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Wilderman M, Tateishi K, O'Connor D, Simonian S, Ratnathicam A, Cook K, De Gregorio L, Hmoud H, De Gregorio J. Safety and efficacy of covered stent grafts in the treatment of emergent access related complications. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00628-6. [PMID: 39168761 DOI: 10.1016/j.carrev.2024.08.011] [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: 05/19/2024] [Revised: 08/06/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Large bore percutaneous access is becoming increasingly common. Parallel to this, we observe an increase in vascular access site complications such as bleeding, dissection, thrombosis or pseudo-aneurysms. This study was aimed to evaluate safety and efficacy of covered stent grafts for fixing large bore vascular access injuries. METHODS A total of 147 Viabahn or Viabahn VBX (WL Gore) stent grafts which were placed across the inguinal ligament in emergent settings in 136 patients, were retrospectively analyzed. The two endpoints were the technical success rate, defined by complete arterial repair, and long-term stent graft patency. We also looked at the need for open conversion, wound infections, and in hospital and 30-day mortality. We followed the patients using duplex ultrasound and computed tomography angiogram to assess for arterial patency, freedom from intervention, stent kinking and clinical symptoms. RESULTS 30 Viabahn and 117 Viabahn VBX (WL Gore) stent grafts were placed in the distal external iliac artery and into the proximal common femoral artery of 136 patients. Indications for intervention were bleeding in 92 patients (68 %), flow limiting dissection in 41 patients (30 %) and symptomatic AVF in 3 patients (2 %). Primary technical success rate was 100 %. Limited 3-year follow up (101/136 patients) showed 99 % patency with no evidence of stent fracture, stenosis or kinking except in one patient who needed target lesion revascularization due to neointimal hyperplasia. CONCLUSIONS Covered stent grafts can be placed safely, efficiently, and effectively in the distal external iliac and common femoral arteries across the inguinal ligament. These stent grafts can be used as an alternative therapeutic option to open surgery in patients with large bore vascular access injuries.
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Affiliation(s)
- Michael Wilderman
- Department of Vascular Surgery, Bergen Vascular Institute, Hackensack, NJ, USA.
| | - Kazuya Tateishi
- Department of Cardiovascular Services, Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - David O'Connor
- Department of Vascular Surgery, Bergen Vascular Institute, Hackensack, NJ, USA
| | - Sophia Simonian
- Department of Vascular Surgery, Bergen Vascular Institute, Hackensack, NJ, USA
| | - Anjali Ratnathicam
- Department of Vascular Surgery, Bergen Vascular Institute, Hackensack, NJ, USA
| | - Kristen Cook
- Department of Vascular Surgery, Bergen Vascular Institute, Hackensack, NJ, USA
| | | | - Hosam Hmoud
- Department of Cardiology, Lenox Hill Hospital Northwell Health, New York, NY, USA
| | - Joseph De Gregorio
- Department of Cardiovascular Services, Englewood Hospital and Medical Center, Englewood, NJ, USA
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2
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Fujiwara T, Ikeda H, Kuriyama A, Ono T, Takada K, Handa A, Uezato M, Kinosada M, Kurosaki Y, Chin M. Inferior Epigastric Artery Injury due to Femoral Venipuncture for Neuroendovascular Intervention: Two Cases Requiring Transcatheter Arterial Embolization. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 16:467-473. [PMID: 37502792 PMCID: PMC10370989 DOI: 10.5797/jnet.cr.2022-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/01/2022] [Indexed: 07/29/2023]
Abstract
Objective Injury to the inferior epigastric artery (IEA) caused by femoral puncture may lead to retroperitoneal hematoma. We report on two cases of IEA injury due to femoral venipuncture for neuroendovascular intervention that resulted in hemorrhagic shock and required transcatheter arterial embolization. Case Presentations A 67-year-old woman and a 71-year-old man receiving dual antiplatelet therapy sustained injury to a branch of the IEA in the process of right femoral venipuncture for neuroendovascular intervention. In both cases, stent placement in the intracranial artery was accomplished as intended with systemic heparinization throughout the procedure; however, the patients became hypotensive during the procedure, and contrast-enhanced CT scans taken after the stenting revealed extravasation of contrast from the IEA and retroperitoneal hematoma. Transcatheter arterial embolization of the bleeding branch of the IEA was performed with the left femoral approach, and subsequent angiography confirmed the disappearance of the extravasation of contrast. Conclusion Femoral venipuncture for neuroendovascular intervention in patients receiving antithrombotic agents may cause IEA injury requiring transcatheter arterial embolization. The risk of IEA injury may be reduced by using the femoral head as a reference, performing ultrasound-guided puncture, and confirming the course of the IEA by femoral angiography before venipuncture.
