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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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He Q, Xiong Y, Yu Y, Chen Z. Transarterial embolization for enoxaparin-induced massive abdominal wall hematoma: A case report and literature review. Asian J Surg 2024; 47:1865-1866. [PMID: 38185548 DOI: 10.1016/j.asjsur.2023.12.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/25/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Qifan He
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China
| | - Yue Xiong
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China
| | - Yihui Yu
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China
| | - Zhonghua Chen
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China.
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3
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Eltahir BA, Abdelhameed ME, Abdulla Ghaleb WE. Lateral Abdominal Wall Hematoma Mimicking Aortic Dissection Presentation: A Case Report. Cureus 2024; 16:e54717. [PMID: 38524083 PMCID: PMC10960730 DOI: 10.7759/cureus.54717] [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] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Lateral abdominal wall hematoma is a rare clinical entity but a great mimicker of other diseases' clinical presentations. In this case report, we present a 42-year-old male patient with a constellation of signs and symptoms that were mistaken for aortic dissection before the lateral abdominal wall hematoma diagnosis was confirmed with computed tomography (CT) imaging. Uncontrolled hypertension and persistent cough were most likely predisposing factors; the patient was managed conservatively and discharged in a stable condition.
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Affiliation(s)
- Babiker A Eltahir
- Department of Emergency, NMC Royal Hospital, Khalifa City, Abu Dhabi, ARE
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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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Minici R, Fontana F, Venturini M, Guzzardi G, Piacentino F, Spinetta M, Bertucci B, Serra R, Costa D, Ielapi N, Coppola A, Guerriero P, Apollonio B, Santoro R, Mgjr Research Team, Brunese L, Laganà D. A Multicenter Retrospective Cohort Study Evaluating the Clinical Outcomes of Patients with Coagulopathy Undergoing Transcatheter Arterial Embolization (TAE) for Acute Non-Neurovascular Bleeding. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1333. [PMID: 37512144 PMCID: PMC10383976 DOI: 10.3390/medicina59071333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Transcatheter arterial embolization (TAE) is the mainstay of treatment for acute major hemorrhage, even in patients with coagulopathy and spontaneous bleeding. Coagulopathy is associated with worsening bleeding severity and higher mortality and clinical failure rates. Furthermore, some unanswered questions remain, such as the definition of coagulopathy, the indication for TAE or conservative treatment, and the choice of embolic agent. This study aims to assess the efficacy and safety of TAE for spontaneous non-neurovascular acute bleeding in patients with coagulopathy. Materials and Methods: This study is a multicenter analysis of retrospectively collected data of consecutive patients with coagulopathy who had undergone, from January 2018 to May 2023, transcatheter arterial embolization for the management of spontaneous hemorrhages. Results: During the study interval (January 2018-May 2023), 120 patients with coagulopathy underwent TAE for spontaneous non-neurovascular acute bleeding. The abdominal wall was the most common bleeding site (72.5%). The most commonly used embolic agent was polyvinyl alcohol (PVA) particles or microspheres (25.0%), whereas coils and gelatin sponge together accounted for 32.5% of the embolic agents used. Technical success was achieved in all cases, with a 92.5% clinical success rate related to 9 cases of rebleeding. Complications were recorded in 12 (10%) patients. Clinical success was significantly better in the group of patients who underwent correction of the coagulopathy within 24 h of TAE. Conclusions: Transcatheter arterial embolization (TAE) is effective and safe for the management of acute non-neurovascular bleeding in patients with coagulopathy. Correction of coagulopathy should not delay TAE and vice versa, as better clinical outcomes were noted in the subgroup of patients undergoing correction of coagulopathy within 24 h of TAE.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Marco Spinetta
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Bernardo Bertucci
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Davide Costa
- Department of Law, Economics and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Pasquale Guerriero
- Radiology Unit, Santobono-Pausilipon Hospital, 80129 Naples, Italy
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
| | | | - Rita Santoro
- Haemophilia and Thrombosis Center, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | | | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
- Scientific Committee of the Italian National Institute of Health (Istituto Superiore di Sanità, ISS), 00161 Rome, Italy
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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6
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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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7
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Minici R, Fontana F, Venturini M, Guzzardi G, Siciliano A, Piacentino F, Serra R, Coppola A, Guerriero P, Apollonio B, Santoro R, Team MGJRR, Brunese L, Laganà D. Transcatheter Arterial Embolization (TAE) in the Management of Bleeding in the COVID-19 Patient. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1062. [PMID: 37374266 PMCID: PMC10305036 DOI: 10.3390/medicina59061062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Increasing attention is being paid to the coagulation disorders associated with SARS-CoV-2 infection. Bleeding accounts for 3-6% of COVID-19 patient deaths, and is often a forgotten part of the disease. The bleeding risk is enhanced by several factors, including spontaneous heparin-induced thrombocytopenia, thrombocytopenia, the hyperfibrinolytic state, the consumption of coagulation factors, and thromboprophylaxis with anticoagulants. This study aims to assess the efficacy and safety of TAE in the management of bleeding in COVID-19 patients. Materials and Methods: This multicenter retrospective study analyzes data from COVID-19 patients subjected to transcatheter arterial embolization for the management of bleeding from February 2020 to January 2023. Results: Transcatheter arterial embolization was performed in 73 COVID-19 patients for acute non-neurovascular bleeding during the study interval (February 2020-January 2023). Coagulopathy was observed in forty-four (60.3%) patients. The primary cause of bleeding was spontaneous soft tissue hematoma (63%). A 100% technical success rate was recorded; six cases of rebleeding resulted in a 91.8% clinical success rate. No cases of non-target embolization were observed. Complications were recorded in 13 (17.8%) patients. The efficacy and safety endpoints did not differ significantly between the coagulopathy and non-coagulopathy groups. Conclusions: Transcatheter Arterial Embolization (TAE) is an effective, safe and potentially life-saving option for the management of acute non-neurovascular bleeding in COVID-19 patients. This approach is effective and safe even in the subgroup of COVID-19 patients with coagulopathy.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.)
