE can be attempted in the treatment of recurrent bleeding, but there is a risk of ischemia/infarct in the gastrointestinal tract involved.

Gastrointestinal Bleeding on Call: Questions and Answers and One Person's Opinions

Gastrointestinal (GI) bleeding represents one of the more morbid forms of hemorrhage that interventional radiologists deal with on an on-call basis. Bleeding from the GI tract takes many forms and has many etiologies. While venous bleeds from varices are often treated emergently with placement of a transjugular intrahepatic portosystemic shunt, arterial hemorrhages are treated most effectively with embolization procedures. Embolization must be performed in specific ways, however, in an effort to decrease the risk of bowel ischemia; this also requires choosing the right patients in whom to perform embolization procedures. This article will provide a discussion on when to perform embolization and how, what to do with specific patient populations such as those with coagulopathy, and which patients should be considered for emergent treatment versus those that can be postponed.

Placement of a Viabahn stent-graft for hepatic artery pseudoaneurysm complicated by arterial dissection caused by a guiding sheath

A 69-year-old man was transferred to our hospital for massive hemorrhage from a right hepatic artery pseudoaneurysm 5 months after surgery for gastric cancer. Stent-graft placement was planned to avoid fatal hepatic infarction, and a guiding sheath was advanced deeply into the tortuous and stenotic right hepatic artery beyond the pseudoaneurysm for safe deployment of a stent-graft. However, this advancement caused arterial dissection of the right hepatic artery. After the guiding sheath was pulled back, a Viabahn stent-graft was successfully advanced over a guidewire to exclude the pseudoaneurysm. We consider that a Viabahn stent-graft is more flexible than a guiding sheath and that advancing a Viabahn stent-graft directly from a proximally placed guiding sheath is safer than advancing a guiding sheath into a tortuous and stenotic abdominal artery.

Superselective renal artery embolization for bleeding complications after percutaneous renal biopsy: a single-center experience

OBJECTIVE

This study aimed to determine if superselective renal artery embolization is a safe and effective method of treating bleeding complications after percutaneous renal biopsy.

METHODS

From January 2006 to December 2017, 43 patients (22 men and 21 women, mean age: 44.5 ± 14.0 years) underwent angiography for post-biopsy bleeding complications following percutaneous biopsy. Patients underwent angiography and superselective artery embolization. We recorded serum creatinine and hemoglobin values to assess the effect of embolization.

RESULTS

Successful embolization was achieved in all patients. There was a pseudoaneurysm in 10 cases, arteriovenous fistula in eight, contrast media extravasation in 16, arteriovenous fistula combined with contrast media extravasation in five, and pseudoaneurysm combined with arteriovenous fistula in four. The embolic substance was a microcoil only or combined with a gelatin sponge. The mean creatinine value was not different at 1 day and 1 week after embolization compared with before embolization. Mean hemoglobin values were significantly higher at 1 day and 1 week after embolization than before embolization.

CONCLUSIONS

Superselective renal artery embolization is a safe and effective treatment for post-biopsy bleeding complications after percutaneous renal biopsy. Lumbar or iliolumbar artery angiography is necessary if renal arteriography shows no signs of hemorrhage.

Unplanned reoperation after radical gastrectomy for gastric cancer: causes, risk factors, and long-term prognostic influence

Purpose

Unplanned reoperation (URO) after radical gastrectomy for gastric cancer (GC) mostly results from serious postoperative complications. At present, there is still controversy over the predictive factors for URO. Our goal was to identify the risk factors for URO and to investigate its potential impact on long-term survival.

Patients and methods

We included 2,852 GC patients who underwent a gastrectomy. Multivariate logistic regression analyses were performed to determine the risk factors for URO. Patients were randomly selected from the non-URO group by 1:4 propensity score matching with multiple parameters with patients from the URO group. The survival disparity of 34 URO patients and 136 non-URO patients was examined using the Kaplan-Meier method and the multivariate Cox proportional hazard model.

Results

The incidence of URO was 1.4% (39/2, 852). The primary cause of URO was intra-abdominal bleeding (53.9%, 21/39). Multivariate logistic regression analyses revealed that male gender (OR = 4.630, 95% CI = 1.412-15.152, P = 0.011), diabetes (OR = 4.189, 95% CI = 1.705-10.290, P = 0.002), and preoperative hypoproteinemia (OR = 2.305, 95% CI = 1.079-4.923, P = 0.031) were independent risk factors for URO. With regard to early surgical outcomes, patients undergoing URO had a longer hospital stay (P < 0.001), higher incidence of postoperative complications (P < 0.001), and greater mortality (P < 0.001) compared with the non-URO group. No significant correlation was found between URO and cancer-specific survival in univariate (P = 0.275) and multivariate (P = 0.090) survival analyses.

Conclusion

Male gender, diabetes, and preoperative hypoproteinemia were suggested as independent risk factors for URO. URO was associated with longer hospital stay and increased perioperative mortality, but might not be correlated with long-term mortality.