Case report of Modified Viabahn Open Revascularization TEChnique (VORTEC) as a rescue strategy for hepatic artery dissection after initial endovascular treatment of postpancreaticoduodenectomy hemorrhage

Rationale: Currently endovascular treatments are commonly utilized to treat postpancreaticoduodenectomy hemorrhage. However, when endovascular procedure went wrong, open surgery with ligation of the culprit vessels would be the most common salvage method. With Modified Viabahn Open Revascularization TEChnique (VORTEC), we can try to rescue the vessel without sacrificing it by introduction of another endovascular stent under direct method.

Patient concerns: A 76-year-old man with stage IIIA ampulla vater adenocarcinoma underwent pancreaticoduodenectomy and experience pancreatic leak complicated with postpancreaticoduodenectomy hemorrhage.

Diagnosis: Emergent angiography revealed extravasation from proper hepatic artery.

Interventions: A 6 mm Viabahn stent was deployed but no distal runoff. Operation was shifted to emergent laparotomy and revealed intimal dissection of hepatic artery. Modified VORTEC was performed with guidewire redirected to true lumen and another stent was deployed under direct vision.

Outcomes: Patient's hepatic artery was preserved and with no consequent liver failure.

Lesson: Modified VORTEC method could be used as salvage strategy for artery dissection after initial endovascular treatment failed.