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Affiliation(s)
- Toshio Fujiwara
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Hiroyuki Ikeda
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takafumi Ono
- Department of Diagnostic Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Kensuke Takada
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akira Handa
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Minami Uezato
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masanori Kinosada
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yoshitaka Kurosaki
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masaki Chin
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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3
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Semeraro V, Vidali S, Borghese O, Ganimede MP, Gandini R, Di Stasi C, Burdi N. Glue Embolization in the Management of Rectus Sheath Hematomas. Vasc Endovascular Surg 2022; 56:269-276. [PMID: 35068270 DOI: 10.1177/15385744211068742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aims to describe the results achieved in the management of rectus sheath hematoma (RSH) using glue embolization. METHOD Data about all consecutive patients presenting with RSH, between January 2005 and December 2020 were retrospectively reviewed. RSHs were classified according to the Berna CT scan Classification. Clinical and technical outcomes were evaluated during in-hospital period and 1-month follow-up. RESULTS Among 74 patients presenting with RSH, CTA revealed an active bleeding in 61 (n = 42, 69% women; median age = 68.8 y range: 47-91). 19 cases of type 1 RSH (25.7%), under anticoagulation therapy and hemodynamically stable, were successfully managed conservatively. Conversely, endovascular embolization with cyanoacrylate glue diluted with ethiodized oil (Lipiodol Ultrafluid, Guerbet, France) was needed in n = 42 (56.8%) patients, in 16 cases after failure of conservative management; a single session of percutaneous glue embolization was adequate to achieve technical and clinical success in all patients with stabilization or progressive improvement of hemoglobin values after procedure (7.1 + 1.8 g/dL pre-procedure vs 11.1 + 1.6 g/dL post-procedure). No major complications occurred. Two minor complications were reported: 1 case (2.4%) of puncture site-related complication (local self-limiting hematoma) and 1 case (2.4%) of post-embolization syndrome (abdominal pain) spontaneously regressive. The median hospital stay was 7 d. At 30-day follow-up, 2 patients (2.7%) died of multiorgan failure. CONCLUSIONS In the management of RSH, glue embolization was shown to be safe and efficacious. Glue allowed the immediate occlusion of both the "front and back doors" of bleeding without the need to reach the bleeding point, preventing potentially life-threatening recurrence.
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Affiliation(s)
- Vittorio Semeraro
- Department of Interventional Radiology, 170131Santissima Annunziata Hospital,Taranto, Italy
| | - Sofia Vidali
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, 18654University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Ottavia Borghese
- Angio-cardio-thoracic Pathophysiology and Imaging, Sapienza University, Rome, Italy
| | - Maria Porzia Ganimede
- Department of Interventional Radiology, 170131Santissima Annunziata Hospital,Taranto, Italy
| | - Roberto Gandini
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, 18654University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Carmine Di Stasi
- Department of Interventional Radiology, 170131Santissima Annunziata Hospital,Taranto, Italy
| | - Nicola Burdi
- Department of Neuroradiology, Santissima Annunziata Hospital, Taranto, Italy
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4
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Dryer EA, Abaza M, Almehmi A. Inferior epigastric artery injury after percutaneous imaging-guided peritoneal dialysis catheter placement. Radiol Case Rep 2021; 17:332-335. [PMID: 34876960 PMCID: PMC8633519 DOI: 10.1016/j.radcr.2021.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 11/30/2022] Open
Abstract
Inferior epigastric artery (IEA) injury is a rare clinical entity that is usually associated with abdominal wall procedures and injuries though can also be spontaneous, particularly in individuals with coagulopathy. Of all described mechanisms of injury, percutaneous peritoneal dialysis (PD) catheter insertion is a rarely encountered, particularly in instances where insertion is performed under imaging guidance. While this injury is self-limited, it can be associated with hemodynamic instability and acute blood loss anemia, which can be fatal if left untreated. Computed tomographic (CT) angiography is the diagnostic method of choice. Transcatheter arterial embolization is an effective treatment modality with a high success rate. Here, we describe a 41-year-old female who underwent percutaneous PD catheter insertion that, despite intraprocedural imaging guidance, was complicated by large hemoperitoneum and clinical instability. Prompt identification of IEA injury followed by immediate intervention with coil embolization led to a successful outcome for this patient in the setting of a life-threatening uncommon complication of such procedure. The details of the diagnostic evaluation and management are outlined.
