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Tiralongo F, Toscano S, Mosconi C, Iezzi R, Giurazza F, Castiglione DG, Falsaperla D, Vacirca F, Ini' C, Corvino F, Lavalle S, Venturini M, Foti PV, Palmucci S, Basile A. Spontaneous retroperitoneal hematoma treated with transarterial embolization: a systematic review and metanalysis. CVIR Endovasc 2024; 7:50. [PMID: 38789727 PMCID: PMC11126549 DOI: 10.1186/s42155-024-00462-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to evaluate the safety, technical, and clinical effectiveness of percutaneous Transarterial Embolization (TAE) in treating spontaneous retroperitoneal hematomas as well as assess treatment outcomes in patients who underwent target or empirical embolization. MATERIALS AND METHODS Through the PubMed, Embase, and Google Scholar databases, an extensive search was performed in the fields of spontaneous retroperitoneal hematomas treated with transcatheter arterial embolization. We collected pooled data on 141 patients from 6 separate articles selected according to the inclusion and exclusion criteria. RESULTS Technical success rate was 100% in all six studies, for both targeted and empirical embolization. The clinical success rate varied from 56.3 to 89.5%. The total number of complications related to the embolization procedure was 10 events out of 116 procedures analyzed. Empirical or empirical embolization was performed in three studies, where the source of active bleeding was not evident during DSA. A meta-analysis compared the rebleeding rates between targeted and empirical embolization groups. The odds ratio from pooled data from the three assessed studies (72 patients) showed no significant difference in rebleeding rates after empirical TAE compared with targeted TAE. CONCLUSIONS TAE is a safe, effective, and potentially life-saving procedure for the treatment of life-threatening spontaneous retroperitoneal hematomas. Empirical and targeted TAE procedures demonstrate a relatively low risk of complications, compared to the high technical and relatively high clinical success rates.
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Affiliation(s)
- Francesco Tiralongo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy.
| | - Stefano Toscano
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria Di Bologna, via Albertoni 15, Bologna, 40138, Italy
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia-Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, l.go A gemelli 8, Rome, 00168, Italy
- Istituto di Radiodiagnostica, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital of Naples, Naples, 80131, Italy
| | - Davide Giuseppe Castiglione
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
| | - Daniele Falsaperla
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
| | - Francesco Vacirca
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
| | - Corrado Ini'
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
| | - Fabio Corvino
- Interventional Radiology Department, Cardarelli Hospital of Naples, Naples, 80131, Italy
| | - Salvatore Lavalle
- Faculty of Medicine and Surgery, University of Enna Kore, Enna, 94100, Italy
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, Varese, 21100, Italy
| | - Pietro Valerio Foti
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", UOSD I.P.T.R.A, University of Catania, University Hospital Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
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Cacioppa LM, Floridi C, Cocozza MA, Bruno A, Modestino F, Martella C, Rosati M, Paccapelo A, Mosconi C, Candelari R. The prominent role of percutaneous transarterial embolization in the treatment of anterior abdominal wall hematomas: the results of three high volume tertiary referral centers. LA RADIOLOGIA MEDICA 2023; 128:1125-1137. [PMID: 37458907 PMCID: PMC10473986 DOI: 10.1007/s11547-023-01678-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/29/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Percutaneous transarterial embolization (PTE) represents a fast, safe and effective option for life-threatening anterior abdominal wall hematomas (AWHs) and those unresponsive to conservative treatment. Our study aims to assess cumulative results of safety, technical and clinical success of PTE performed in three high-volume tertiary referral centers and to evaluate the efficacy of the different embolic materials employed. MATERIALS AND METHODS A consecutive series of 124 patients (72.8 ± 14.4 years) with AWHs of different etiology submitted to PTE were retrospectively collected and analyzed. Clinical success, defined as absence of recurrent bleeding within 96 h from PTE, was considered as primary endpoint. The results of the comparison of three groups based on embolic agent employed were also analyzed. RESULTS Spontaneous AWHs accounted for 62.1%, iatrogenic for 21.8% and post-traumatic for 16.1% of cases. SARS-CoV-19 infection was present in 22.6% of patients. The most commonly embolized vessels were epigastric inferior artery (n = 127) and superior epigastric artery (n = 25). Technical and clinical success were 97.6 and 87.1%, respectively. Angiographic signs of active bleeding were detected in 85.5% of cases. Four (4%) major complications were reported. The comparison of the three groups of embolic agents (mechanical, particulate/fluid and combined) showed no statistically significant differences in terms of clinical success. SARS-CoV-2 infection was found to be an independent factor for recurrent bleeding and poor 30-day survival. CONCLUSION PTE performed with all the embolic agent employed in our centers is a safe and effective tool in the treatment of life-threatening anterior AWH of each origin.