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.P.); (A.C.)
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.P.); (A.C.)
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy;
| | - Agostino Siciliano
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.)
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.P.); (A.C.)
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.P.); (A.C.)
| | - Pasquale Guerriero
- Radiology Unit, Santobono-Pausilipon Hospital, 80129 Naples, Italy;
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | | | - Rita Santoro
- Haemophilia and Thrombosis Center, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | - MGJR Research Team
- Magna Graecia Junior Radiologists Research Team, 88100 Catanzaro, Italy;
| | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
- Scientific Committee of the Italian National Institute of Health (Istituto Superiore di Sanità, ISS), 00161 Rome, Italy
| | - Domenico Laganà
- Radiology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy
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8
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Minici R, Venturini M, Fontana F, Guzzardi G, Pingitore A, Piacentino F, Serra R, Coppola A, Santoro R, Laganà D. Efficacy and Safety of Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs) in Transcatheter Arterial Embolization (TAE) of Acute Non-Neurovascular Bleeding: A Multicenter Retrospective Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040710. [PMID: 37109668 PMCID: PMC10146444 DOI: 10.3390/medicina59040710] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Transcatheter arterial embolization (TAE) is part of the daily practice of most interventional radiologists worldwide. The ideal liquid embolic agent is far from being identified. Non-adhesive liquid embolic agents (NALEA) harden from the outside to the inside, resulting in deep penetration, known as "magma-like" progression, which permits a more distal embolization with good control of the embolic material. This multicenter retrospective cohort study aims to assess the efficacy, feasibility and safety of transcatheter arterial embolization (TAE) with ethylene-vinyl alcohol (EVOH)-based NALEAs (Onyx and Squid) in acute bleeding outside of the neurovascular area. Materials and Methods: This study is a multicenter analysis of retrospectively collected data of consecutive patients who had undergone, from January 2015 to December 2022, transcatheter arterial embolization with non-adhesive EVOH-based agents in the setting of acute non-neurovascular bleeding. Results: Fifty-three patients underwent transcatheter arterial embolization for acute non-neurovascular bleeding. Eight (15.1%) procedures were performed in patients with coagulopathy. The most used concentration of EVOH-based NALEAs was 34 (i.e., 8%), with a mean dose of 0.5 (±0.3) mL. The mean CT-to-groin time, the mean procedure time, the mean CT-to-embolization time and the mean fluoroscopy time were 22.9 (±12.4) min, 27.5 (±7) min, 50.3 (±13.1) min and 7.5 (±2.8) min, respectively. Technical success was achieved in all cases with a 96.2% clinical success rate. Complications were recorded in six (11.3%) patients. No statistically significant differences were observed between the group of patients with coagulopathy and the group of patients without coagulopathy in terms of efficacy and safety endpoints. Conclusions: Transcatheter arterial embolization (TAE) performed with non-adhesive EVOH-based embolic agents is an effective, feasible and safe strategy for the management of acute non-neurovascular bleeding, even in the subgroup of patients with coagulopathy.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, Varese 21100, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, Varese 21100, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | | | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, Varese 21100, Italy
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, University Hospital Mater Domini, 88100 Catanzaro, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, Varese 21100, Italy
| | - Rita Santoro
- Haemophilia and Thrombosis Center, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy
| | - Domenico Laganà
- Radiology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, 88100 Catanzaro, Italy
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9
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Abrashev H, Ananiev J, Georgieva E. Case Report: Spontaneous Left Inferior Epigastric Artery Injury in a COVID-19 Female Patient Undergoing Anticoagulation Therapy. J Clin Med 2023; 12:jcm12051842. [PMID: 36902629 PMCID: PMC10003174 DOI: 10.3390/jcm12051842] [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: 01/05/2023] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Since the beginning of the pandemic, a recommendation was made for the use of anticoagulants in high-risk hospitalized patients. This therapeutic approach has positive and negative effects regarding the outcome of the disease. Anticoagulant therapy prevents thromboembolic events, but it can also lead to spontaneous hematoma formation, or be accompanied by massive active bleeding. We present a 63-year-old COVID-19-positive female patient with a massive retroperitoneal hematoma and spontaneous left inferior epigastric artery injury.
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Affiliation(s)
- Hristo Abrashev
- Department of Special Surgery, Orthopedics, and Traumatology, Clinic of Vascular Surgery, Medical Faculty, Trakia University, 6000 Stara Zagora, Bulgaria
| | - Julian Ananiev
- Department of General and Clinical Pathology, Forensic Medicine and Deontology and Dermatovenereology, Medical Faculty, Trakia University, 6000 Stara Zagora, Bulgaria
| | - Ekaterina Georgieva
- Department of General and Clinical Pathology, Forensic Medicine and Deontology and Dermatovenereology, Medical Faculty, Trakia University, 6000 Stara Zagora, Bulgaria
- Department of Chemistry and Biochemistry, Medical Faculty, Trakia University, 6000 Stara Zagora, Bulgaria
- Correspondence: ; Tel.: +359-878552006
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10
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Venturini M, Piacentino F, Coppola A, Fontana F. Editorial of Special Issue “Embolization Techniques: State of the Art and Future Perspectives”. J Clin Med 2022; 11:jcm11175109. [PMID: 36079041 PMCID: PMC9456612 DOI: 10.3390/jcm11175109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Correspondence: ; Tel.: +39-0332-393607
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
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11
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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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