Possibilities of Endovascular Hemostasis in Treatment of Pancreatic Bleeding

Pancreatic hemorrhage is one of the most severe complications of various pancreatic diseases that are difficult to treat even in multidisciplinary hospitals. Mortality from pancreatic hemorrhage can reach up to ۸۰%. This study aimed to evaluate the possibility of maintaining endovascular homeostasis in the treatment of patients with pancreatic hemorrhage. This retrospective multicenter study included ۴۵ patients (۳۳ men and ۱۲ women) in the age range of ۲۷-۸۴ years. More than ۵۰% (n=۲۳) of the patients were diagnosed with chronic pancreatitis. Malignant pancreatic lesions were observed in ۲۲ patients; of whom۱۱ patients had acute necrotizing pancreatitis. Acute bleeding was observed in ۳۹ (۸۶.۶%) patients, and ۶ (۱۳.۳%) patients showed chronic symptoms. Single-shot and recurrent bleeding was recorded in ۲۲(۴۸.۹%) and ۲۳ (۵۱.۱%) patients. In total, ۵۷ patients underwent endovascular surgery. Moreover, ۴۵ patients underwent primary surgery and another ۱۲ (۲.۲%) underwent reoperation due to recurrent bleeding. Intraoperative complications occurred in ۱ (۲.۲%) patient, and postoperative complications occurred in another. Out of all ۴۵ patients, seven patients had ۱۵ episodes of recurrent bleeding, of whom four patients showed recurrent bleeding at the in-hospital period, and the other three were under local supervision after the previous endovascular intervention. Out of the ۴۵ patients, ۳۵ (۷۷.۷%) survived and another ۱۰ (۲۲.۲%) died due to multiple organ failure (n=۸) and recurrent bleeding and hemorrhagic shock (n=۲). Out of ۱۰ patients who died, ۴, ۳, and ۳patients showed malignant pancreatic lesions after surgery, acute pancreatitis, and chronic pancreatitis, respectively. Endovascular hemostatic interventions can significantly increase the survival rate in severe groups of patients with pancreatic bleeding. Endovascular hemostasis is a safe procedure and may be called the “method of choice” in the treatment of pancreatic bleeding, especially in combination with percutaneous draining, aspiration, and injection of liquid embolic agents into leakage of pancreatic juice.

Keywords:

Acute necrotizing pancreatitis , chronic pancreatitis , Embolization coils , Liquid embolic agents , Malignancy of pancreas , pancreatic bleeding , Stent grafts