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Affiliation(s)
- Laura Maria Cacioppa
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy.
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy.
| | - Chiara Floridi
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Maria Adriana Cocozza
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Antonio Bruno
- Diagnostic and Interventional Radiology Unit, Maggiore Hospital "C. A. Pizzardi", 40133, Bologna, Italy
| | - Francesco Modestino
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Claudia Martella
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Marzia Rosati
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Alexandro Paccapelo
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Roberto Candelari
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
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Tiralongo F, Giurazza F, Di Pietro S, Lucatelli P, Mosconi C, Contegiacomo A, Vacirca F, Ciaglia S, Cocozza MA, Castiglione DG, Falsaperla D, Ini' C, Zanghì GN, Granata A, Venturini M, Basile A. Spontaneous Abdominal Wall Hematoma Treated with Percutaneous Transarterial Embolization: Diagnostic Findings, Procedural Outcome, and Efficacy-A Multicenter Study. J Clin Med 2023; 12:4779. [PMID: 37510894 PMCID: PMC10381274 DOI: 10.3390/jcm12144779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Endovascular management of abdominal wall hematomas (AWHs) is now the primary treatment option in hemodynamically stable patients, and it is often preferred to surgical interventions. The purpose of this multicentric study was to assess the safety, technical, and clinical success of percutaneous transarterial embolization (PTAE) of spontaneous AWHs to evaluate the efficacy of blind or empiric embolization compared to targeted embolization and to compare the outcome of the endovascular treatment approach in patients affected by COVID-19 and non-COVID-19 patients. We retrospectively enrolled 112 patients with spontaneous AWHs who underwent PTAE, focusing on signs of bleeding at pre-procedural CTA and DSA. Patients were separated into two groups depending on whether a blind or targeted embolization approach was used. We also divided patients into COVID-19 and non-COVID-19 groups. The mean age of the study population was 68.6 ± 15.8 years. CTA and DSA revealed signs of active bleeding in 99 and 88 patients, respectively. In 21 patients, blind embolization was performed. The overall technical success rate was 99%. Clinical success was obtained in 96 patients (86%), while 16 (14%) re-bled within 96 h. One patient reported a major peri-procedural complication. The comparison between blind and targeted embolization approaches showed no statistically significant differences in the characteristics of groups and technical and clinical success rates. No significant differences were found in the procedural outcome between COVID-19 and non-COVID-19 groups. Our study confirmed that PTAE is effective for treating spontaneous AWHs, even in COVID-19 patients. It suggests that the efficacy and safety of blind embolization are comparable to targeted embolization.
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Affiliation(s)
- Francesco Tiralongo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital of Naples, 80131 Naples, Italy
| | - Stefano Di Pietro
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Andrea Contegiacomo
- Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Vacirca
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Simone Ciaglia
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Maria Adriana Cocozza
- Department of Radiology, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Davide Giuseppe Castiglione
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Daniele Falsaperla
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Corrado Ini'
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | | | - Antonio Granata
- Nephrology and Dialysis Unit, "Cannizzaro" Hospital, 95123 Catania, Italy
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, 21100 Varese, Italy
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
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Hörer TM, Ierardi AM, Carriero S, Lanza C, Carrafiello G, McGreevy DT. Emergent vessel embolization for major traumatic and non-traumatic hemorrhage: Indications, tools and outcomes. Semin Vasc Surg 2023; 36:283-299. [PMID: 37330241 DOI: 10.1053/j.semvascsurg.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 06/19/2023]
Abstract
Endovascular embolization of bleeding vessels in trauma and non-trauma patients is frequently used and is an important tool for bleeding control. It is included in the EVTM (endovascular resuscitation and trauma management) concept and its use in patients with hemodynamic instability is increasing. When the correct embolization tool is chosen, a dedicated multidisciplinary team can rapidly and effectively achieve bleeding control. In this article, we will describe the current use and possibilities for embolization of major hemorrhage (traumatic and non-traumatic) and the published data supporting these techniques as part of the EVTM concept.
