Bleeding complications after pancreatic surgery: interventional radiology management

Abstract

Surgical intervention in the pancreas region is complex and carries the risk of complications, also of vascular nature. Bleeding after pancreatic surgery is rare but characterized by high mortality. This review reports epidemiology, classification, diagnosis and treatment strategies of hemorrhage occurring after pancreatic surgery, focusing on the techniques, roles and outcomes of interventional radiology (IR) in this setting. We then describe the roles and techniques of IR in the treatment of other less common types of vascular complications after pancreatic surgery, such as portal vein (PV) stenosis, portal hypertension and bleeding of varices.

Keywords: Embolization; interventional radiology (IR); pancreatic resection; postpancreatectomy hemorrhage; stent-graft.

Figure 1

A patient presented with significative anemization 3 days after pancreatic surgery. (A) An urgent CT scan was performed that revealed a pseudoaneurysm of the splenic artery; (B) the finding was confirmed at arteriography; (C,D) embolization was performed deploying coils distally and proximally to the PSA (“sandwich” technique), and completed with 1 cc of cyanoacrylate; (E,F) a control MDCT scan confirmed the exclusion of the pseudoaneurysm and the absence of bleeding. PSA, pseudoaneurysm; MDCT, multidetector computer tomography.

Figure 2

During pancreatic surgery a mesenteric vessel was unintentionally damaged. Hemorrhage was treated surgically with packing and compression but significative anemization was still observed. (A,B) A MDCT scan was performed which revealed a superior mesenteric artery (SMA) pseudoaneurysm with signs of active bleeding; (C,D) arteriography confirmed the active blushing at the level of the SMA; (E,F) selective embolization was successfully performed using 2–3 mm coils. MDCT, multidetector computer tomography.