Safety and effectiveness of transarterial embolization for splenic artery hemorrhage in patients undergoing radical gastrectomy

Kichang Han, ManDeuk Kim, Michael Diffley, Joon Ho Kwon, Gyoung Min Kim, Woosun Choi, Yong Seek Kim, Junhyung Lee, Jong Yun Won, Do Yun Lee

Research output: Contribution to journalArticle

Abstract

Background: Perigastric lymph nodes are dissected during gastrectomy, potentially resulting in life-threatening postoperative bleeding. Purpose: To evaluate the safety and effectiveness of transarterial embolization (TAE) for bleeding from the splenic artery in patients who underwent gastrectomy. Material and Methods: Between January 2004 and December 2016, 14,523 patients underwent gastrectomy at our institution, and ten patients (nine men; mean age = 64.7 years; age range = 51–80 years) underwent TAE for postoperative bleeding from the splenic artery. The location of bleeding was classified as either: (i) the main splenic artery (MSA) or (ii) the parenchymal splenic artery (PSA). The clinical outcomes of TAE were explored. Results: Bleeding occurred at a median of 13.5 days (range = 4–34 days) after gastrectomy. The onset of bleeding was late in all patients and clinically manifested as abdominal bleeding in seven patients and luminal bleeding in three patients. Technical and clinical success rates were 100% and 70%, respectively. The three major complications occurred only in patients with MSA bleeding, resulting in two 30-day mortality cases and one splenic abscess with fistula formation to the jejunum. The causes of death were infarctions in the spleen and/or remnant stomach and sepsis. Conclusion: TAE seems to be effective in stabilizing patients with bleeding from the splenic artery. Moreover, TAE with curative intent may be performed for bleeding from the PSA; however, further resection of the remnant stomach and/or spleen seems to be required to avoid sepsis and mortality in case of bleeding from the MSA.

Original languageEnglish
Pages (from-to)939-945
Number of pages7
JournalActa Radiologica
Volume59
Issue number8
DOIs
Publication statusPublished - 2018 Aug 1

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Splenic Artery
Gastrectomy
Hemorrhage
Safety
Gastric Stump
Sepsis
Spleen
Mortality
Jejunum
Abscess
Infarction
Fistula
Cause of Death

All Science Journal Classification (ASJC) codes

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

Cite this

Han, Kichang ; Kim, ManDeuk ; Diffley, Michael ; Kwon, Joon Ho ; Kim, Gyoung Min ; Choi, Woosun ; Kim, Yong Seek ; Lee, Junhyung ; Won, Jong Yun ; Lee, Do Yun. / Safety and effectiveness of transarterial embolization for splenic artery hemorrhage in patients undergoing radical gastrectomy. In: Acta Radiologica. 2018 ; Vol. 59, No. 8. pp. 939-945.
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abstract = "Background: Perigastric lymph nodes are dissected during gastrectomy, potentially resulting in life-threatening postoperative bleeding. Purpose: To evaluate the safety and effectiveness of transarterial embolization (TAE) for bleeding from the splenic artery in patients who underwent gastrectomy. Material and Methods: Between January 2004 and December 2016, 14,523 patients underwent gastrectomy at our institution, and ten patients (nine men; mean age = 64.7 years; age range = 51–80 years) underwent TAE for postoperative bleeding from the splenic artery. The location of bleeding was classified as either: (i) the main splenic artery (MSA) or (ii) the parenchymal splenic artery (PSA). The clinical outcomes of TAE were explored. Results: Bleeding occurred at a median of 13.5 days (range = 4–34 days) after gastrectomy. The onset of bleeding was late in all patients and clinically manifested as abdominal bleeding in seven patients and luminal bleeding in three patients. Technical and clinical success rates were 100{\%} and 70{\%}, respectively. The three major complications occurred only in patients with MSA bleeding, resulting in two 30-day mortality cases and one splenic abscess with fistula formation to the jejunum. The causes of death were infarctions in the spleen and/or remnant stomach and sepsis. Conclusion: TAE seems to be effective in stabilizing patients with bleeding from the splenic artery. Moreover, TAE with curative intent may be performed for bleeding from the PSA; however, further resection of the remnant stomach and/or spleen seems to be required to avoid sepsis and mortality in case of bleeding from the MSA.",
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Safety and effectiveness of transarterial embolization for splenic artery hemorrhage in patients undergoing radical gastrectomy. / Han, Kichang; Kim, ManDeuk; Diffley, Michael; Kwon, Joon Ho; Kim, Gyoung Min; Choi, Woosun; Kim, Yong Seek; Lee, Junhyung; Won, Jong Yun; Lee, Do Yun.