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Affiliation(s)
- Tal M Hörer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Södra Grev Rosengatan, 701 85 Örebro, Sweden; Department of Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Örebro, Sweden; Carmel Lady Davis Hospital, Technion Medical Faculty, Haifa, Israel.
| | - Anna Maria Ierardi
- Radiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Serena Carriero
- Post Graduate School of Radiology, University of Milan, Milan, Italy
| | - Carolina Lanza
- Post Graduate School of Radiology, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - David T McGreevy
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Södra Grev Rosengatan, 701 85 Örebro, Sweden
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Fior D, Di Provvido S, Leni D, Corso R, Moramarco LP, Pileri M, Grasso RF, Santucci D, Faiella E. Spontaneous Soft Tissue Hematomas in Patients with Coagulation Impairment: Safety and Efficacy of Transarterial Embolization. Tomography 2023; 9:1083-1093. [PMID: 37368541 DOI: 10.3390/tomography9030089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this study is to report the authors' experience of percutaneous transarterial embolization (TAE) in patients with spontaneous soft tissue hematomas (SSTH) and active bleeding with anticoagulation impairment. The study retrospectively identified 78 patients who received a diagnosis of SSTH by CT scan and underwent TAE between 2010 and 2019 in a single trauma center. The patients were stratified using Popov classification into categories: 2A, 2B, 2C, and 3. The patient's 30-day survival after TAE was considered the primary outcome; immediate technical success, the need for additional TAE, and TAE-related complications were considered secondary outcomes. Immediate technical success, complication rate, and risk factors for death were analyzed. Follow-up stopped on day 30 from TAE. 27 patients (35%) fell into category 2A, 8 (10%) into category 2B, 4 (5%) into category 2C, and 39 (50%) into category 3. Immediate technical success was achieved in 77 patients (98.7%). Complications included damage at the arterial puncture site (2 patients, 2.5%) and acute kidney injury (24 patients, 31%). Only 2 patients (2.5%) had been discharged with a new diagnosis of chronic kidney disease. The 30-day overall mortality rate was 19% (15 patients). The mortality rate was higher in hemodynamically unstable patients, in Popov categories 2B, 2C, and 3, and in patients with an initial eGFR < 30 mL/min × 1.73 m2. The study demonstrated a higher mortality risk for categories 2B, 2C, and 3 compared to category 2A. Nonetheless, TAE has proven effective and safe in type 2A patients. Even though it is unclear whether type 2A patients could benefit from conservative treatment rather than TAE, in the authors' opinion, a TAE endovascular approach should be promptly considered for all patients in ACT with active bleeding demonstrated on CT scans.
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Affiliation(s)
- Davide Fior
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Stefano Di Provvido
- Department of Radiology, Desio Hospital, ASST Brianza, Via Giuseppe Mazzini 1, Desio, 20832 Monza, Italy
| | - Davide Leni
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, 20900 Monza, Italy
| | - Rocco Corso
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, 20900 Monza, Italy
| | - Lorenzo Paolo Moramarco
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Matteo Pileri
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Rosario Francesco Grasso
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Domiziana Santucci
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Eliodoro Faiella
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
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Becker LS, Stöhr F, Maus V, Dewald CLA, Meyer BC, Wacker FK, Kloeckner R, Hinrichs JB. Intraarterial embolizations in life-threatening spontaneous retroperitoneal and rectus sheath hemorrhage (SRRSH): a three-center experience. Emerg Radiol 2023:10.1007/s10140-023-02137-6. [PMID: 37120665 PMCID: PMC10390605 DOI: 10.1007/s10140-023-02137-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE To retrospectively evaluate the technical and clinical success of interventional treatments employed in three University medical centers and to develop work-flow recommendations for intra-arterial embolizations in patients with life-threatening spontaneous retroperitoneal and rectus sheath hemorrhage (SRRSH). MATERIALS AND METHODS Retrospective evaluation of all patients with contrast-enhanced CT and digital subtraction angiography (DSA) for SRRSH from 01/2018 to 12/2022, amounted to 91 interventions in 83 patients (45f, 38m) with a mean age of 68.1 ± 13.2 years. Analysis of the amount of bleeding and embolized vessels, choice of embolization material, technical success, and 30-day mortality was performed. RESULTS Pre-interventional contrast-enhanced CT demonstrated active contrast extravasation in 79 cases (87%). DSA identified a mean of 1.4 ± 0.88 active bleeds in all but two interventions (98%), consisting of 60 cases with a singular and 39 cases of >1 bleeding artery, which were consecutively embolized. The majority of patients underwent embolization with either n-butyl-2-cyanoacrylate (NBCA; n=38), coils (n=21), or a combination of embolic agents (n=23). While the technical success rate was documented at 97.8%, 25 patients (30%) died within 30 days after the initial procedure, with mortality rates ranging from 25 to 86% between the centers, each following different diagnostic algorithms. CONCLUSION Embolotherapy is a safe therapy option with high technical success rates in patients with life-threatening SRRSH. To maximize clinical success and survival rates, we propose a standardized approach to angiography as well as a low threshold for re-angiography.
