Transcatheter Embolization for Arterial Bleeding around the Pancreatic Head

[Background/Objective] To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) around the pancreatic head, and identify the factors associated with clinical failure.[Methods] We evaluated 41 patients (27 men, median age 67 years) who underwent TAE for arterial bleeding around the pancreatic head from April 2005 to May 2019 at St. Marianna University Hospital. Clinical success, technical success, rebleeding, complications (assessed using the Society of Interventional Radiology classification 2013), and laboratory data were evaluated. Univariate and multivariate analysis were performed to identify the factors associated with clinical failure.[Results] The clinical and technical success rates were 70.7% (29/41) and 90.2% (37/41), respectively. A grade 4 complication (duodenal necrosis) occurred in a patient who was treated with N-butyl cyanoacrylate embolization. Compared with the clinical success group, the clinical failure group had a lower hemoglobin (P=0.0315), fibrinogen (P=0.0119), and platelet count (P=0.0103), and a longer prothrombin time-international normalized ratio (P=0.0036). In univariate analysis, the significant predictors of clinical failure were coagulopathy (odds ratio (OR) 14.4, 95% confidence interval (CI) 2.84–73.01), use of N-butyl cyanoacrylate (OR 5.25, 95% CI 1.23–22.39), and level of embolization (gastroduodenal artery) (OR 7.08, 95% CI 1.31–38.3). Multivariate analysis revealed coagulopathy as the significant predictor (OR 8.11, 95% CI 1.34–49.2).[Conclusion] TAE is effective for managing bleeding around the pancreatic head. Although TAE is relatively safe, caution is required to avoid disastrous complications.