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Affiliation(s)
- Emily A Dryer
- University of Alabama at Birmingham, Dept. of Medicine, Division of Nephrology, Birmingham, AL
| | - Masa Abaza
- University of Alaska at Anchorage, Dept. of Biology, Anchorage, AL
| | - Ammar Almehmi
- University of Alabama at Birmingham, Dept. of Radiology and Medicine, 619 19th Street South, Birmingham, AL 35294
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Kinoshita M, Enomoto H, Hiraoka J, Takaoka Y, Matsunaga N, Takechi K, Akagawa Y, Osaki K, Ohnishi N, Tani H. A Newly Developed Micro-Balloon Catheter that Allows Temporary Distal Blocking Selection in a Single Line During Transcatheter Arterial Embolization. Cardiovasc Intervent Radiol 2021; 44:1137-1140. [PMID: 33709277 DOI: 10.1007/s00270-021-02808-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/13/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Mitsuhiro Kinoshita
- Department of Radiology, Tokushima Red Cross Hospital, 103 Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan.
| | - Hideaki Enomoto
- Department of Radiology (Diagnostic Radiology), Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Junichiro Hiraoka
- Department of Radiology, Tokushima Red Cross Hospital, 103 Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan
| | - Yukiko Takaoka
- Department of Radiology (Diagnostic Radiology), Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Naoki Matsunaga
- Department of Emergency & Clinical Care Medicine, Tokushima Red Cross Hospital, 103 Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan
| | - Katsuya Takechi
- Department of Radiology, Tokushima Red Cross Hospital, 103 Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan
| | - Yoko Akagawa
- Department of Radiology, Tokushima Red Cross Hospital, 103 Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan
| | - Kyosuke Osaki
- Department of Radiology, Tokushima Red Cross Hospital, 103 Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan
| | - Norio Ohnishi
- Department of Radiology, Tokushima Red Cross Hospital, 103 Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan
| | - Hayato Tani
- Department of Radiology, Tokushima Red Cross Hospital, 103 Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan
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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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7
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Diamantopoulos A, Mulholland D, Katsanos K, Ahmed I, McGrath A, Karunanithy N, Sabharwal T. Transcatheter Embolization of the Inferior Epigastric Artery: Technique and Clinical Outcomes. Vasc Endovascular Surg 2020; 55:221-227. [PMID: 33308092 DOI: 10.1177/1538574420980576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Symptomatic rectus muscle sheath hematoma may be the result of bleeding originating from the inferior epigastric artery. We report the technique and the results from a series of consecutive patients treated by transcatheter embolization, evaluating both ipsilateral and contralateral retrograde approaches. METHODS This was a retrospective study including patients with verified rectus muscle sheath hematoma as a result of active extravasation from the inferior epigastric artery referred for transcatheter embolization. Technical success, clinical success and major complications were calculated. In addition, minor complications, blood transfusions required after a technically successful embolization, length of stay, peri-procedural and 30-day mortality and overall survival at 6 months were obtained. All statistical analysis was performed using SPSS. RESULTS Twenty-one patients (mean age = 59.67 ± 19.51 years old) were included. The cause of the bleeding in the vast majority was iatrogenic trauma (n = 12/21, 57.14%). Both contralateral (n = 12/21, 57.14%%) and ipsilateral (n = 9/21, 42.86%) retrograde approaches were used. Embolic materials included micro-coils (n = 13/20, 65%), microspheres (PVA) (n = 1/20, 5%), a combination of PVA and micro-coils (n = 5/20, 25%) and gel-foam (n = 1/20, 5%). Overall technical success was 95.2% (n = 20/21) while clinical success was achieved in all but one of the technically successful cases 95% (n = 19/20). One patient died peri-procedurally due to profound hemodynamic shock. There were no other major complications. Additional transfusion was necessary in 7 patients (n = 7/21, 33.33%). There was a significant increase in the hemoglobin levels after the embolization (7.03 ± 1.78 g/dL pre-procedure Vs 10.91 ± 1.7 g/dL post-procedure, p = 0.048). The median hospital stay was 8 days. The peri-procedure and 30-day mortality was 4.8% (n = 1/21) and 28.6% (n = 6/21) respectively. The 6-month survival was 61.9% (13/21). CONCLUSION Percutaneous embolization of the inferior epigastric artery is a minimally invasive method with satisfactory results. Both ipsilateral and contralateral retrograde approaches are feasible.