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Affiliation(s)
- Lena S Becker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Fabian Stöhr
- Institute of Diagnostic and Interventional Radiology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Volker Maus
- Institute of Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Cornelia L A Dewald
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Bernhard C Meyer
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frank K Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Roman Kloeckner
- Institute of Diagnostic and Interventional Radiology, Johannes Gutenberg University Mainz, Mainz, Germany
- Institute for Interventional Radiology, University Clinic Schleswig-Holstein - Campus Lübeck, Lübeck, Germany
| | - Jan B Hinrichs
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Li X, Guan J, Partovi S. Embolization of Spontaneous Retroperitoneal Hemorrhage: An Individualized Approach is Needed. Cardiovasc Intervent Radiol 2023; 46:498-499. [PMID: 36859504 DOI: 10.1007/s00270-023-03398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Xin Li
- Department of Interventional Radiology, Hospital of The University of Pennsylvania, Philadelphia, PA, USA
| | - Justin Guan
- Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Sasan Partovi
- Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA.
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Increased reliability of CT-imaging signs of bleeding into soft tissue in patients with COVID-19 for planning transarterial embolization. Abdom Radiol (NY) 2023; 48:1164-1172. [PMID: 36692545 PMCID: PMC9872064 DOI: 10.1007/s00261-023-03810-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Spontaneous bleeding into the soft tissues of the abdominal and thoracic wall is described as complication of anticoagulant therapy. Computed tomography (CT) allows to detect the presence of extravasation of the contrast agent into a hematoma, which is indicated as a sign of ongoing bleeding. Other specific CT signs of such coagulopathic bleeding have been described earlier. AIM OF THE STUDY To evaluate the significance of specific coagulopathic CT signs for predicting the dynamics of spontaneous bleeding into soft tissues in patients with COVID-19. MATERIALS AND METHODS A retrospective study included 60 patients with COVID-19 with spontaneous bleeding into soft tissues and extravasation of a contrast agent on CT. In addition to extravasation, a "hematocrit effect" was detected in 43 patients on CT. Of these, 39 had extravasation in the form of a "signal flare." All patients underwent transarterial catheter angiography (TCA). To assess the prognostic value of CT signs, the results of CT and TCA compared. The absence of extravasation on the TCA more often corresponded to stopped bleeding. RESULTS Extravasation on TCA found in 27 (45%) patients. The presence of the "hematocrit effect" or the combination of this sign with the phenomenon of a "signal flare" on CT (n = 43) led to more frequent confirmation of extravasation on TCA than in their absence (n = 17): 23.5% vs. 53.4% (p = 0.028). CONCLUSION The presence of a fluid level and the phenomenon of a "signal flare" on CT in the structure of spontaneous hematomas of the soft tissues of the abdominal and thoracic wall in COVID-19 patients more often corresponded to ongoing bleeding on the TCA. The absence of coagulopathic CT signs more often corresponded to stopped bleeding.
