2021 Volume 41 Issue 6 Pages 417-425
We evaluated the therapeutic results of transcatheter arterial embolization（TAE）for postoperative pseudoaneurysm rupture, and clarified the technical problems associated with each bleeding site. Between 2001 and 2019, 24 patients experienced hemorrhage after surgery due to the development of pseudoaneurysms. The primary diseases were gastric cancer in 6 patients, bile duct cancer in 6 patients, ampullary cancer in 3 patients, pancreatic cancer in 2 patients, gallbladder cancer in 1 patient, colon cancer in 1 patient, and benign disease in 5 patients. The operative procedure was pancreatectomy in 15 cases（including pancreaticoduodenectomy in 11 cases）. Embolization with pushable microcoils was performed for a total of 23 events of hemorrhage, and was successful in all cases, except one with celiac trunk aneurysm, because of coil migration, in whom the treatment was combined with insertion of detachable balloon. TAE was performed once in 16 cases, twice in 6 cases, and thrice in 2 cases. The most frequent site of bleeding was the gastroduodenal artery stump（11 cases）. The complications of TAE were hepatic infarction in 3 cases（one requiring plasma exchange）and duodenal perforation in 1 case. Of the 24 patients who underwent TAE, hemostasis was achieved and the patients were discharged alive in 22 cases（91.7％）. The case in which hemostasis was difficult to establish by TAE had celiac trunk bleeding. The two cases in which bleeding could not be stopped had peripheral hemorrhage from the SMA with an intractable pancreatic fistula.
