Efficacy of transarterial embolisation in patients with life-threatening spontaneous retroperitoneal haematoma

Klausenitz, Catharina; Kuehn, Jens Peter; Noeckler, K.; Radosa, Christoph Georg; Hoffmann, Ralf; Teichgraeber, Ulf; Mensel, Birger

doi:10.1016/j.crad.2020.10.003

Cited by 17 publications

(58 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There are now retrospective studies suggesting the advantages of liquid embolic agents as they provide rapid complete occlusion compared to others such as coils. [12] In the study, most of the embolization were performed with Onyx-18 (Table 2). The selection of this material was mainly based on two factors, on the one hand the morphology of the responsible artery, in all cases small calibre arteries, and on the other hand the presence of a coagulation disorder.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Haematomas in Anticoagulated Covid-19 Patients: Diagnosis and Treatment by Embolization

López-Martínez

Molina-Nuevo

Pedrosa-Jiménez

et al. 2022

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

Purpose To assess the safety and efficacy of embolization for spontaneous bleeding in anticoagulated patients with COVID-19. Material and Methods Single center retrospective study in 9 patients with COVID-19 who experienced bleeding complications following anticoagulation. The study included 8 men and 1 woman aged from 48 to 80 years (mean 69.7 years), who had a total of 10 soft tissue haematomas: 1 in the thigh, 1 in the anterior abdominal wall, 6 retroperitoneal and 2 thoracic haematomas. All patients were referenced for vascular embolization, mostly with Onyx-18. Results A total of 10 haematomas were embolized in 9 patients. Technical success was achieved in all patients. No complications or adverse events were noted. One patient required percutaneous drainage of an infected haematoma 88 days after embolization. The mean hemoglobin level before embolization was 8,64 mg/dL and increased to 9,08 mg/dL after embolization (p = 0,3). After embolization all patients recovered haemodynamic stability and blood pressure levels improved. Seven patients resumed anticoagulation therapy after embolization. There were no recurrences or new bleedings in all treated patients. No patients required any additional invasive therapies or surgery. Mean intensive unit care and hospital stay was 6.7 and 35.2 days, respectively. All patients were discharged and were well at follow-up clinic visits 2-7 months after embolization. Seven patients performed a control CT scan 1-6 months after embolization, showing complete resolution of the haematoma. Conclusion Embolization is safe and effective to treat spontaneous haematomas in anticoagulated patients with COVID-19, allowing to resume anticoagulation therapy. Level of evidence IV Level 4, case-series.

show abstract

Section: Discussionmentioning

confidence: 99%

Spontaneous Haematomas in Anticoagulated Covid-19 Patients: Diagnosis and Treatment by Embolization

López-Martínez

Molina-Nuevo

Pedrosa-Jiménez

et al. 2022

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

show abstract

“…Invasive treatments, such as surgery or transarterial embolization of the bleeding vessels, are currently reserved to patients with expanding hematomas, that are hemodynamically unstable or with neurological impairment (especially in posterior wall hematomas). In recent years, the endovascular treatment of AWH has been increasingly used for patients in which conservative treatments were not sufficiently effective, and it is often preferred to surgical interventions [ 2 , 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to the literature, AWH is a condition more commonly observed in elderly patients, especially those with comorbidities [ 18 ]. In a study conducted by Klausenitz et al [ 2 ] on 30 patients who underwent DSA and embolization therapy for retroperitoneal bleeding, the mean age of the patients was 71.9 ± 9.8 years; in a review of the literature on rectus sheath hematoma, Hatjipetrou et al [ 3 ] revealed a mean age of patients suffering from this condition ranging between 46 to 69 years. Moreover, a study performed by Barral et al [ 19 ] on 112 patients with spontaneous soft-tissue hematomas who underwent TAE revealed a mean age of 72 ± 14 years.…”

Section: Discussionmentioning

confidence: 99%

“…AWHs are relatively uncommon findings, but they may be a life-threatening condition, often associated with other conditions such as abdominal trauma, anticoagulation or iatrogenic injuries. The exact incidence and prevalence of AWH, however, are still unknown [ 1 , 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…It was suggested that more aggressive approaches should be reserved for unresponsive and complicated patients [ 10 ]. In case of hemodynamically unstable patients, surgical intervention such as open surgery with exploration and ligation of the bleeding vessel is taken into account, but this technique often fails [ 2 , 4 ]. In recent years, catheter-directed angiography and embolization have become additional options for patients with life-threatening AWH [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Pietro

Tiralongo

Desiderio

et al. 2022

JCM

View full text Add to dashboard Cite

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.

show abstract

Spontaneous Retroperitoneal Haemorrhage: Efficacy of Conservative Management and Embolisation

Lukies

Gipson

Tan

et al. 2023

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

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.

show abstract

Efficacy of transarterial embolisation in patients with life-threatening spontaneous retroperitoneal haematoma

Cited by 17 publications

References 29 publications

Spontaneous Haematomas in Anticoagulated Covid-19 Patients: Diagnosis and Treatment by Embolization

Spontaneous Haematomas in Anticoagulated Covid-19 Patients: Diagnosis and Treatment by Embolization

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

Spontaneous Retroperitoneal Haemorrhage: Efficacy of Conservative Management and Embolisation

Contact Info

Product

Resources

About