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Oh CH, Cho SB, Kwon H. Clinical Outcomes and Safety of Transcatheter Arterial Embolization in Patients with Traumatic or Spontaneous Psoas and Retroperitoneal Hemorrhage. J Clin Med 2024; 13:3317. [PMID: 38893030 PMCID: PMC11172624 DOI: 10.3390/jcm13113317] [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: 05/09/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Background: We aimed to assess the effectiveness and safety of transcatheter arterial embolization (TAE) in the management of spontaneous or traumatic psoas and/or retroperitoneal hemorrhage. Methods: This single-center retrospective study enrolled 36 patients who underwent TAE for the treatment of psoas and/or retroperitoneal hemorrhage between May 2016 and February 2024. Results: The patients' mean age was 61.3 years. The spontaneous group (SG, 47.1%) showed higher rates of anticoagulation therapy use compared with the trauma group (TG, 15.8%) (p = 0.042). The TG (94.7%) demonstrated higher survival rates compared with the SG (64.7%; p = 0.023). Clinical failure was significantly associated with the liver cirrhosis (p = 0.001), prothrombin time (p = 0.004), and international normalized ratio (p = 0.007) in SG and pRBC transfusion (p = 0.008) in TG. Liver cirrhosis (OR (95% CI): 55.055 (2.439-1242.650), p = 0.012) was the only identified independent risk factor for primary clinical failure in the multivariate logistic regression analysis. Conclusions: TAE was a safe and effective treatment for psoas and/or retroperitoneal hemorrhage, regardless of the cause of bleeding. However, liver cirrhosis or the need for massive transfusion due to hemorrhage increased the risk of clinical failure and mortality, necessitating aggressive monitoring and treatment.
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Affiliation(s)
- Chang Hoon Oh
- Department of Radiology, Ewha Womans Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea;
| | - Soo Buem Cho
- Department of Radiology, Ewha Womans Seoul Hospital, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Hyeyoung Kwon
- Department of Radiology, Chungnam University Hospital, Chungnam University School of Medicine, Daejeon 35015, Republic of Korea;
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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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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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Lukies M, Gipson J, Tan SY, Clements W. Spontaneous Retroperitoneal Haemorrhage: Efficacy of Conservative Management and Embolisation. Cardiovasc Intervent Radiol 2023; 46:488-495. [PMID: 36720738 PMCID: PMC9888734 DOI: 10.1007/s00270-023-03359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/03/2023] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the efficacy of conservative management and embolisation in patients with spontaneous retroperitoneal haemorrhage. METHODS Single-centre retrospective case-control study of patients with spontaneous retroperitoneal haemorrhage treated conservatively or with embolisation. Patients aged ≥ 18 years were identified from CT imaging reports stating a diagnosis of retroperitoneal haemorrhage or similar and images reviewed for confirmation. Exclusion criteria included recent trauma, surgery, retroperitoneal vascular line insertion, or other non-spontaneous aetiology. Datapoints analysed included treatment approach (conservative or embolisation), technical success, clinical success, and mortality outcome. RESULTS A total of 54 patients met inclusion criteria, who were predominantly anticoagulated (74%), male (72%), older adults (mean age 69 years), with active haemorrhage on CT (52%). Overall mortality was 15%. Clinical success was more likely with conservative management (36/38) than embolisation (9/16; p < 0.01), and all-cause (1/38 vs 7/16; p < 0.01) and uncontrolled primary bleeding (1/38 vs 5/16; p < 0.01) mortality were higher with embolisation. However, embolised patients more commonly had active bleeding on CT (15/38 vs 13/16; p < 0.01), shock (5/38 vs 6/16; p < 0.04), and higher blood transfusion volumes (mean 2.2 vs 5.9 units; p < 0.01). After one-to-one propensity score matching, differences in clinical success (p = 0.04) and all-cause mortality (p = 0.01) remained; however, difference in uncontrolled primary bleeding mortality did not (p = 0.07). CONCLUSION Conservative management of SRH is likely to be effective in most patients, even in those who are anticoagulated and haemodynamically unstable, with variable success seen after embolisation in a more unstable patient group, supporting the notion that resuscitation and optimisation of coagulation are the most vital components of treatment.