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Affiliation(s)
- Athanasios Diamantopoulos
- Department of Radiology, 8945Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, London, UK.,School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Douglas Mulholland
- Department of Radiology, 8945Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, London, UK
| | - Konstantinos Katsanos
- Department of Interventional Radiology, Patras University Hospital, School of Medicine, Patras, Rion, Greece
| | - Irfan Ahmed
- Department of Radiology, 8945Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, London, UK
| | - Andrew McGrath
- Department of Radiology, 57978Beaumont Hospital, Dublin, Ireland
| | - Narayan Karunanithy
- Department of Radiology, 8945Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, London, UK
| | - Tarun Sabharwal
- Department of Radiology, 8945Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, London, UK
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8
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Traumatic abdominal wall injuries-a primer for radiologists. Emerg Radiol 2020; 28:361-371. [PMID: 32827286 DOI: 10.1007/s10140-020-01842-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/13/2020] [Indexed: 12/12/2022]
Abstract
Traumatic abdominal wall injuries encompass a broad clinical and radiological spectrum and are identified in approximately 9% of blunt trauma patients. The most severe form of abdominal wall injury-a traumatic abdominal wall hernia-is seen in less than 1.5% of blunt abdominal trauma patients. However, the incidence of concurrent intra-abdominal injuries in these patients is high and can result in significant morbidity and mortality. Although the diagnosis of abdominal wall injuries is typically straight forward on CT, associated injuries may distract the interpreting radiologist in more subtle cases. Thus, it is important for the radiologist to identify abdominal wall injuries and their associated injuries on admission CT, as these injuries typically require surgical correction early in the course of their management. Untreated abdominal wall injuries subject the patient to increased risk of delayed bowel incarceration and strangulation. Therefore, it is important for the radiologist to be knowledgeable of injuries to the abdominal wall and commonly associated injuries to provide optimal patient triage and expedite management.
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Pech M, Serafin Z, Fischbach F, Damm R, Jargiełło T, Seidensticker M, Powerski M. Transarterial embolization of acute iatrogenic hemorrhages: predictive factors for mortality and outcome. Br J Radiol 2020; 93:20190413. [PMID: 32142365 PMCID: PMC10993211 DOI: 10.1259/bjr.20190413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Iatrogenic hemorrhages occur in 0.5-16% of medical procedures. A retrospective study was conducted to analyze technical and clinical outcome of transarterial embolization (TAE) used for acute iatrogenic hemorrhage and to identify factors predicting outcome. METHODS All patients undergoing TAE for acute iatrogenic bleeding from 2006 to 2013 were retrospectively analyzed. Primary end points were technical and clinical success or failure and 30 day mortality. RESULTS A total of 153 patients underwent 182 TAEs. Factors associated with clinical failure were lower blood hemoglobin concentration, use of higher number of units of red blood cell concentrate, TAE performed at night or weekend, embolization of more than one vessel, shock state before digital subtraction angiography (DSA), and intensive care before TAE. In multivariate analysis, independent factors for clinical success were hemoglobin concentration, number of units of red blood cell concentrate, and TAE of more than one vessel. Technical failure was associated with female gender, failure to detect signs of bleeding in DSA, TAE of more than one vessel, and shock state before DSA. Bleeding related to anticoagulation medication resulted in a significantly higher mortality rate compared with bleeding due to the remaining causes (30% vs 15%, p < 0.05). CONCLUSION Despite excellent technical success, the mortality rate was significant. The only factors affecting clinical success were bleeding intensity and extent of injury. Bleeding attributed to anticoagulation is related to high mortality and therefore requires special attention. ADVANCES IN KNOWLEDGE This study gives insights into morbidity and mortality of iatrogenic bleedings and the technical and clinical success rates of TAE in a large study population.
