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

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.