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Affiliation(s)
- Matthew Lukies
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004 Australia ,Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Jacob Gipson
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004 Australia
| | - Sia Yang Tan
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004 Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004 Australia ,Department of Surgery, Monash University, Melbourne, VIC Australia ,National Trauma Research Institute, Melbourne, VIC Australia
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Prostatic Artery Embolization for Benign Prostatic Obstruction: Single-Centre Retrospective Study Comparing Microspheres Versus n-Butyl Cyanoacrylate. Cardiovasc Intervent Radiol 2022; 45:814-823. [PMID: 35266024 DOI: 10.1007/s00270-022-03069-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/24/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE To compare the safety and efficacy of n-butyl cyanoacrylate glue (NBCA) versus microspheres for prostatic artery embolization (PAE) in patients with benign prostatic obstruction (BPO). MATERIALS AND METHODS This institutional review board-approved, single-centre, retrospective study included consecutive patients undergoing PAE from September 2017 to July 2020. Age, medical history, previous treatment, pre- and post-PAE prostatic volumes and International Prostate Symptom Scores (IPSSs) were systematically analysed. Procedural duration, dosimetry, immediate and delayed complications were recorded. Patients at the beginning of the study were treated with microspheres and patients at the end of the study with NBCA. The main outcome measures were the absolute and relative changes in IPSS at 3 months. Statistical analyses comprised unpaired t-tests, Wilcoxon tests, Chi-2 tests, uni- and multivariate linear regressions. RESULTS Sixty-two patients were included (median age: 65.9 years). Thirty-two patients were treated with microspheres and 30 with NBCA. There were no significant baseline differences between the two groups except for the baseline PSA (P = 0.0251). Average procedural and fluoroscopy times, and radiation exposure were significantly lower in the NBCA group versus the microspheres group (80.7 ± 22.5 versus 112 ± 42.1 min [P = 0.0011], 24.2 ± 9.6 min versus 42.1 ± 20.2 min [P = 0.0001], 12,004.6 ± 6702 uGy.m2 versus 25,614.9 ± 15,749.2 uGy.m2 [P = 0.0001], respectively). Immediate complications were all minor, and there were no significant differences between the two groups (4/32 [12.5%] with microspheres versus 7/30 [23.3%] with NBCA, P = 0.4335), nor for delayed complications (P = 1). No association was found between the PAE techniques and the absolute change in IPSS at 3 months (-10.2 ± 7.9 with microspheres versus -9.5 ± 7.6 with NBCA, P = 0.7157). CONCLUSION PAE using NBCA was safe and effective for symptomatic BPO, with faster procedures, lower radiation exposure and similar safety and efficacy compared to microspheres. Operator learning curve could have biased the procedural times and radiation exposure between groups favouring NBCA.