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Transarterial Embolization for Spontaneous Soft-Tissue Hematomas: Predictive Factors for Early Death. J Pers Med 2022; 13:jpm13010015. [PMID: 36675676 PMCID: PMC9862993 DOI: 10.3390/jpm13010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The aim of this retrospective monocentric study was to assess the safety and efficacy of spontaneous soft-tissue hematoma transarterial embolization (TAE) and to evaluate predictive factors for early mortality (≤30 days) after TAE for spontaneous soft-tissue hematoma (SSTH). MATERIALS AND METHODS Between January 2010 and March 2022, all patients referred to our hospital for spontaneous soft-tissue hematoma and treated by emergency TAE were reviewed. Inclusion criteria were patients: ≥18-year-old, with active bleeding shown on preoperative multidetector row computed tomography, with spontaneous soft-tissue hematoma, and treated by TAE. Exclusion criteria were patients with soft-tissue hematomas of traumatic, iatrogenic, or tumoral origin. Clinical, biological, and imaging records were reviewed. Imaging data included delimitation of hematoma volume and presence of fluid level. Univariate and multivariate analyses were performed to check for associations with early mortality. RESULTS Fifty-six patients were included. Median age was 75.5 [9-83] ([Q1-Q3] years and 23 (41.1%) were males. Fifty-one patients (91.1%) received antiplatelet agent and/or anticoagulant therapy. All 56 patients had active bleeding shown on a preoperative CT scan. Thirty-seven (66.0%) hematomas involved the retroperitoneum. Median hemoglobin level was 7.6 [4.4-8.2] g/dL. Gelatine sponge was used in 32/56 (57.1%) procedures. Clinical success was obtained in 48/56 (85.7%) patients and early mortality occurred in 15/56 (26.8%) patients. In univariate and multivariate analysis, retroperitoneal location and volume of hematoma were associated with early mortality. CONCLUSION Retroperitoneal location and volume of hematoma seem to be risk factors for early death in the context of TAE for spontaneous soft-tissue hematoma. Larger multicenter studies are necessary to identify others predictive factors for early mortality and to anticipate which patients may benefit from an interventional strategy with TAE.
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Ierardi AM, Carrafiello G. Spontaneous Haematomas and Embolization: The Challenging Choice of the Embolic Agent. Cardiovasc Intervent Radiol 2022; 45:1007-1009. [PMID: 35581473 PMCID: PMC9113614 DOI: 10.1007/s00270-022-03160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/23/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
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Spontaneous Retroperitoneal Hematoma Treated with Percutaneous Transarterial Embolization in COVID-19 Era: Diagnostic Findings and Procedural Outcome. Tomography 2022; 8:1228-1240. [PMID: 35645387 PMCID: PMC9149958 DOI: 10.3390/tomography8030101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Spontaneous retroperitoneal hematomas are a relatively common occurrence in hospitalized patients with COVID-19 related pneumonia, and endovascular treatment of trans-arterial embolization (TAE) may be a life-saving procedure after failure of medical and supportive therapy. The aim of our study was to evaluate spontaneous retroperitoneal hematomas in the COVID-19 era, focusing on their imaging features at CTA and DSA and on the safety, as well as technical and clinical success, of TAE, comparing patients affected by COVID-19 and non-COVID-19 patients. (2) Materials and Methods: We retrospectively enrolled 24 patients with spontaneous retroperitoneal hematoma who underwent TAE; of these, 10 were hospitalized for COVID-19-related pneumonia, while the other 14 were without COVID-19 infection. We evaluated the demographic data, hemoglobin values before and after the procedure, preprocedural aPTT, preprocedural INR, diagnostic and interventional imaging findings, procedural outcome (technical success) and survival periprocedural (clinical success), and major and minor complications. (3) Results: The mean age of the study population was 72.7 ± 11.2 years. CTA revealed signs of active bleeding in 20 patients (83%). DSA showed signs of active bleeding in 20 patients (83%). In four patients (17%), blind embolization was performed. The overall technical success rate was 100%. Clinical success was achieved in 17 patients (71%), while seven patients (29%) rebled within 96 h, and all of them were retreated. No major periprocedural complication was reported. The comparison between the two groups did not show statistically significant differences for gender, mean age, mean pre- and postprocedural hemoglobin, aPTT and INR, mean hematoma volume (cm3), or mean delay between CT and DSA. Active bleeding at CTA was detected in 90% of COVID-19 patients and 79% of non-COVID-19 patients (p = 0.61). At DSA, active bleeding was assessed in eight out of 10 (80%) patients in the COVID-19 group and 12 out of 14 (86%) patients in the non-COVID-19 group (p = 1). Technical success was obtained in 100% of patients in both groups. Clinical success rates were 70% for COVID-19 group and 71% for the non-COVID-19 group. We found no statistical significance between the clinical success rates of retroperitoneal spontaneous hematoma embolization in patients with or without SARS-CoV-2 infection. (4) Conclusions: We suggest that, similar to what has been reported in other studies in non-COVID-19 patients, TAE should be considered an important safe, effective, and potentially life-saving option for the management and the treatment of patients affected by COVID-19 who present with spontaneous retroperitoneal hematoma and who could not benefit from conservative treatment.
