Clinical Research Of Interventional Treatment Of Delayed Hemorrhage After Abdominal Surgery

Objective1.To evaluate the safety and efficacy of interventional radiology in the treatment of delayed post-pancreatectomy hemorrhage(PPH).2.To evaluate the clinical effects of interventional treatment in patients with delayed hemorrhage after abdominal surgery,and Factors associated with rebleeding were also analysed.Materials and methods1.Between January 2010 and June 2017,61 patients referred for angiography with delayed post-pancreatectomy hemorrhage were included.There were 50 men and 11 women,with a mean age of 59 years.The most common symptom was extraluminal hemorrhage(n = 47,77.0 %),followed by intraluminal hemorrhage(n = 14,23.0 %).Outcome measures included technical success,rebleeding and complications.Site of rebleeding and re-intervention success associated with rebleeding were also analysed.2.From October 2009 to October 2016,Seventy-six patients who underwent angiography due to delayed postoperative hemorrhage were retrospective analyzed.The patients presented with positive angiography without embolization or if the bleeding was the specialty of other disciplines(urology,gynecology)were excluded.Endovascular procedures were classified as embolized group(source of bleeding identified on angiogram and treated)and no embolized group(no abnormality identified,no treatment performed).The outcomes of two groups were compared and Factors associated with rebleeding were also analysed.Results1.Endovascular embolization or stent was attempted in 47 of the 61(77.0%)patients which an active site of bleeding was demonstrated by angiography.Endovascular procedures were performed only with coils in 30 patients;a combination of coils and gelfoam in 15 patients;stent in 2 patients.Technical success,clinical success and rebleeding rate were observed in 97.9 %(46/47),72.3%(34/47)and 27.7 %(13/47),respectively.The median delay until rebleeding was 2 days(0–30d)and the primary source of rebleeding was former embolized artery(7/13,53.8 %).The acute rebleeding was controlled in 5 of 8(62.5%)patients underwent endovascular treatment only.No severe complications such as gastrointestinal or hepatic necrosis occurred in all patients.The overall 30-day mortality rate was 12.8%(6/47)and 4 patients died of rebleeding.2.In 53(70 %)of the seventy-six patients,involved artery was identified and performed embolization.In the embolization group,technical success,and clinical success rate was 98.1 %(52/53)and 71.7 %(38/53),respectively.No severe complications such as gastrointestinal or hepatic necrosis occurred in all patients.Rebleeding rates were 28.3% and 52.2 % among the embolization group and the no embolization group,respectively(p=0.046).There were no significant differences in the re-intervention success rates(53.3% vs 75.0%)and 30-day mortality(17.0% vs 13.0%)between the two groups.Multivariate analysis showed that using of vasopressor agents was only independent factor associated with rebleeding(p=0.022).Conclusion1.endovascular treatment allows effective,minimally invasive control of delayed post-pancreatectomy hemorrhage.Most patients are successfully treated by endovascular approaches alone.2.Most patients are successfully treated by endovascular approaches.Although,Patients with negative findings on angiography have higher rebleeding rate than patients with active bleeding during angiograph-guided embolization.The risk of rebleeding was increased by the use of vasopressor agents before interventional treatment.