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Affiliation(s)
- Maciej Pech
- Department of Radiology and Nuclear Medicine, University of
Magdeburg, Magdeburg,
Germany
- Department of Radiology, Medical University of
Gdańsk, Gdańsk,
Poland
| | - Zbigniew Serafin
- Department of Radiology and Diagnostic Imaging, Nicolaus
Copernicus University, Bydgoszcz,
Poland
| | - Frank Fischbach
- Department of Radiology and Nuclear Medicine, University of
Magdeburg, Magdeburg,
Germany
| | - Robert Damm
- Department of Radiology and Nuclear Medicine, University of
Magdeburg, Magdeburg,
Germany
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology,
Medical University of Lublin,
Lublin, Poland
| | - Max Seidensticker
- Department of Radiology, University Hospital
Munich, Munich,
Germany
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, University of
Magdeburg, Magdeburg,
Germany
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10
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de Oliveira Leite TF. Superselective transcatheter arterial embolization of iatrogenic inferior epigastric artery after paracentesis: Unusual manifestation of hemoperitoneum. Int J Surg Case Rep 2020; 74:32-35. [PMID: 32777764 PMCID: PMC7417668 DOI: 10.1016/j.ijscr.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/05/2022] Open
Abstract
Hemoperitoneum is a rare complication in paracentesis. Paracentesis should be guided by ultrasound. Embolization of the lower epigastric artery is feasible and safe.
Introduction Paracentesis is a safe procedure and can be performed as a therapy or diagnosis in cancer patients, liver cirrhosis, heart or liver failure. Presentation of case 59-year-old man with alcoholic liver cirrhosis with ascites and coagulation abnormalities. After diagnostic paracentesis he presented hemodynamic instability with signs of hypovolemic shock and hemoperitoneum. Computed angiotomography with signs of active bleeding and pseudoaneurysm at the site of paracentesis. Discussion The interventional radiology unit was referred and submitted to arteriography, which demonstrated active bleeding from the left lower epigastric artery. It was successfully treated by transcatheter embolization with 100−300 μm PVA particles. Conclusion Transcatheter embolization with PVA particles is a fast, safe, minimally invasive, reliable method with a high technical success rate for the treatment of active bleeding resulting from injury to the lower epigastric artery.
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Affiliation(s)
- Tulio Fabiano de Oliveira Leite
- Medical School of Ribeirão Preto, University of São Paulo, Rua Rafael Rinaldi, 365, APT 601, Uberlândia, Minas Gerais, 38400.384, Brazil.
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11
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Manual on-the-fly physician postprocessing of computed tomographic angiography data guides embolotherapy of atypical bleeding following paracentesis; a case report. Clin Imaging 2019; 58:1-4. [PMID: 31207444 DOI: 10.1016/j.clinimag.2019.03.006] [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] [Received: 09/19/2018] [Revised: 01/23/2019] [Accepted: 03/07/2019] [Indexed: 11/24/2022]
Abstract
Major bleeding, typically due to laceration of abdominal wall arteries or venous varices, is a rare but serious complication of paracentesis. We report a case of major bleeding post paracentesis to evidence that a sequence of 1) customized post processing of computed tomographic angiography data for periprocedural guidance, followed by 2) transcatheter cyanoacrylate glue embolotherapy, is the optimal treatment of this complication.