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Decker JA, Brill LM, Orlowski U, Varga-Szemes A, Emrich T, Schoepf UJ, Schwarz F, Kröncke TJ, Scheurig-Münkler C. Spontaneous Iliopsoas Muscle Hemorrhage-Predictors of Associated Mortality. Acad Radiol 2022; 29:536-542. [PMID: 34176729 DOI: 10.1016/j.acra.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Spontaneous iliopsoas muscle hemorrhage (SIPH) is a rare clinical condition associated with high mortality. In this work we aimed to retrospectively investigate the predictors of mortality in a single-institution cohort of consecutive SIPH patients. MATERIALS AND METHODS Consecutive patients (n = 61, 30 men, 76 years [range 51-93]) with computed tomography (CT) confirmed diagnosis of SIPH were retrospectively included between January 2010 and April 2020. CT studies were assessed for signs of active bleeding, extramuscular retroperitoneal hematoma, visible sedimentation, and hematoma volume. Medication history, laboratory parameters, comorbidities, and disease management were also recorded. All parameters were subsequently examined with regard to their impact on outcome and survival. Univariate and multivariate Cox regressions were performed to identify variables associated with time to death. RESULTS The overall mortality was 22.9%. A total of 77% of patients received anticoagulant therapy prior to the onset of SIPH. Active bleeding in contrast enhanced CT (CECT) was the only independent variable associated with shorter survival (p = 0.01, hazard ratio 7.05 [1.45-34.20]). Hematoma volume or extramuscular retroperitoneal hematoma had no significant influence on short-term mortality. CONCLUSION Only active bleeding but not hematoma volume or extra-muscular bleeding is an independent risk factor for short-term mortality in patients with SIPH.
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Di Pietro S, Tiralongo F, Desiderio CM, Vacirca F, Palmucci S, Giurazza F, Venturini M, Basile A. Efficacy of Percutaneous Transarterial Embolization in Patients with Spontaneous Abdominal Wall Hematoma and Comparison between Blind and Targeted Embolization Approaches. J Clin Med 2022; 11:jcm11051270. [PMID: 35268360 PMCID: PMC8911449 DOI: 10.3390/jcm11051270] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Endovascular treatment of abdominal wall hematomas (AWHs) has been increasingly used when conservative treatments were not sufficiently effective, and it is often preferred to surgical interventions. The aim of our study was to evaluate the safety and technical and clinical success of percutaneous transarterial treatment of AWH and to evaluate the efficacy of blind embolization compared to targeted embolization. Materials and Methods: We retrospectively enrolled 43 patients (23 men and 20 females) with spontaneous AWH who underwent digital subtraction angiography (DSA) and embolization, focusing on the presence of signs of bleeding at pre-procedural CT-Angiography (CTA) and at DSA. Furthermore, we divided patients into two groups depending on blind or targeted embolization approaches. Results: The mean age of the study population was 71 ± 12 years. CTA revealed signs of active bleeding in 31 patients (72%). DSA showed signs of active bleeding in 34 patients (79%). In nine patients (21%), blind embolization was performed. The overall technical success rate was 100%. Clinical success was achieved in 33 patients (77%), while 10 patients (23%) rebled within 96 h, and all of them were re-treated. No major peri-procedural complication was reported. The comparison between blind and targeted embolization showed no statistically significant differences for characteristics of groups and for clinical success rates (78% and 77%, respectively, −p = 0.71). The technical success was 100% in both groups. Conclusions: Our study confirms that transarterial embolization is a safe and effective option for the treatment of spontaneous AWHs, and it suggests that the efficacy and safety of blind embolization is comparable to non-blind.
