Clinical value of DSA in diagnosis and treatment of delayed pancreaticoduodenectomy hemorrhage

Abstract

Abstract:

ObjectiveTo evaluate the clinical efficacy and application value of digital subtraction angiography (DSA) in the management of delayed pancreaticoduodenectomy(PD) hemorrhage(PPH).MethodsA retrospective analysis was conducted on the clinical data of 38 patients who underwent DSA for delayed PPH at Zhongshan Hospital, Fudan University, between January 2019 and December 2024. The technical success rate and clinical outcomes of interventional treatment were the primary focus of the evaluation.ResultsAmong 726 patients who underwent PD, 38 (5.2%) experienced delayed bleeding. Of these, 30 (78.9%) showed positive findings on DSA. The distribution of bleeding sites was as follows: gastroduodenal artery (18 cases), common hepatic artery (1 case), the first branch of the jejunal artery (2 cases), proper hepatic artery (2 cases), right hepatic artery (1 case), middle hepatic artery (1 case), left hepatic artery (3 cases), origin of the splenic artery (1 case), and right gastroepiploic artery (1 case). Interventional treatments included microcoil embolization (17 cases), microcoil combined with gelatin sponge embolization (4 cases), covered stent implantation (7 cases), and gelatin sponge embolization alone and microspheres embolization (1 case each). Successful hemostasis was achieved in 28 (93.3%) patients through DSA-guided interventional treatment, while 2 patients required surgical hemostasis due to recurrent bleeding.ConclusionsDSA-guided interventional embolization offers advantages such as minimal invasiveness, precise localization, and effective hemostasis, making it the preferred treatment strategy for delayed PPH.

Key words:Pancreaticoduodenectomy(PD),Pancreaticoduodenectomy hemorrhage(PPH),Digital subtraction angiography(DSA)

CLC Number:

WANG Jiwen, WANG Chunyan, SHEN Sheng, LIU Han, ZHANG Wei, LIU Houbao. Clinical value of DSA in diagnosis and treatment of delayed pancreaticoduodenectomy hemorrhage[J]. Journal of Surgery Concepts & Practice, 2025, 30(2): 125-131.

Figures/Tables4

Item	Category	Number of Patients
Gender	Male	28
Female	10
Age（years）	<60	8
60 ‒ 69	17
≥70	13
Diagnosis	Distal bile duct adenocarcinoma	5
Duodenal papillary adenocarcinoma	23
Pancreatic ductal adenocarcinoma	9
Other ampullary diseases	1
Time of bleeding	< 1 week	4
1‒2 weeks	24
>2 weeks	10
Bleeding manifestation	Gastrointestinal bleeding	9
Intra-abdominal bleeding	25
Gastrointestinal + intra-abdominal bleeding	4

Tab 1

Tab 2

Clinical manifestations and DSA results of delayed PPH patients

No.	Gender	Age	Time of bleeding （postoperative days）	Bleeding manifestation	Target vessel	DSA treatment
1	M	72	7	Gastrointestinal bleeding	The first branch of the jejunal artery	Microcoil embolization of the first jejunal artery branch
2	M	65	8	Intra-abdominal bleeding	Negative	None
3	M	73	25	Gastrointestinal bleeding+ intra-abdominal bleeding	GDA	Microcoil embolization of the proper hepatic artery to the common hepatic artery segment
4	F	68	11	Gastrointestinal bleeding	Negative	None
5	M	57	8	Gastrointestinal bleeding	GDA	Microcoil embolization of the left hepatic artery (with GDA originating from the left hepatic artery)
6	M	65	28	Gastrointestinal bleeding	GDA	Covered stent placement
7	M	68	9	Gastrointestinal bleeding	Left hepatic artery	Gelatin sponge embolization
8	M	73	17	Intra-abdominal bleeding	GDA	Covered stent placement
9	M	57	7	Intra-abdominal bleeding	Negative	None
10	M	70	6	Gastrointestinal bleeding+ intra-abdominal bleeding	Negative	None
11	M	42	9	Intra-abdominal bleeding	Common hepatic artery	Microcoil embolization of the proper hepatic artery to the common hepatic artery segment
12	M	69	10	Intra-abdominal bleeding	GDA	Microcoil embolization of the segment from the right hepatic artery to the common hepatic artery
13	F	61	8	Gastrointestinal bleeding	GDA	Covered stent placement
14	F	59	6	Gastrointestinal bleeding	GDA	Covered stent placement
15	M	61	13	Gastrointestinal bleeding+ intra-abdominal bleeding	GDA	Microcoil embolization of the proper hepatic artery to the common hepatic artery segment，gelatin sponge and microcoil embolization of the middle adrenal artery
16	M	46	12	Intra-abdominal bleeding	Left hepatic artery	Microcoil and gelatin sponge embolization
17	F	71	12	Gastrointestinal bleeding	Left hepatic artery	Microcoil embolization of the proper hepatic artery to the common hepatic artery segment
18	F	60	11	Intra-abdominal bleeding	GDA	Microcoil embolization of the proper hepatic artery to the common hepatic artery segment
19	M	70	8	Intra-abdominal bleeding	Right gastroepiploic artery	Microcoil + gelatin sponge embolization of the left gastroepiploic artery, microcoil embolization of the proper hepatic artery to the common hepatic artery segment
20	M	63	7	Intra-abdominal bleeding	GDA	Microcoil embolization of the GDA stump with gelatin sponge embolization of pancreatic arteries
21	M	71	8	Intra-abdominal bleeding	GDA	Covered stent placement
22	M	63	6	Gastrointestinal bleeding	Middle hepatic artery	Microspheres embolization
23	F	64	11	Intra-abdominal bleeding	GDA	Covered stent placement
24	F	77	11	Intra-abdominal bleeding	GDA	Microcoil embolization of the left hepatic artery (with GDA originating from the left hepatic artery)
25	M	80	22	Intra-abdominal bleeding	GDA	Microcoil embolization of the proper hepatic artery to the common hepatic artery segment
26	M	65	9	Gastrointestinal bleeding+ intra-abdominal bleeding	Proper hepatic artery	Microcoil embolization of the proper hepatic artery to the common hepatic artery segment
27	M	64	35	Intra-abdominal bleeding	The first branch of the jejunal artery	Microcoil embolization of the first jejunal artery branch
28	F	59	9	Intra-abdominal bleeding	GDA	Covered stent placement
29	M	72	19	Intra-abdominal bleeding	Negative	None
30	M	70	8	Gastrointestinal bleeding	GDA	Microcoil embolization of the proper hepatic artery to the common hepatic artery segment
31	M	71	18	Intra-abdominal bleeding	Proper hepatic artery	Microcoil embolization of the proper hepatic artery to the common hepatic artery segment
32	M	67	21	Intra-abdominal bleeding	GDA	Microcoil embolization of the proper hepatic artery to the common hepatic artery segment
33	M	64	6	Intra-abdominal bleeding	GDA	Microcoil embolization of the proper hepatic artery to the common hepatic artery segment
34	F	67	14	Intra-abdominal bleeding	Splenic artery	Microcoil embolization of the splenic artery from its origin to the celiac trunk
35	M	50	15	Intra-abdominal bleeding	Negative	None
36	M	77	7	Intra-abdominal bleeding	Negative	None
37	M	57	16	Intra-abdominal bleeding	Negative	None
38	F	68	7	Intra-abdominal bleeding	Right hepatic artery	Microcoil embolization of the posterior branch of the right hepatic artery

Tab 2

Fig 1

Fig 2

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