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Patidar Y, Srinivasan SV, Singh J, Patel RK, Chandel K, Mukund A, Sharma MK, Sarin SK. Clinical Outcomes of Transcatheter Arterial Embolization Using N-butyl-2-cyanoacrylate (NBCA) in Cirrhotic Patients. J Clin Exp Hepatol 2022; 12:353-361. [PMID: 35535058 PMCID: PMC9077175 DOI: 10.1016/j.jceh.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To evaluate the clinical outcomes of transcatheter arterial embolization (TAE) with n-butyl-2-cyanoacrylate (NBCA) for treatment of bleeding in cirrhotic patients. Materials and methods A total of 35 cirrhotic patients (26 men, 9 women; mean age, 48.4 ± 11.1) who underwent TAE with NBCA for bleeding from January 2011 to December 2020 were retrospectively analysed. Only cirrhotic patients with active arterial bleeding confirmed on computed tomography (CT) were included. Fifteen patients were hemodynamically unstable before embolization procedure, and coagulopathy was observed in 32 patients. The mean MELD score and Child Pugh score were 24 ± 9.9 and 9.9 ± 2.2, respectively. The mean haemoglobin level and mean number of RBC units transfused before embolization were 7.4 ± 1.4 g/dL and 10.2 ± 4, respectively. The technical, clinical success rate and 30-day mortality rate were evaluated. Results Technical success and clinical success rates were achieved in 100% and 82.8% of patients, respectively. Overall 30-day mortality rate was 48%. No major complications related to the embolization procedure was seen. Only the greater number of RBC units transfused before the embolization procedure (OR = 1.81, 95% CI = 1.17-2.80, P = 0.007) was significantly associated with clinical failure. Greater number of RBC units transfused (OR = 1.53, 95% CI: 1.00-2.34, P = 0.004) and higher Child Pugh score (OR 2.44, 95% CI 1.26-4.71, P = 0.008) were significantly associated with higher 30-day mortality rate. Conclusion Transcatheter arterial embolization using NBCA can be used as the effective treatment option for bleeding in cirrhotic patients which has a high technical and clinical success despite the grave prognosis associated with cirrhosis.
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Key Words
- CT, computed tomography
- INR, international normalized ratio
- IQR, Interquartile range
- MELD, model for end-stage liver disease
- NASH, non-alcoholic steatohepatitis
- NBCA
- NBCA, N-butyl-2-cyanoacrylate
- OR, Odds ratio
- PVA, polyvinyl alcohol
- RBC, red blood cell
- TAE, transarterial embolization
- acute arterial bleeding
- cirrhotic patients
- coagulopathy
- transcatheter arterial embolization
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Affiliation(s)
- Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Shyam V. Srinivasan
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Jitender Singh
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Ranjan K. Patel
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Karamvir Chandel
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Manoj K. Sharma
- Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
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Liao ED, Puckett Y. A Proposed Algorithm on the Modern Management of Rectus Sheath Hematoma: A Literature Review. Cureus 2021; 13:e20008. [PMID: 34987899 PMCID: PMC8716009 DOI: 10.7759/cureus.20008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/05/2022] Open
Abstract
Rectus sheath hematoma (RSH) is a common entity with no clearly established protocol for management. Existing literature on RSH is outdated and does not incorporate modern technological advances in medicine and imaging. A total of 21 studies were included in this literature review based on PubMed and Google Scholar searches. Modern literature was selected from the last 10 years with the inclusion of three past pieces of literature. We performed a literature review to identify the latest research on RSH management and to consolidate an algorithm to help guide modern RSH treatment. Current RSH classification, scoring system, algorithm, and other predictors for treatment plan are discussed. The best RSH management requires early recognition of RSH followed by the appropriate implementation of conservative management and procedural intervention. The decision on picking the treatment of choice is assisted with the use of predictors, such as hematoma size, rate of hemoglobin drop, and the number of blood transfusions. Further studies are needed to clearly establish predictors among the different types of procedural intervention, and we hope the consolidated algorithm on current literature can help promote the standardization of protocol in the future.
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Affiliation(s)
- En-Dien Liao
- Critical Care Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Yana Puckett
- Surgery, West Virginia University School of Medicine, Charleston, USA
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Comby PO, Guillen K, Chevallier O, Lenfant M, Pellegrinelli J, Falvo N, Midulla M, Loffroy R. Endovascular Use of Cyanoacrylate-Lipiodol Mixture for Peripheral Embolization: Properties, Techniques, Pitfalls, and Applications. J Clin Med 2021; 10:4320. [PMID: 34640339 PMCID: PMC8509239 DOI: 10.3390/jcm10194320] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 12/30/2022] Open
Abstract
Endovascular embolization agents are particles and fluids that can be released into the bloodstream through a catheter to mechanically and/or biologically occlude a target vessel, either temporarily or permanently. Vascular embolization agents are available as solids, liquids, and suspensions. Although liquid adhesives (glues) have been used as embolic agents for decades, experience with them for peripheral applications is generally limited. Cyanoacrylates are the main liquid adhesives used for endovascular interventions and have a major role in managing vascular abnormalities, bleeding, and many vascular diseases. They can only be injected as a mixture with ethiodized oil, which provides radiopacity and modulates the polymerization rate. This review describes the characteristics, properties, mechanisms of action, modalities of use, and indications of the cyanoacrylate-Lipiodol® combination for peripheral embolization.
