Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding

Kichang Han, Bestun Mustafa Ahmed, ManDeuk Kim, Jong Yun Won, Do Yun Lee, Gyoung Min Kim, Joon Ho Kwon, Sung Il Park, Sung Hoon Noh, WooJin Hyung

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The aim of this study was to retrospectively investigate the feasibility and safety of transcatheter arterial embolization in the management of postgastrectomy arterial bleeding. Methods: Between January 2004 and July 2015, 13,246 patients underwent total or subtotal gastrectomy at our institution, and 24 patients (18 men; mean age 66.8 years; range 42–80 years) underwent transcatheter arterial embolization for postoperative arterial bleeding identified on angiography. Results: Postgastrectomy arterial bleeding occurred after subtotal gastrectomy in 14 patients (58%) and after total gastrectomy in 10 patients (42%), after a mean of 17 days (range 1–57 days). It manifested itself as luminal bleeding in 10 patients and as abdominal bleeding in 14 patients. Technical success was achieved in all 24 patients (100%). The clinical success rate was 79% (19-24); there were three transcatheter-arterial-embolization–related major complications that resulted in death within 30 days (12%), one case of recurrent bleeding, and one case of persistent bleeding. The cause of death included infarctions in the spleen and/or remnant stomach (n = 2) and bowel perforation (n = 1). The commonest bleeding focus was the gastroduodenal artery (46%, 11 patients), followed by the splenic artery (29%, 7 patients). By surgery type, the gastroduodenal artery was the commonest site of bleeding in subtotal gastrectomy (64%, 9/14) and the splenic artery was commonest site of bleeding in total gastrectomy (50%, 5/10). Conclusions: Transcatheter arterial embolization demonstrated high technical and clinical success rates with an acceptable complication rate in the management of postgastrectomy arterial bleeding. However, transcatheter arterial embolization may not be the best treatment option in patients who have undergone subtotal gastrectomy and bled from the splenic artery owing to the high risk of infarctions of the remnant stomach and the spleen.

Original languageEnglish
Pages (from-to)887-894
Number of pages8
JournalGastric Cancer
Volume20
Issue number5
DOIs
Publication statusPublished - 2017 Sep 1

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Hemorrhage
Gastrectomy
Splenic Artery
Gastric Stump
Infarction
Spleen
Arteries
Cause of Death
Angiography
Safety

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Han, Kichang ; Ahmed, Bestun Mustafa ; Kim, ManDeuk ; Won, Jong Yun ; Lee, Do Yun ; Kim, Gyoung Min ; Kwon, Joon Ho ; Park, Sung Il ; Hoon Noh, Sung ; Hyung, WooJin. / Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding. In: Gastric Cancer. 2017 ; Vol. 20, No. 5. pp. 887-894.
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title = "Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding",
abstract = "Background: The aim of this study was to retrospectively investigate the feasibility and safety of transcatheter arterial embolization in the management of postgastrectomy arterial bleeding. Methods: Between January 2004 and July 2015, 13,246 patients underwent total or subtotal gastrectomy at our institution, and 24 patients (18 men; mean age 66.8 years; range 42–80 years) underwent transcatheter arterial embolization for postoperative arterial bleeding identified on angiography. Results: Postgastrectomy arterial bleeding occurred after subtotal gastrectomy in 14 patients (58{\%}) and after total gastrectomy in 10 patients (42{\%}), after a mean of 17 days (range 1–57 days). It manifested itself as luminal bleeding in 10 patients and as abdominal bleeding in 14 patients. Technical success was achieved in all 24 patients (100{\%}). The clinical success rate was 79{\%} (19-24); there were three transcatheter-arterial-embolization–related major complications that resulted in death within 30 days (12{\%}), one case of recurrent bleeding, and one case of persistent bleeding. The cause of death included infarctions in the spleen and/or remnant stomach (n = 2) and bowel perforation (n = 1). The commonest bleeding focus was the gastroduodenal artery (46{\%}, 11 patients), followed by the splenic artery (29{\%}, 7 patients). By surgery type, the gastroduodenal artery was the commonest site of bleeding in subtotal gastrectomy (64{\%}, 9/14) and the splenic artery was commonest site of bleeding in total gastrectomy (50{\%}, 5/10). Conclusions: Transcatheter arterial embolization demonstrated high technical and clinical success rates with an acceptable complication rate in the management of postgastrectomy arterial bleeding. However, transcatheter arterial embolization may not be the best treatment option in patients who have undergone subtotal gastrectomy and bled from the splenic artery owing to the high risk of infarctions of the remnant stomach and the spleen.",
author = "Kichang Han and Ahmed, {Bestun Mustafa} and ManDeuk Kim and Won, {Jong Yun} and Lee, {Do Yun} and Kim, {Gyoung Min} and Kwon, {Joon Ho} and Park, {Sung Il} and {Hoon Noh}, Sung and WooJin Hyung",
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Han, K, Ahmed, BM, Kim, M, Won, JY, Lee, DY, Kim, GM, Kwon, JH, Park, SI, Hoon Noh, S & Hyung, W 2017, 'Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding', Gastric Cancer, vol. 20, no. 5, pp. 887-894. https://doi.org/10.1007/s10120-017-0700-2

Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding. / Han, Kichang; Ahmed, Bestun Mustafa; Kim, ManDeuk; Won, Jong Yun; Lee, Do Yun; Kim, Gyoung Min; Kwon, Joon Ho; Park, Sung Il; Hoon Noh, Sung; Hyung, WooJin.

In: Gastric Cancer, Vol. 20, No. 5, 01.09.2017, p. 887-894.

Research output: Contribution to journalArticle

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T1 - Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding

AU - Han, Kichang

AU - Ahmed, Bestun Mustafa

AU - Kim, ManDeuk

AU - Won, Jong Yun

AU - Lee, Do Yun

AU - Kim, Gyoung Min

AU - Kwon, Joon Ho

AU - Park, Sung Il

AU - Hoon Noh, Sung

AU - Hyung, WooJin

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Background: The aim of this study was to retrospectively investigate the feasibility and safety of transcatheter arterial embolization in the management of postgastrectomy arterial bleeding. Methods: Between January 2004 and July 2015, 13,246 patients underwent total or subtotal gastrectomy at our institution, and 24 patients (18 men; mean age 66.8 years; range 42–80 years) underwent transcatheter arterial embolization for postoperative arterial bleeding identified on angiography. Results: Postgastrectomy arterial bleeding occurred after subtotal gastrectomy in 14 patients (58%) and after total gastrectomy in 10 patients (42%), after a mean of 17 days (range 1–57 days). It manifested itself as luminal bleeding in 10 patients and as abdominal bleeding in 14 patients. Technical success was achieved in all 24 patients (100%). The clinical success rate was 79% (19-24); there were three transcatheter-arterial-embolization–related major complications that resulted in death within 30 days (12%), one case of recurrent bleeding, and one case of persistent bleeding. The cause of death included infarctions in the spleen and/or remnant stomach (n = 2) and bowel perforation (n = 1). The commonest bleeding focus was the gastroduodenal artery (46%, 11 patients), followed by the splenic artery (29%, 7 patients). By surgery type, the gastroduodenal artery was the commonest site of bleeding in subtotal gastrectomy (64%, 9/14) and the splenic artery was commonest site of bleeding in total gastrectomy (50%, 5/10). Conclusions: Transcatheter arterial embolization demonstrated high technical and clinical success rates with an acceptable complication rate in the management of postgastrectomy arterial bleeding. However, transcatheter arterial embolization may not be the best treatment option in patients who have undergone subtotal gastrectomy and bled from the splenic artery owing to the high risk of infarctions of the remnant stomach and the spleen.

AB - Background: The aim of this study was to retrospectively investigate the feasibility and safety of transcatheter arterial embolization in the management of postgastrectomy arterial bleeding. Methods: Between January 2004 and July 2015, 13,246 patients underwent total or subtotal gastrectomy at our institution, and 24 patients (18 men; mean age 66.8 years; range 42–80 years) underwent transcatheter arterial embolization for postoperative arterial bleeding identified on angiography. Results: Postgastrectomy arterial bleeding occurred after subtotal gastrectomy in 14 patients (58%) and after total gastrectomy in 10 patients (42%), after a mean of 17 days (range 1–57 days). It manifested itself as luminal bleeding in 10 patients and as abdominal bleeding in 14 patients. Technical success was achieved in all 24 patients (100%). The clinical success rate was 79% (19-24); there were three transcatheter-arterial-embolization–related major complications that resulted in death within 30 days (12%), one case of recurrent bleeding, and one case of persistent bleeding. The cause of death included infarctions in the spleen and/or remnant stomach (n = 2) and bowel perforation (n = 1). The commonest bleeding focus was the gastroduodenal artery (46%, 11 patients), followed by the splenic artery (29%, 7 patients). By surgery type, the gastroduodenal artery was the commonest site of bleeding in subtotal gastrectomy (64%, 9/14) and the splenic artery was commonest site of bleeding in total gastrectomy (50%, 5/10). Conclusions: Transcatheter arterial embolization demonstrated high technical and clinical success rates with an acceptable complication rate in the management of postgastrectomy arterial bleeding. However, transcatheter arterial embolization may not be the best treatment option in patients who have undergone subtotal gastrectomy and bled from the splenic artery owing to the high risk of infarctions of the remnant stomach and the spleen.

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