Vascular stent graft for the treatment of post-pancreaticoduodenectomy hemorrhage and risk factors for rebleeding.

Abstract

Background: To investigate the effectiveness and safety of vascular stent graft in the treatment of post-pancreaticoduodenectomy hemorrhage (PPH) and to determine independent risk factors for rebleeding.

Methods: A retrospective review of 24 patients who received a vascular stent graft for the treatment of PPH between April 2016 and April 2021 was conducted. The site(s) and time of onset of hemorrhage, angiographic findings, endovascular treatment techniques, and risk factors for rebleeding after stent graft placement in these patients were analyzed.

Results: The vascular stent grafts were successfully placed in 22 of the 24 patients, indicating a technical success rate of 91.7 %. The median time of hemorrhage onset was 18.5 days (range 0.25-37 days). Bleeding sites included the gastroduodenal artery (GDA) stump (n = 12) and the common and proper hepatic arteries CHA-PHA (n = 10). Nineteen patients had available imaging follow-up data for 12-2521 days, and the stent grafts were patent in 94.7 % of patients (18/19). The clinical success rate was 68.2 % (15/22). Rebleeding occurred after 31.8 % (7/22) interventions at a median interval of 6 days (range 2-27 days). In multivariate analysis, body mass index (BMI) ≥24.8 (OR = 6.159, 95 % CI: 1.020-37.181; P = 0.048) and pancreatic fistula (OR = 23.391, 95 % CI: 1.078-507.769; P = 0.045) were independent risk factors for rebleeding after stent graft placement.

Conclusions: Vascular stent graft is effective and safe for PPH, especially at the site of the GDA stump and the CHA-PHA. Recurrent bleeding is not rare with such treatment, and BMI and pancreatic fistula are independent risk factors for rebleeding.