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The Importance of Early Angiography

Norihiro Sato, MD; Koji Yamaguchi, MD; Shuji Shimizu, MD; Takashi Morisaki, MD; Kazunori Yokohata, MD; Kazuo Chijiiwa, MD; Masao Tanaka, MD

Arch Surg. 1998;133:1099-1102.

Objective  To evaluate the efficacy of early angiography in the diagnosis and treatment of delayed arterial hemorrhage as a significant complication following pancreatectomy.

Design  Retrospective case series.

Setting  University hospital; 6-year period between January 1992 and December 1997.

Patients and Intervention  Of a total of 81 patients undergoing pancreatic head resection, 10 (12%) developed massive arterial hemorrhage after surgery. All 10 patients underwent an emergency angiography and 8 of these were managed by transcatheter arterial embolization.

Results  Before onset of major bleeding, 9 patients (90%) had developed intra-abdominal abscess resulting from pancreatic fistula or other anastomotic leak, and all 10 patients had had preliminary minor bleeding. The angiogram demonstrated an exact site of bleeding as a pseudoaneurysm in all 10 patients. Transcatheter arterial embolization achieved temporary control of bleeding in all 8 patients for whom embolization was attempted and complete hemostasis in 5 of the 8 subsequently, yielding a success rate of 63%. Overall, 4 patients (40%) died of complications related directly to the major hemorrhage or the transcatheter arterial embolization technique.

Conclusions  An emergency angiography should be considered in all patients who develop either a sentinel or massive gastrointestinal bleed following pancreatectomy irrespective of suspected intra-abdominal sepsis. Transcatheter arterial embolization allows temporary control of massive hemorrhage and hemodynamic stabilization in most cases, and prevents the need for high-risk emergency surgery.

From the Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan.

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