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Affiliation(s)
- Pierre-Olivier Comby
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (P.-O.C.); (M.L.)
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France; (K.G.); (O.C.)
| | - Kévin Guillen
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France; (K.G.); (O.C.)
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (J.P.); (N.F.); (M.M.)
| | - Olivier Chevallier
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France; (K.G.); (O.C.)
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (J.P.); (N.F.); (M.M.)
| | - Marc Lenfant
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (P.-O.C.); (M.L.)
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France; (K.G.); (O.C.)
| | - Julie Pellegrinelli
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (J.P.); (N.F.); (M.M.)
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (J.P.); (N.F.); (M.M.)
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (J.P.); (N.F.); (M.M.)
| | - Romaric Loffroy
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France; (K.G.); (O.C.)
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (J.P.); (N.F.); (M.M.)
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Patrone R, Granata V, Belli A, Palaia R, Albino V, Piccirillo M, Fusco R, Tatangelo F, Nasti G, Avallone A, Izzo F. The safety and efficacy of Glubran 2 as biliostatic agent in liver resection. Infect Agent Cancer 2021; 16:19. [PMID: 33726798 PMCID: PMC7968309 DOI: 10.1186/s13027-021-00358-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
Background Biloma, an encapsulated collection of bile outside the biliary tree, supported by a predominantly iatrogenic biliary fistula, and bile likeage are two of the most important surgical complications after liver resection. We, hypothesized to conduct a project aimed to prevent, or reduce, the formation of biloma or biliary fistula applying on the hepatic resection area the cyanoacrylate glue (Glubran2). Methods We searched in our surgical database all patients underwent liver resection for mCRC from January 2013 to December 2018 and we found a total of 510 patients. 205 patients for Group A (study population: included patients in which we have used Glubran2 during surgical procedure) and 113 patients for Group B (control group), were enrolled. Results In both Groups no patients died during hospitalization and the 30-day mortality was 0 %. During follow-up in Group A, a biliary fistula was found in 2 patients (1 %) versus 3 patients in the Group B (2,6 %). In patients enrolled in Group A no adverse event were reported relate to the use of Glubran2. Conclusions It is possible to affirm that the use of Glubran2 as biliostatic agent after liver resection is useful to prevent bile leakage complication and biloma formation and its use demonstrated to be safe and feasible during liver surgery.
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Affiliation(s)
- Renato Patrone
- PhD ICTH, University Federico II, Via Sergio Pansinin 5, 80131, Naples, Italy
| | - Vincenza Granata
- Department of Support to Cancer Pathways Diagnostics Area, Radiology Unit, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy. .,Radiology Division, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy.
