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Complementary Roles of Surgery and Transcatheter Occlusive Techniques

Arthur C. Waltman, MD; Patrick R. Luers, MD; Christos A. Athanasoulis, MD; Andrew L. Warshaw, MD

Arch Surg. 1986;121(4):439-443.

Abstract
• Massive arterial hemorrhage from multiple sites caused by tissue Injury and infection following severe pancreatitis occurred In 12 patients, who were treated with the combination of angiographic embolization techniques and surgery; five survived. Complete hemostasis was obtained in eight of 12 patients who underwent primary angiographic therapy. Bleeding was temporarily controlled in two patients, who then underwent directed surgical ligation of the bleeding vessel under more favorable conditions. In two patients, bleeding was not controlled. The use of permanent occluding materials, particularly bucrylate, resulted in the highest success rate. When the bleeding artery could not be individually catheterized for safe occlusion, balloon occlusion or vasopressin infusion stabilized the patient's condition, with a decrease in the rate of bleeding prior to subsequent surgical therapy. Inadequate control of further tissue necrosis and sepsis was the cause of death in five of the seven patients who died. The other two patients died of recurrent hemorrhage despite attempts at both arteriographic occlusion and surgical ligation.

(Arch Surg 1986;121:439-443)

Author Affiliations
From the Angiography Section, Department of Radiology (Drs Waltman, Luers, and Athanasoulis), and Surgical Services (Dr Warshaw), Massachusetts General Hospital, Boston. Dr Luers is now with the Department of Radiology, Cottonwood Hospital Medical Center, University of Utah, Salt Lake City.

Footnotes
Accepted for publication Jan 3, 1986.

Read before the 66th Annual Meeting of the New England Surgical Society, Dixville Notch, NH, Oct 12, 1985.

Reprint requests to Angiography Section, Department of Radiology, Massachusetts General Hospital, Fruit Street, Boston, MA 02114 (Dr Waltman).

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