In: Acta Radiologica, Vol. 59, No. 8, 01.08.2018, p. 939-945.

Research output: Contribution to journalArticle

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T1 - Safety and effectiveness of transarterial embolization for splenic artery hemorrhage in patients undergoing radical gastrectomy

AU - Han, Kichang

AU - Kim, ManDeuk

AU - Diffley, Michael

AU - Kwon, Joon Ho

AU - Kim, Gyoung Min

AU - Choi, Woosun

AU - Kim, Yong Seek

AU - Lee, Junhyung

AU - Won, Jong Yun

AU - Lee, Do Yun

PY - 2018/8/1

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N2 - Background: Perigastric lymph nodes are dissected during gastrectomy, potentially resulting in life-threatening postoperative bleeding. Purpose: To evaluate the safety and effectiveness of transarterial embolization (TAE) for bleeding from the splenic artery in patients who underwent gastrectomy. Material and Methods: Between January 2004 and December 2016, 14,523 patients underwent gastrectomy at our institution, and ten patients (nine men; mean age = 64.7 years; age range = 51–80 years) underwent TAE for postoperative bleeding from the splenic artery. The location of bleeding was classified as either: (i) the main splenic artery (MSA) or (ii) the parenchymal splenic artery (PSA). The clinical outcomes of TAE were explored. Results: Bleeding occurred at a median of 13.5 days (range = 4–34 days) after gastrectomy. The onset of bleeding was late in all patients and clinically manifested as abdominal bleeding in seven patients and luminal bleeding in three patients. Technical and clinical success rates were 100% and 70%, respectively. The three major complications occurred only in patients with MSA bleeding, resulting in two 30-day mortality cases and one splenic abscess with fistula formation to the jejunum. The causes of death were infarctions in the spleen and/or remnant stomach and sepsis. Conclusion: TAE seems to be effective in stabilizing patients with bleeding from the splenic artery. Moreover, TAE with curative intent may be performed for bleeding from the PSA; however, further resection of the remnant stomach and/or spleen seems to be required to avoid sepsis and mortality in case of bleeding from the MSA.

AB - Background: Perigastric lymph nodes are dissected during gastrectomy, potentially resulting in life-threatening postoperative bleeding. Purpose: To evaluate the safety and effectiveness of transarterial embolization (TAE) for bleeding from the splenic artery in patients who underwent gastrectomy. Material and Methods: Between January 2004 and December 2016, 14,523 patients underwent gastrectomy at our institution, and ten patients (nine men; mean age = 64.7 years; age range = 51–80 years) underwent TAE for postoperative bleeding from the splenic artery. The location of bleeding was classified as either: (i) the main splenic artery (MSA) or (ii) the parenchymal splenic artery (PSA). The clinical outcomes of TAE were explored. Results: Bleeding occurred at a median of 13.5 days (range = 4–34 days) after gastrectomy. The onset of bleeding was late in all patients and clinically manifested as abdominal bleeding in seven patients and luminal bleeding in three patients. Technical and clinical success rates were 100% and 70%, respectively. The three major complications occurred only in patients with MSA bleeding, resulting in two 30-day mortality cases and one splenic abscess with fistula formation to the jejunum. The causes of death were infarctions in the spleen and/or remnant stomach and sepsis. Conclusion: TAE seems to be effective in stabilizing patients with bleeding from the splenic artery. Moreover, TAE with curative intent may be performed for bleeding from the PSA; however, further resection of the remnant stomach and/or spleen seems to be required to avoid sepsis and mortality in case of bleeding from the MSA.

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