Pancreaticoduodenal Arcades As Salvage Route for Transarterial Embolization of Life-threatening Hepatic Hemorrhage in Patients with Severe Celiac Axis Stenosis: Case Series

Overview

Journal Int J Surg Case Rep

Specialty General Surgery

Date 2018 May 16

PMID 29763851

Citations 2

Authors

Ali Barah

Ahmed Omar

Ayman El-Menyar

Omran Almokdad

Ahmed Sayedin

Ala Alsherbini

Ahmed Almuzrakshi

Hatem Khalaf

Hassan Al-Thani

Affiliations

Soon will be listed here.

Abstract

Introduction: Various transarterial embolotherapies for different hepatic etiologies are performed through the celiac axis (CA). However, this pathway is not always patent due to the extensive stenosis or occlusion of the origin of CA. In such situations, the pancreaticoduodenal arcades (PDAs) catheterization is the main alternative to gain access to the hepatic arteries as demonstrated in clinical studies.

Presentation Of Case: We report two cases of life-threating hepatic hemorrhage indicated for emergency transarterial embolization (TAE).

Discussion: The massive hemorrhage was due to spontaneous rupture of hepatocellular carcinoma (HCC) in the first case and due to post liver blunt trauma in the second case. Owing to severe stenosis of the origin of CA, PDAs were used as a salvage alternative route for emergency TAE of hepatic arteries.

Conclusion: Endovascular management of massive hepatic hemorrhage in cases of inaccessibility to hepatic arteries through CA is a highly challenging situation in which the technical success depends on the operator experience, choice of the material and anatomical knowledge of hepatic arterial collateral supply.

Citing Articles

Ruptured Hepatocellular Carcinoma: What Do Interventional Radiologists Need to Know?.

Yan J, Li T, Deng M, Fan H Front Oncol. 2022; 12:927123.

PMID: 35785181 PMC: 9243354. DOI: 10.3389/fonc.2022.927123.

Management for traumatic hepatic injury diagnosed by contrast-enhanced ultrasonography in a patient with an occluded coeliac axis: a case report.

Sul Y, Kim Y J Int Med Res. 2021; 49(6):3000605211019926.

PMID: 34162257 PMC: 8236796. DOI: 10.1177/03000605211019926.

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