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Affiliation(s)
- Stefano Di Pietro
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
| | - Francesco Tiralongo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
- Correspondence: ; Tel.: +39-393-2067-572
| | - Carla Maria Desiderio
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
| | - Francesco Vacirca
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
| | - Stefano Palmucci
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
| | - Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital of Naples, 80131 Naples, Italy;
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, 21100 Varese, Italy;
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
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Management of Spontaneous Bleeding in COVID-19 Inpatients: Is Embolization Always Needed? J Clin Med 2021; 10:jcm10184119. [PMID: 34575230 PMCID: PMC8469448 DOI: 10.3390/jcm10184119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND critically ill patients with SARS-CoV-2 infection present a hypercoagulable condition. Anticoagulant therapy is currently recommended to reduce thrombotic risk, leading to potentially severe complications like spontaneous bleeding (SB). Percutaneous transcatheter arterial embolization (PTAE) can be life-saving in critical patients, in addition to medical therapy. We report a major COVID-19 Italian Research Hospital experience during the pandemic, with particular focus on indications and technique of embolization. METHODS We retrospectively included all subjects with SB and with a microbiologically confirmed SARS-CoV-2 infection, over one year of pandemic, selecting two different groups: (a) patients treated with PTAE and medical therapy; (b) patients treated only with medical therapy. Computed tomography (CT) scan findings, clinical conditions, and biological findings were collected. RESULTS 21/1075 patients presented soft tissue SB with an incidence of 1.95%. 10/21 patients were treated with PTAE and medical therapy with a 30-days survival of 70%. Arterial blush, contrast late enhancement, and dimensions at CT scan were found discriminating for the embolization (p < 0.05). CONCLUSIONS PTAE is an important tool in severely ill, bleeding COVID-19 patients. The decision for PTAE of COVID-19 patients must be carefully weighted with particular attention paid to the clinical and biological condition, hematoma location and volume.
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Teta M, Drabkin MJ. Fatal retroperitoneal hematoma associated with Covid-19 prophylactic anticoagulation protocol. Radiol Case Rep 2021; 16:1618-1621. [PMID: 33880136 PMCID: PMC8049380 DOI: 10.1016/j.radcr.2021.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 01/30/2023] Open
Abstract
Due to the association between Covid-19 and thromboembolic events, there has been a surge in anticoagulation use during the pandemic based on evolving guidelines for management of hospitalized Covid-19 patients. Spontaneous soft tissue hematoma can be a severe complication of anticoagulation. Herein we present a fatal case of severe spontaneous soft tissue hematoma secondary to anticoagulant therapy in a 67kg 81-year-old female with chronic kidney disease who was admitted to the hospital with Covid-19 pneumonia. There is currently no evidence of mortality benefit among Covid-19 patients on high-dose anticoagulation. In the future we hope that practitioners will consider the bleeding risks of anticoagulation and consider patients’ age, weight and renal function when determining prophylactic anticoagulation regimens in Covid-19 patients.
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Affiliation(s)
- Michael Teta
- Critical Care, Catholic Health, Long Island, New York
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Lucatelli P, Rocco B, Nardis PG, Cannavale A, Bezzi M, Catalano C, Corona M. Bleeding in COVID Patients: What We Have Understood So Far. Cardiovasc Intervent Radiol 2021; 44:666-668. [PMID: 33511426 PMCID: PMC7843001 DOI: 10.1007/s00270-021-02775-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
| | - Bianca Rocco
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Pier Giorgio Nardis
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Alessandro Cannavale
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Mario Corona
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
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Nakama R, Kadoya T, Kimura T, Arakawa K, Ogura T, Kase K. Transcatheter Arterial Embolization of a Gluteal Pseudoaneurysm Due to Ground-Level Fall in an Elderly Woman Taking Apixaban. INTERVENTIONAL RADIOLOGY 2021; 6:1-3. [PMID: 35910527 PMCID: PMC9327326 DOI: 10.22575/interventionalradiology.2020-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/11/2020] [Indexed: 12/05/2022]
Abstract
A 90-year-old woman prescribed with apixaban was admitted to a hospital after a ground-level fall. She was transferred to our hospital for advanced evaluation and treatment. Contrast-enhanced computed tomography showed a pseudoaneurysm inside the right gluteus maximus muscle. Angiography revealed an aneurysm of the peripheral branch of the inferior gluteal artery and multiple slight pseudoaneurysms of the peripheral branch of the internal iliac artery. We performed transcatheter arterial embolization using a gelatin sponge. After embolization, the hemoglobin stabilized. She was transferred to another hospital for rehabilitation. The use of direct oral anticoagulants in the elderly can lead to significant hemorrhage with minimal trauma. Transcatheter arterial embolization is a minimally invasive and safe procedure for such cases of trauma.