| | - Andrea Belli
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Raffaele Palaia
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Vittorio Albino
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Mauro Piccirillo
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Roberta Fusco
- Department of Support to Cancer Pathways Diagnostics Area, Radiology Unit, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Fabiana Tatangelo
- Department of Support to Cancer Pathways Diagnostics Area, Pathology and Cytopathology Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - IRCCS Napoli", Naples, Italy
| | - Guglielmo Nasti
- Department Corp-S Care and Research of Cancer of the Abdominal District, Oncology Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - IRCCS Napoli", Naples, Italy
| | - Antonio Avallone
- Department Corp-S Care and Research of Cancer of the Abdominal District, Oncology Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - IRCCS Napoli", Naples, Italy
| | - Francesco Izzo
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
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Albuquerque TVC, Monsignore LM, de Castro-Afonso LH, Elias-Junior J, Muglia VF, Abud DG. Transarterial embolization with n-butyl cyanoacrylate for the treatment of abdominal wall hemorrhage. ACTA ACUST UNITED AC 2021; 26:216-222. [PMID: 32209512 DOI: 10.5152/dir.2019.19348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE We aimed to evaluate the effectiveness and safety of n-butyl cyanoacrylate (n-BCA) in the context of the transarterial embolization (TAE) of abdominal wall hemorrhage in an urgent scenario. METHODS A retrospective study of cases admitted from January 2008 to December 2017 in the emergency unit of our institution revealed 11 patients with abdominal wall hemorrhage who underwent digital subtraction angiography and TAE with n-BCA. We analyzed the sex, age, hemorrhagic risk factors, etiology, embolized vessel, technical success (no rebleeding in the embolized area), clinical success (hemoglobin level control and hemodynamic stability after the procedure), complications inherent to the procedure, and clinical outcome (mortality in 30 days). RESULTS The mean age was 63.4 years (52-83 years), with a predominance of the female sex (64%). The majority (91%) of patients presented hemorrhagic risk factors (chronic hepatopathy and anticoagulation drug usage). Spontaneous hemorrhage was present in 18% of patients, and the other 82% had an iatrogenic etiology. Technical success was achieved in 100% of the patients, which required the embolization of inferior epigastric artery in 10 patients (91%), circumflex iliac artery in 2 (18%), and superior epigastric artery in 1 (9%). Five patients were hemodynamically unstable, and despite achieving technical success, 4 (36%) died in less than 30 days due to decompensation of their clinical comorbidities caused by the acute phase. There were no complications inherent to the procedures. CONCLUSION The present study concludes that TAE with n-BCA is a safe and effective treatment for abdominal wall hemorrhage in an urgent scenario, with high rates of technical and clinical success.
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Affiliation(s)
- Tales Vieira Cavalcanti Albuquerque
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, São Paulo University Ribeirão Preto School of Medicine, São Paulo, Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, São Paulo University Ribeirão Preto School of Medicine, São Paulo, Brazil
| | - Luis Henrique de Castro-Afonso
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, São Paulo University Ribeirão Preto School of Medicine, São Paulo, Brazil
| | - Jorge Elias-Junior
- Division of Abdominal Radiology, Department of Radiology, Hematology and Oncology, São Paulo University Ribeirão Preto School of Medicine, São Paulo, Brazil
| | - Valdair Francisco Muglia
- Division of Abdominal Radiology, Department of Radiology, Hematology and Oncology, São Paulo University Ribeirão Preto School of Medicine, São Paulo, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, São Paulo University Ribeirão Preto School of Medicine, São Paulo, Brazil
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Contrella BN, Park AW, Wilkins LR, Sheeran D, Hassinger TE, Angle JF. Spontaneous Rectus Sheath Hematoma: Factors Predictive of Conservative Management Failure. J Vasc Interv Radiol 2020; 31:323-330. [PMID: 31734076 DOI: 10.1016/j.jvir.2019.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate radiographic, laboratory, and clinical factors associated with conservative management (CM) failure in spontaneous rectus sheath hematoma (RSH). MATERIALS AND METHODS Retrospective review of 72 patients with spontaneous RSH between 2006 and 2017 was performed. Patients were initially managed conservatively and then divided into 2 groups based on decision to embolize. No differences were found between embolization (n = 32) and CM (n = 40) groups in age (67.5 vs 69.5 y; P = .79), sex (31% vs 38% male; P = .58), body mass index (27.7 vs 25.7 kg/m2; P = .20), or medical comorbidities. Univariate analyses compared initial hemoglobin level, change in hemoglobin level, coagulation parameters, transfusion requirements, hematoma volume, and active extravasation on computed tomographic (CT) angiography between groups. Multivariable logistic regression identified factors predictive of CM failure. A scoring system was then created to predict CM failure. RESULTS CM failed in 32 of 72 patients. Multivariable regression identified active extravasation on CT angiography (P = .02), hematoma volume (P = .01), and packed red blood cell (pRBC) transfusion of ≥ 4 U (P = .03) as predictors of embolization. A scoring system using these factors along with maximum rate of hemoglobin decrease yielded a sensitivity of 100% and specificity of 98% in determining need for embolization. CONCLUSIONS CM for RSH was more likely to fail in patients with active extravasation on CT angiography, larger hematoma volume, pRBC transfusion of ≥ 4 U, and higher rate of hemoglobin decrease. Using these parameters, a scoring system was created that achieved high sensitivity and specificity in identifying patients who would require embolization.
