Stent Graft Placement for Upper Abdominal Artery Injury

Abstract

Postpancreatectomy hemorrhage accounts for the majority of vascular injuries in the upper abdominal region. Bleeding associated with pancreatic fistula has a high case fatality rate and requires immediate hemostasis. In the past, liver failure occurred in some cases after performing coil embolization of the common hepatic artery for hemorrhage due to hepatic artery injury. Recently, self-expanding Viabahn stent grafts have been indicated for vascular injuries, making it possible to more safely perform endovascular treatment. The Viabahn is an ideal stent graft for endovascular repair of tortuous visceral arteries because of its flexibility. Bleeding after pancreatectomy most often occurs from the gastroduodenal artery stump, for which the Via-bahn is particularly useful for stent graft placement. In this paper, we describe various pre-cautions and tips regarding Viabahn placement for bleeding in the upper abdominal arteries and present some illustrative cases.
With the advent of the Viabahn, treatment strategies for vascular injury have changed significantly. There are still many points to consider, such as devising optimal delivery methods and determining long-term results, but its use is expected to become more widespread in the future.