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How to control massive bleeding from the hepatic artery
Delayed hepatic arterial haemorrhage after pancreaticoduodenectomy (PD) is not a common but a fatal complication, occurring in 7% of all patients. Its ideal management remains unclear and controversial.
A research article published on August 7, 2010 in the World Journal of Gastroenterology addresses this question. The authors reported the clinical outcome of 9 patients with life-threatening haemorrhage from a ruptured hepatic artery pseudoaneurysm after PD after treatment with a new interventional technique, namely placement of stent-grafts. This technique provides a good alternative option for the control of haemorrhage from ruptured hepatic artery pseudoaneurysm after PD, especially in those who cannot undergo embolisation. Although the number of patients was small, the procedure demonstrated a lower mortality than conventional surgical intervention.
Based on their results, placement of stent-grafts for acute lifethreatening bleeding from hepatic artery pseudoaneurysm is a valuable alternative to embolisation and surgical intervention. If technically possible, this technique should be considered the first-line treatment for bleeding from the common and proper hepatic artery, particularly in patients with a non-portal vein. Further data are required to evaluate its technical success rate, complications, and long-term outcome in a larger number of patients.
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