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Affiliation(s)
- Benjamin N Contrella
- Department of Radiology, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908.
| | - Auh Whan Park
- Department of Radiology, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908
| | - Luke R Wilkins
- Department of Radiology, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908
| | - Daniel Sheeran
- Department of Radiology, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908
| | - Taryn E Hassinger
- Department of Medical Imaging and Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908
| | - J Fritz Angle
- Department of Radiology, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908
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12
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Nezu K, Yoshioka T, Katayama H, Fukushi T, Kyan A. Spontaneous iliopsoas muscle hematoma secondary to disseminated intravascular coagulation caused by nafamostat mesilate allergy: a case study. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0207-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Loffroy R, Falvo N, Nakaï M, Pescatori L, Aho-Gléglé S, Gehin S, Berthod PE, Né R, Vincent J, Ghiringhelli F, Midulla M, Chevallier O. Partial splenic embolization with Glubran ®2/Lipiodol ® mixture for oncological patients with hypersplenism-related thrombocytopenia requiring systemic chemotherapy. Quant Imaging Med Surg 2019; 9:409-417. [PMID: 31032188 DOI: 10.21037/qims.2019.03.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Partial splenic embolization (PSE) has been used to improve thrombocytopenia related to hypersplenism. The optimal embolic agent is still debated. The purpose of this study was to evaluate the safety, hematologic response and outcomes of PSE with cyanoacrylate glue for oncological patients with hypersplenism-related thrombocytopenia requiring systemic chemotherapy (SC). Methods Retrospective single-center observational report of cancer patients with thrombocytopenia related to hypersplenism and requiring SC who underwent PSE with N-butyl cyanoacrylate-methacryloxy sulfolane (NBCA-MS) Glubran®2 glue between February 2015 and September 2017. All patients were treated under local anesthesia with a Glubran®2/Lipiodol® mixture of 1:5 ratio. They all received empiric antibiotic coverage. Splenic volume and parenchyma infarction rate were evaluated by CT scan within 1 month of PSE. Primary and secondary endpoints of the current study included a platelet count increase >150×109/L and the initiation of SC, respectively. Periprocedural laboratory values and adverse events were recorded. Results PSE was performed in eight patients (6 males, 2 females; median age, 59 years; range, 33-75 years) for a technical success of 100%. For procedures with adequate follow-up, primary and secondary endpoints were achieved in 100% (7 of 7 patients) and 100% (7 of 7 patients) of patients, respectively. One patient died before follow-up, unrelated to the procedure. Mean splenic infarction post-PSE was 55% (range, 21-70%) on CT scan. For 7 patients with laboratory follow-up, the mean platelet count significantly increased from 74×109/L [range, (62-83) ×109/L] immediately before PSE to a peak level of 272×109/L [range, (161-417) ×109/L] 10 days after PSE (P<0.05). All patients could receive SC after PSE. No non-target glue embolization occurred. All patients experienced a transient and moderate postembolization syndrome. No severe postembolization syndrome occurred. No major complication was reported. The mean overall survival was 7.9 months (range, 0.6-10.4 months) among the 8 patients after PSE. Conclusions PSE with cyanoacrylate glue is safe and effective in the management of thrombocytopenia related to hypersplenism in cancer patients. It allows sufficient platelet count improvement for administration of SC.
