Covered stent placement for gastroduodenal artery stump hemorrhage after pancreaticoduodenectomy: long-term patency and risk factor of stent failure

Objective: To evaluate the long-term outcomes of covered stent placement in patients with gastroduo-denal artery (GDA) stump hemorrhage after pancrea-ticoduodenectomy (PD) and to identify risk factors of stent failure. Methods and materials: Covered stent was placed in total of 21 patients for GDA stump hemorrhage after PD from September 2012 to March 2021. Technical and clinical success, complications, and stent patency were retrospectively evaluated. Nine relevant variables were analyzed to determine risk factors for stent failure. Results: In 20 of 21 patients (95.2%), the GDA stump was completely excluded with covered stent place-ment. Immediate hemostasis was achieved in the 20 patients and rebleeding from jejunal artery occurred in one patient which was successfully embolized one day after the stent placement. There was no procedure-related complication or early mortality (<30 days). During follow-up period (median 655.5 days), stent thrombosis was found on CT in 10 patients (50.0%, 10/20) without any laboratory or CT abnormalities. One thrombosed stent migrated into the jejunum 20 months after placement. The six-month, one-year, and two-year stent patency were 81.9%, 52.9%, and 37.8%, respectively (median 620 days). The recurrence of primary malignancy was associated with stent failure (HR 5.70; 95% CI 1.18–27.76, p = 0.03). Conclusions: Covered stent placement is an effective and safe management of postoperative GDA stump hemorrhage. Stent failure occurred frequently (50%) but did not cause liver ischemia. Stent failure was associated with recurrence of primary malignancy. Advances in knowledge 1. Covered stent placement is an effective and safe management of postoperative GDA stump hemorrhage. 2. Stent failure occurred frequently (50%) but did not cause liver ischemia. 3. Stent failure was associated with recurrence of primary malignancy.