Efficacy of interventional therapy for post-pancreaticoduodenectomy hemorrhage and factors influencing rebleeding: A multicenter retrospective study

To evaluate digital subtraction angiography (DSA) imaging features, interventional treatment efficacy, and risk factors for rebleeding in postpancreatectomy hemorrhage (PPH). This retrospective study analyzed PPH patients undergoing interventional therapy (2013–2022). DSA was performed in all cases, with positive findings prompting intervention. Statistical analysis of DSA angiography manifestations, bleeding sites, success rate of interventional treatment and hemostasis. Univariate and multivariate logistic regression analysis was used to analyze the independent risk factors for rebleeding after interventional treatment for PPH. A total of 192 patients were included. (1) DSA Examination: All 192 patients underwent DSA examination, the positive rate of the initial DSA examination was 78.65 % (151/192). The primary imaging manifestations included contrast medium spillage and pseudoaneurysm formation, with hemorrhage sites being the gastroduodenal artery (60 cases), hepatic artery (35 cases), superior mesenteric artery (38 cases), etc. (2) Interventional Therapy: 142 patients underwent interventional therapy (108 embolizations and 34 stent placements), resulting in a success rate of 90.85 % (129/142). (3) Independent risk factors for rebleeding after intervention in patients with PPH included: the surgical duration(P = 0.035), bleeding volume(P < 0.001), pancreatic fistula(P = 0.001), ECOG score(P = 0.011), pre-interventional leukocyte counts(P = 0.012), and the neutrophil/lymphocyte ratio(P = 0.047). Interventional diagnosis and treatment of PPH can facilitate prompt diagnosis and intervention, resulting in a high success rate of hemostasis and notable outcomes. However, it is important to note that some patients remain at risk for rebleeding after successful interventional hemostasis, necessitating close monitoring of clinical indices and proactive intervention for patients experiencing rebleeding.