How to control massive bleeding from the hepatic artery

A research team from China investigated the minimal invasive techniques to stop the life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm after pancreaticoduodenectomy. They found that placement of stent-grafts is an effective and safe procedure for acute life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm.

Delayed hepatic arterial hemorrhage 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 hemorrhage 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 hemorrhage from ruptured hepatic artery pseudoaneurysm after PD, especially in those who cannot undergo embolization. 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 embolization 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.