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Affiliation(s)
- Rakuhei Nakama
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
- Department of Radiology, Saiseikai Utsunomiya Hospital
| | - Takashi Kadoya
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
| | - Takuya Kimura
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
| | | | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
| | - Kenichi Kase
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
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Klausenitz C, Kuehn JP, Noeckler K, Radosa CG, Hoffmann RT, Teichgraeber U, Mensel B. Efficacy of transarterial embolisation in patients with life-threatening spontaneous retroperitoneal haematoma. Clin Radiol 2020; 76:157.e11-157.e18. [PMID: 33138981 DOI: 10.1016/j.crad.2020.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/08/2020] [Indexed: 01/25/2023]
Abstract
AIM To evaluate the technical and clinical success of embolisation in patients with life-threatening spontaneous retroperitoneal haematoma (SRH) and to assess predictors of clinical outcome. MATERIALS AND METHODS Thirty patients (mean age: 71.9±9.8 years) with SRH underwent digital subtraction angiography (DSA). All patients received anticoagulant or antiplatelet medication or a combination of both at the time the SRH occurred. RESULTS Pre-interventional computed tomography angiography (CTA) revealed active retroperitoneal bleeding in 28 of 30 (93.3%) patients. DSA identified active haemorrhage in 22 of 30 patients (73.3%). Twenty-nine of 30 (96.7%) patients underwent embolisation. n-Butyl-2-cyanoacrylate (NBCA) was used in 15 patients (51.7%), coils were used in 10 patients (34.5%), and both embolic agents were used in four patients (13.8%). The technical success rate was 100%. Pre-interventional haemoglobin levels increased significantly after embolotherapy from 70.9±16.1 g/l to 87±11.3 g/l (p<0.001), whereas partial thromboplastin time decreased from 58±38 to 30±9 seconds (p<0.001) after embolotherapy. The need for transfusion of concentrated red cells decreased from 3±2.2 to 1±1.1 units (p<0.001) after the intervention. Clinical success was achieved in 19 of 29 (65.5%) patients. No major procedure-related complications occurred. Seven patients (24.1%) died within 30 days after the procedure. CONCLUSION Embolotherapy in patients with life-threatening SRH leads to a high technical success rate and is a safe therapeutic option. The clinical success rate was acceptable and influenced by pre-interventional coagulation status and by the amount of transfused concentrated red cells.
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Affiliation(s)
- C Klausenitz
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - J-P Kuehn
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - K Noeckler
- Department of Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany
| | - C G Radosa
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - R-T Hoffmann
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - U Teichgraeber
- Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - B Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany; Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
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Nakayama M, Kato K, Yoshioka K, Sato H. Coagulopathy-related soft tissue hematoma: a comparison between computed tomography findings and clinical severity. Acta Radiol Open 2020; 9:2058460120923266. [PMID: 32528727 PMCID: PMC7263130 DOI: 10.1177/2058460120923266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/08/2020] [Indexed: 11/15/2022] Open
Abstract
Background Despite increases in the incidence of coagulopathy-related soft-tissue hematoma (CRSH), the relationship between computed tomography (CT) features and clinical severity remains unclear. Purpose To retrospectively evaluate the correlation between CT findings and clinical outcomes in CRSH. Material and Methods We retrospectively reviewed data of patients diagnosed with CRSH between March 2011 and March 2018. CRSH was morphologically classified according to the presence or absence of the fluid level pattern and was also divided into groups with or without extravasation as per CT findings. These CT findings were compared with the patients' vital signs and laboratory investigation results. Results A total of 47 patients with CRSH were examined. Fluid level and non-fluid level patterns were observed in 28 (60%) and 19 (40%) patients, respectively. Anticoagulant therapy and extravasation were significantly correlated with the fluid level pattern. However, other clinicolaboratory outcomes, including shock index, hemoglobin, hematocrit, platelet count, and coagulation factors, showed no significant difference between the two patterns. In the comparison of hematomas with and without extravasation, none of the clinicolaboratory outcomes except for anticoagulant therapy showed significant differences. Conclusion CRSH with a fluid level pattern is significantly associated with extravasation. However, extravasation, which is generally suggestive of active bleeding, does not seem to be related to clinical severity in CRSH.
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Affiliation(s)
- Manabu Nakayama
- Department of Radiology, Iwate Medical University, Morioka, Japan
- Manabu Nakayama, Department of Radiology, Iwate Medical University, 19-1, Uchimaru, Morioka, Iwate 020-8505, Japan.
| | - Kenichi Kato
- Department of Radiology, Iwate Medical University, Morioka, Japan
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Dilemma in management of hemorrhagic myositis in dermatomyositis. Rheumatol Int 2019; 40:331-336. [DOI: 10.1007/s00296-019-04501-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/11/2019] [Indexed: 01/22/2023]
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