Efficacy of Percutaneous Transarterial Embolization in Patients with Spontaneous Abdominal Wall Hematoma and Comparison between Blind and Targeted Embolization Approaches

Abstract

Background: Endovascular treatment of abdominal wall hematomas (AWHs) has been increasingly used when conservative treatments were not sufficiently effective, and it is often preferred to surgical interventions. The aim of our study was to evaluate the safety and technical and clinical success of percutaneous transarterial treatment of AWH and to evaluate the efficacy of blind embolization compared to targeted embolization. Materials and Methods: We retrospectively enrolled 43 patients (23 men and 20 females) with spontaneous AWH who underwent digital subtraction angiography (DSA) and embolization, focusing on the presence of signs of bleeding at pre-procedural CT-Angiography (CTA) and at DSA. Furthermore, we divided patients into two groups depending on blind or targeted embolization approaches. Results: The mean age of the study population was 71 ± 12 years. CTA revealed signs of active bleeding in 31 patients (72%). DSA showed signs of active bleeding in 34 patients (79%). In nine patients (21%), blind embolization was performed. The overall technical success rate was 100%. Clinical success was achieved in 33 patients (77%), while 10 patients (23%) rebled within 96 h, and all of them were re-treated. No major peri-procedural complication was reported. The comparison between blind and targeted embolization showed no statistically significant differences for characteristics of groups and for clinical success rates (78% and 77%, respectively, −p = 0.71). The technical success was 100% in both groups. Conclusions: Our study confirms that transarterial embolization is a safe and effective option for the treatment of spontaneous AWHs, and it suggests that the efficacy and safety of blind embolization is comparable to non-blind.

Spontaneous Retroperitoneal Hematoma Treated with Percutaneous Transarterial Embolization in COVID-19 Era: Diagnostic Findings and Procedural Outcome

“…As mentioned before, despite the lack of specific guidelines on the treatment of spontaneous retroperitoneal hematoma, recent studies suggest that TAE plays an important role in the management of this condition, representing a safe and effective option for the treatment of spontaneous abdominal wall hematomas, including retroperitoneal hematomas [ 11 , 21 ]. Hemodynamically unstable patients can be also treated with TAE, due to its minimally invasive and quick therapeutic effect, compared to surgical treatment [ 20 ].…”

“…Multiphasic CT represents the gold standard for the identification of a spontaneous retroperitoneal hematomas [ 15 ]. CTA assessed in the preprocedural setting allows recognizing CT signs of active bleeding and identifying the bleeding vessel, thus providing valuable assistance to the interventional radiologist in planning the embolization procedure, and influencing the timing of therapeutic treatment [ 11 , 15 ].…”

“…As reported in another study [ 34 ], the most common embolic material used in our study was a combination of coils and gel foam, and this finding was maintained across both groups; when DSA showed no signs of active bleeding, empirical or “blind” embolization was always performed. It is worth noting that a recent study published by Di Pietro et al suggested that blind embolization is comparable to targeted (or non-bind) embolization approach, in terms of efficacy and safety, in the treatment of spontaneous abdominal wall hematomas, including retroperitoneal hematomas [ 11 ].…”

“…There is a lack of focused studies about the incidence or prevalence of this condition, but it has been reported that hematomas of the psoas muscle occur in 0.1–0.6% of patients who have risk factors such as elderly age and undergoing anticoagulation therapy or hemodialysis [ 11 ].…”

“…Computed tomography angiography (CTA) is the gold standard for the identification of SRH, allowing a rapid diagnosis of retroperitoneal hematoma and localization of the site of the bleeding, as well as the extension of the hematoma and the exclusion of other acute abdominal diseases. CTA, moreover, has a key role in the evaluation of the presence of active bleeding within the hematoma, being able to detect bleeding with a flow rate as low as 0.3 mL/min, and to guide the subsequent management of this condition and the therapeutic iter, since the detection of ongoing bleeding within the hematoma has been associated with unsuccessful conservative treatment [ 11 , 15 , 16 , 17 ].…”