151. Hepatic Artery Embolization for Postoperative Hemorrhage: Importance of Arterial Collateral Vessels and Portal Venous Impairment
- Author
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Won Seok Choi, Jun Suh Lee, Chang Jin Yoon, Jae Hwan Lee, Jai Young Cho, and Yoo Seok Yoon
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Collateral Circulation ,Postoperative Hemorrhage ,Hepatic Complication ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Pseudoaneurysm ,0302 clinical medicine ,Hepatic Artery ,Ischemia ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Hepatic artery embolization ,Embolization ,Collateral vessels ,Aged ,Retrospective Studies ,business.industry ,Portal Vein ,Stent ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Hepatic Infarction ,Surgery ,Stenosis ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon ,Artery ,Liver Circulation - Abstract
Purpose To investigate the association between hepatic ischemic complications and hepatic artery (HA) collateral vessels and portal venous (PV) impairment after HA embolization for postoperative hemorrhage. Materials and Methods From October 2003 to November 2019, 42 patients underwent HA embolization for postoperative hemorrhage. HA collateral vessels were classified according to visualization after embolization (grade 1, none; grade 2, 1–4 segmental HA; and grade 3, ≥4 segmental HA). Transhepatic portal vein stent placements were performed in the same session for 5 patients (11.9%) with poor HA collateral vessels (grade 1 or 2) and compromised PV flow (>70% stenosis). Hepatic ischemic complications were analyzed for relevance to HA collateral vessels and PV compromise. Results After HA embolization, HA flow was found to be preserved (grade 3) through intra- and/or extrahepatic collateral vessels in 23 patients (54.8%), and hepatic complications did not occur regardless of PV flow status (0%). Of the 19 patients (45.2%) with poor HA collateral vessels (grade 1 or 2), segmental hepatic infarction occurred in 2 of 15 patients (13.3%) with preserved PV flow (10 naive and 5 stented). The remaining 4 patients with poor HA collateral vessels and untreated compromised PV flow experienced multisegmental hepatic infarction (n = 3) or hepatic failure (n = 1) (100%) (P Conclusions After HA embolization, preserved HA flow (≥4 segmental HA) lowered the risk of hepatic complications regardless of the PV flow. Based on these findings, transhepatic PV stent placement seems to be an effective intervention for the prevention of hepatic complications in cases of poor HA collateral vessels and compromised PV flow.
- Published
- 2020