Endovascular management of major arterial hemorrhage as a complication of inflammatory pancreatic disease
Endovascular management of major arterial hemorrhage as a complication of inflammatory pancreatic disease
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DOI：
10.1016/j.jvir.2007.02.035
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发表时间：
2007-05-01
影响因子：
2.9
通讯作者：
Lees, William R.
中科院分区：
文献类型：
--
作者：
Hyare, Harpreet;Desigan, Sharmini;Lees, William R.
目的：大动脉出血是炎症性胰腺病的重要并发症，总死亡率为 37%。本研究旨在评估胰胆疾病三级转诊中心通过选择性内脏血管造影和经导管动脉栓塞 (TAE) 治疗胰腺炎主要动脉并发症的经验。 材料和方法：对所有因胰腺炎并发症而接受内脏血管造影治疗大出血的患者进行 6 年回顾性分析，确定了 35 名患者（26 名男性，9 名患者）女性），平均年龄 51.2 岁（范围：11-73 岁）。回顾性记录患者人口统计、病史、临床表现、血管造影结果、血管造影治疗和随访结果。技术成功被定义为局灶性病变的血管断流或减少或停止流向目标血管床或器官的血流，临床成功被定义为促使初始栓塞的症状和体征得到解决。 结果：血管造影确定了 54.3% 的患者 (n = 19) 的出血部位，77.1% 的患者 (n = 27) 进行了血管造影干预。这 27 名患者 (n = 22) 中的 81.5% 取得了技术成功，总体临床成功率为 80.0% (n = 28)。 12 名患者需要进行多次血管造影，其中 4 名患者显示新部位出血。死亡率为20%（35例中有7例）。结论：对于胰腺炎性疾病引起的大动脉出血，内脏血管造影可以明确出血部位并实现止血。新部位出血通常需要重复血管造影。死亡率与手术相关的死亡率相当，反映了急性重症胰腺炎的多系统受累。
PURPOSE: Major arterial hemorrhage is an important complication of inflammatory pancreatic disease, with an overall mortality of 37%. The present study was undertaken to evaluate the experience of a tertiary referral center for pancreaticobiliary disease in the management of major arterial complications of pancreatitis with selective visceral angiography and transcatheter arterial embolization (TAE).MATERIALS AND METHODS: A 6-year retrospective analysis of all patients undergoing visceral angiography for major bleeding as a complication of pancreatitis identified 35 patients (26 male, 9 female) with a mean age of 51.2 years (range, 11-73 y). Patient demographics, history, clinical presentation, angiographic findings, angiographic treatment, and follow-up outcomes were retrospectively noted. Technical success was defined as the devascularization of a focal lesion or reduction or cessation of blood flow to a target vascular bed or organ, and clinical success was defined as the resolution of the symptoms and signs that prompted the initial embolization.RESULTS: Angiography identified the site of bleeding in 54.3% of patients (n = 19) and angiographic intervention was performed in 77.1% of patients (n 27). Technical success was achieved in 81.5% of those 27 patients (n = 22), with overall clinical success in 80.0% (n 28). Multiple angiograms were required in 12 patients, with four demonstrating bleeding from new sites. The mortality rate was 20% (7 of 35).CONCLUSIONS: In major arterial hemorrhage resulting from pancreatic inflammatory disease, visceral angiography can identify the site of bleeding and hemostasis can be achieved. Repeat angiography is often required with bleeding from new sites. The mortality rate is comparable to that associated with surgery and reflects multisystem involvement in acute severe pancreatitis.