Coil-assisted N-butyl cyanoacrylate embolization vs covered stent implantation for delayed hemorrhage in hepatobiliary and pancreatic surgery

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BACKGROUND Hemorrhage following pancreaticobiliary surgery is a high-risk complication, with a mortality rate of 16%-38%. At present, minimally invasive endovascular intervention comprising superselective arterial embolization (SAE) and covered stent implantation (CSI) is the treatment of choice. However, in certain cases, both SAE and CSI become infeasible. AIM To evaluate the effectiveness of coil-assisted N-butyl cyanoacrylate (NBCA) embolization in comparison with that of CSI in managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE is infeasible. METHODS Ninety-eight continuous patients (n = 105 cases; mean age, 58.4 years) with delayed massive hemorrhage who were treated with coil-assisted NBCA embolization (NBCA group, n = 45) and/or CSI (CSI group, n = 60) were retrospectively evaluated between March 2014 and December 2023. Data on technical and clinical success, 30-day mortality, and severe intervention-related adverse events were collected and analyzed. RESULTS The technical and clinical success rates in the NBCA group (100% and 93.3%, respectively) were significantly higher than those in the CSI group (88.3% and 73.3%, respectively), with a statistically significant difference between the two groups (P = 0.019 and 0.010, respectively). The 30-day mortality rates and major intervention-related complications were 17.8% and 0%, respectively, in the NBCA group and 18.3% and 1.7% in the CSI group, respectively, with no statistically significant difference between the two groups. CONCLUSION In terms of technical and clinical success, coil-assisted NBCA embolization was more effective than CSI for managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE was not feasible.

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