Prophylactic absorbable gelatin sponge embolization for angiographically occult splenic hemorrhage

Exercise-induced traumatic muscle injuries with active bleeding successfully treated by embolization: three case reports

Muscle injuries caused by indirect trauma during exercise are common. Most of these injuries can be managed conservatively; however, further treatment is required in extreme cases. Although transcatheter arterial embolization is a possible treatment modality, its role in traumatic muscle injuries remains unclear. In this case series, we present three cases of exercise-induced muscle hemorrhage treated by transcatheter arterial embolization with successful outcomes. The damaged muscles were the rectus abdominis, adductor longus, and iliopsoas, and the vascular injuries were accessed via the femoral artery during the procedures.

Emergency endovascular treatments for delayed hemorrhage after pancreaticobiliary surgery: indications, outcomes, and follow-up of a retrospective cohort

PURPOSE

To evaluate the outcomes of emergency endovascular treatments for delayed bleeding after pancreaticobiliary surgery.

METHODS

We retrospectively evaluated 21 patients (M:F = 13:8, median age = 64 years) undergoing 23 endovascular treatments, performed from 2010 to 2017 in a single center. Data collected were patient characteristics; surgery; pathology; incidence of postoperative pancreatic fistulas (POPF); bleeding signs on CT and angiography; damaged artery; endovascular tools used; technical and clinical success; intervals between surgery, endovascular treatment, and discharge; survival rates.

RESULTS

Sixteen patients had pancreatoduodenectomy, three hepaticojejunostomy, two distal pancreatectomy. Indications for surgery were mainly biliary (33%), pancreatic (19%), or duodenal (10%) malignancies. Seventeen patients had "grade C" POPF, three suffered a biliary leak, one had no POPF. Active bleeding was present in 17/23 CTs and in 22/23 angiographies, mostly from hepatic (43%), gastroduodenal (22%), and splenic (13%) arteries. The endovascular treatments were performed with coils (26%), glue (22%), stent-graft (22%), and their combinations (30%). Sixteen patients had a single endovascular treatment, one underwent a second embolization, three had subsequent surgery, one had repeat embolization followed by surgery. Relaparotomy rate was 19%. Median hospital stay was 37 days (range 12-75); median intervals among pancreaticobiliary surgery, endovascular treatment, and discharge were 21 (2-36) and 12 (8-47) days, respectively. We observed 4/21 intrahospital deaths (median: 31 days from endovascular treatment, 4-53); 1-year survival rate of discharged patients was 71%.

CONCLUSIONS

Endovascular treatment using embolization and/or stent-graft placement is a useful first-line intervention to halt postoperative hemorrhage after pancreaticobiliary surgery and decreases the need for urgent relaparotomy.

Trauma CT evaluation prior to selective angiography in patients with traumatic injuries: negative predictive power and factors affecting its utility

PURPOSE

To evaluate the predictive power of arterial injury detected on contrast-enhanced CT (trauma CT (tCT)) imaging obtained prior to selective angiography for treatment of patients with traumatic abdominal and pelvic injuries.

MATERIALS AND METHODS

A retrospective chart review was performed of all patients who underwent angiography after undergoing contrast-enhanced CT imaging for the evaluation/treatment of traumatic injuries to the abdomen and pelvis between March 2014 and September 2018. Data collection included demographics, pertinent history and physical findings, CT and angiography findings, treatment information, and outcomes.

RESULTS

Eighty-nine (63 males, mean age = 45.8 ± 20.5 years) patients that were found to have 102 traumatic injuries on tCT and subsequently underwent angiography met inclusion criteria for this study. Sixty-four injuries demonstrated evidence of traumatic vascular injury on initial tCT. A negative tCT was able to predict subsequent negative angiography in 83% of cases (negative predictive power = 83%). The ability of tCT to rule out a positive finding on subsequent angiography was also 83% (sensitivity = 83%). The average systolic blood pressure and hemoglobin concentration at the time of tCT were higher in patients who had positive tCT than in patients with negative tCT (p < 0.05 and p < 0.01, respectively). The average time to angiography was greater in patients whom had subsequent negative angiography than the patients who had subsequent positive angiography (p < 0.05).

CONCLUSION

Contrast-enhanced CT imaging may be able to help stratify patients who may have subsequent negative angiograms. Hemodynamic factors may affect sensitivity of tCT. Shorter time to angiography may increase the chance of identifying the injury on subsequent angiography.