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Affiliation(s)
- Romaric Loffroy
- Department of Image-Guided Therapy, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- Department of Image-Guided Therapy, François-Mitterrand University Hospital, Dijon, France
| | - Motoki Nakaï
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Lorenzo Pescatori
- Department of Image-Guided Therapy, François-Mitterrand University Hospital, Dijon, France
| | - Serge Aho-Gléglé
- Department of Epidemiology and Biostatistics, François-Mitterrand University Hospital, Dijon, France
| | - Sophie Gehin
- Department of Image-Guided Therapy, François-Mitterrand University Hospital, Dijon, France
| | | | - Romaric Né
- Department of Image-Guided Therapy, François-Mitterrand University Hospital, Dijon, France
| | - Julie Vincent
- Department of Medical Oncology, Georges-François-Leclerc Center, Dijon, France
| | | | - Marco Midulla
- Department of Image-Guided Therapy, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Image-Guided Therapy, François-Mitterrand University Hospital, Dijon, France
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14
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Barral M, Pellerin O, Tran VT, Gallix B, Boucher LM, Valenti D, Sapoval M, Soyer P, Dohan A. Predictors of Mortality from Spontaneous Soft-Tissue Hematomas in a Large Multicenter Cohort Who Underwent Percutaneous Transarterial Embolization. Radiology 2019; 291:250-258. [DOI: 10.1148/radiol.2018181187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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15
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Yata S, Ohuchi Y, Adachi A, Endo M, Takasugi S, Tsukamoto K, Matsumoto K, Kodani M, Makishima J, Fujii S. Is glue embolization safe and effective for gastrointestinal bleeding? INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2018. [DOI: 10.18528/gii180030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Shinsaku Yata
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yasufumi Ohuchi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Akira Adachi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Masayuki Endo
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Shohei Takasugi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Kazumichi Tsukamoto
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Kensuke Matsumoto
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Mika Kodani
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Jun Makishima
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Tottori, Japan
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16
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van den Berg JC. Imaging and endovascular management of traumatic pelvic fractures with vascular injuries. VASA 2018; 48:47-55. [PMID: 30362910 DOI: 10.1024/0301-1526/a000757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This paper will give an overview of the relevant anatomy, management and imaging, aspects as well as therapeutic aspects of traumatic pelvic fractures with vascular injuries.
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Affiliation(s)
- Jos C van den Berg
- 1 Ospedale Regionale di Lugano, Sede Civico, Lugano, Switzerland / University Institute for Diagnostic, Interventional and Pediatric Radiology, Inselspital - University Hospital Berne, Switzerland
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17
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Pugh R, Wessel B, Zuberi OS, Vyleta MS. Iliac bone biopsy complicated by hematoma: Hemostasis achieved with glue injection. Radiol Case Rep 2018; 13:1112-1115. [PMID: 30233739 PMCID: PMC6138938 DOI: 10.1016/j.radcr.2018.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 01/30/2023] Open
Abstract
Serious hemorrhage after a bone biopsy is a rare complication of the procedure. Due to the infrequency of this complication, there is limited literature available regarding the treatment. Here, we present a case of a 70-year-old male who developed a symptomatic gluteal hematoma after an iliac bone lesion biopsy. Hemostasis was achieved by injecting an N-butyl cyanoacrylate glue solution into the bone cannulation site under CT-guidance.
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Affiliation(s)
- Robert Pugh
- University of Louisville, Department of Radiology, Louisville, KY 40202, USA
| | - Bryan Wessel
- University of Louisville, Department of Radiology, Louisville, KY 40202, USA
| | - Omar S Zuberi
- University of Louisville, Department of Radiology, Louisville, KY 40202, USA
| | - Martin S Vyleta
- University of Louisville, Department of Radiology, Louisville, KY 40202, USA
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