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12
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Management of spontaneous soft-tissue hemorrhage secondary to anticoagulant therapy: A cohort study. Am J Emerg Med 2018; 36:2177-2181. [DOI: 10.1016/j.ajem.2018.03.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 11/21/2022] Open
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13
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Moustafa F, Poujol L, Vincent N, Saint-Denis J, Dublanchet N, Breuil N, Heuser S, Lebreton A, Dutheil F, Schmidt J. Characteristics and outcomes of reversed patients admitted to an emergency department for VKA-related intramuscular hematoma. Am J Emerg Med 2018; 36:1257-1261. [DOI: 10.1016/j.ajem.2018.03.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 02/12/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022] Open
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Transcatheter Arterial Embolization with N-Butyl-2-Cyanoacrylate in the Management of Spontaneous Hematomas. Cardiovasc Intervent Radiol 2016; 40:41-49. [PMID: 27646523 DOI: 10.1007/s00270-016-1463-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/09/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Spontaneous hematoma refractory to conservative management is a potentially serious condition that requires prompt diagnosis and intervention. The purpose of this study was to evaluate the performance of computed tomography (CT) in the treatment planning and to report the effectiveness of transcatheter embolization with N-butyl-2-cyanoacrylate (NBCA). MATERIALS AND METHODS Forty-one interventions in 38 patients within a 12-year period were evaluated. CT and angiograms were reviewed for the location of the hematoma, the presence of extravasation, and the correlation of CT and angiography findings. RESULTS Arterial extravasation was present on 34/39 CT scans. Angiograms confirmed the CT scans in 29 cases. Angiograms revealed extravasation in four cases which CT showed venous bleeding (n = 2) or no bleeding (n = 2). Five patients with arterial and 1 patient with venous extravasation on CT images had no extravasation on angiograms. Embolization was performed to all arteries with extravasation on angiograms. Empiric embolization of the corresponding artery on the CT was performed when there was no extravasation on angiograms. Embolization procedures were performed with 15 % NBCA diluted with iodized oil. Technical success was achieved in 40/41 (97.6 %) interventions. Clinical success was achieved in 35 patients with a single, in 1 patient with 2, and in 1 patient with 3 interventions. No complications related to embolization procedure occurred. None of the patients died due to a progression of the hematoma. CONCLUSION NBCA is an effective and safe embolic agent to treat hematoma refractory to conservative management. Contrast-enhanced CT may provide faster and more effective intervention. LEVEL OF EVIDENCE III Retrospective.
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Wong C, Merkur H. Inferior epigastric artery: Surface anatomy, prevention and management of injury. Aust N Z J Obstet Gynaecol 2015; 56:137-41. [PMID: 26627186 DOI: 10.1111/ajo.12426] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 10/21/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Clare Wong
- Sydney West Advanced Pelvic Surgery Unit; Blacktown Hospital; Blacktown NSW Australia
| | - Harry Merkur
- Sydney West Advanced Pelvic Surgery Unit; Blacktown Hospital; Blacktown NSW Australia
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Bui JT, Jajko R, Zivin SP. Massive Hemorrhage from Arterial Access during Intracranial Aneurysm Stent-Assisted Embolization: Endovascular Diagnosis and Therapy. Semin Intervent Radiol 2015; 32:14-7. [PMID: 25762842 DOI: 10.1055/s-0034-1396958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Massive hemorrhage from arterial access in patients receiving anticoagulation and antiplatelet therapy is a rare but potentially devastating complication. The authors present a patient who developed a large retroperitoneal and anterior abdominal wall hemorrhage following an unintentional and unrecognized arterial injury during an endovascular procedure. Reversal of anticoagulation in patients who have undergone stent-assisted coil embolization of intracranial aneurysms is an undesirable approach due to the risk of thromboembolism; rather, transcatheter embolization of the bleeding source should be considered.
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Affiliation(s)
- James T Bui
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Robert Jajko
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Sean P Zivin
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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