The utility of transarterial embolization and computed tomography for life-threatening spontaneous retroperitoneal hemorrhage

Tani, Ryuichiro; Sofue, Keitaro; Sugimoto, Koji; Katayama, Naoto; Hamada, Mostafa A. S.; Maruyama, Koji; Horinouchi, Hiroki; Gentsu, Tomoyuki; Sasaki, Koji; Ueshima, Eisuke; Koide, Yuji; Okada, Takuya; Yamaguchi, Masato; Murakami, Takamichi

doi:10.1007/s11604-019-00815-5

Cited by 18 publications

(32 citation statements)

References 22 publications

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“…6,9 Recent studies underline contemporary diagnosis and therapy is of utmost importance in patients with SRH to prevent a fatal outcome. 7,8,10 Because of the unspecific clinical findings, imaging is key for establishing the correct diagnosis. 5,10,11 Ultrasound can be a primary diagnostic tool to detect free fluid and a mass effect in the retroperitoneal space.…”

Section: Introductionmentioning

confidence: 99%

“…7,8,10 Because of the unspecific clinical findings, imaging is key for establishing the correct diagnosis. 5,10,11 Ultrasound can be a primary diagnostic tool to detect free fluid and a mass effect in the retroperitoneal space. To detect active extravasation and to identify the bleeding site, computed tomography angiography (CTA) and digital subtraction angiography (DSA) are more sensitive and are therefore the imaging techniques of choice.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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To evaluate the technical and clinical success of embolisation in patients with lifethreatening spontaneous retroperitoneal haematoma (SRH) and to assess predictors of clinical outcome.MATERIALS AND METHODS: Thirty patients (mean age: 71.9AE9.8 years) with SRH underwent digital subtraction angiography (DSA). All patients received anticoagulant or antiplatelet medication or a combination of both at the time the SRH occurred.RESULTS: Pre-interventional computed tomography angiography (CTA) revealed active retroperitoneal bleeding in 28 of 30 (93.3%) patients. DSA identified active haemorrhage in 22 of 30 patients (73.3%). Twenty-nine of 30 (96.7%) patients underwent embolisation. n-Butyl-2cyanoacrylate (NBCA) was used in 15 patients (51.7%), coils were used in 10 patients (34.5%), and both embolic agents were used in four patients (13.8%). The technical success rate was 100%. Pre-interventional haemoglobin levels increased significantly after embolotherapy from 70.9AE16.1 g/l to 87AE11.3 g/l (p<0.001), whereas partial thromboplastin time decreased from 58AE38 to 30AE9 seconds (p<0.001) after embolotherapy. The need for transfusion of concentrated red cells decreased from 3AE2.2 to 1AE1.1 units (p<0.001) after the intervention. Clinical success was achieved in 19 of 29 (65.5%) patients. No major procedure-related complications occurred. Seven patients (24.1%) died within 30 days after the procedure.CONCLUSION: Embolotherapy in patients with life-threatening SRH leads to a high technical success rate and is a safe therapeutic option. The clinical success rate was acceptable and

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Furthermore, extravasation on CECT suggests active bleeding. However, extravasation on CECT cannot detect all active bleeding because coagulopathy-related bleeding is intermittent and is influenced by spasm, hypotension, and soft-tissue tamponade in elderly atherosclerotic patients (8,9,11,24). In our comparison of CRSHs with and without extravasation, there was no significant difference in clinicolaboratory factors.…”

Section: Discussionmentioning

confidence: 60%

Coagulopathy-related soft tissue hematoma: a comparison between computed tomography findings and clinical severity

Nakayama

Kato

Yoshioka

et al. 2020

Acta Radiologica Open

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Background Despite increases in the incidence of coagulopathy-related soft-tissue hematoma (CRSH), the relationship between computed tomography (CT) features and clinical severity remains unclear. Purpose To retrospectively evaluate the correlation between CT findings and clinical outcomes in CRSH. Material and Methods We retrospectively reviewed data of patients diagnosed with CRSH between March 2011 and March 2018. CRSH was morphologically classified according to the presence or absence of the fluid level pattern and was also divided into groups with or without extravasation as per CT findings. These CT findings were compared with the patients’ vital signs and laboratory investigation results. Results A total of 47 patients with CRSH were examined. Fluid level and non-fluid level patterns were observed in 28 (60%) and 19 (40%) patients, respectively. Anticoagulant therapy and extravasation were significantly correlated with the fluid level pattern. However, other clinicolaboratory outcomes, including shock index, hemoglobin, hematocrit, platelet count, and coagulation factors, showed no significant difference between the two patterns. In the comparison of hematomas with and without extravasation, none of the clinicolaboratory outcomes except for anticoagulant therapy showed significant differences. Conclusion CRSH with a fluid level pattern is significantly associated with extravasation. However, extravasation, which is generally suggestive of active bleeding, does not seem to be related to clinical severity in CRSH.

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“…This was a significant clinical occurrence, and we selected a conservative treatment method to manage the retroperitoneal bleeding. Transcatheter embolization has been suggested to be effective for managing massive retroperitoneal hemorrhaging ( 9 ), even in cases with multiple bleeding points, as in the present patient ( 10 ).…”

Section: Discussionmentioning

confidence: 78%

Atypical Aortic Coarctation in a Patient with an Acute Exacerbation of Multiple Organ Failure: Successful Endovascular Therapy and Spontaneous Retroperitoneal Bleeding

Inoguchi¹,

Kaku²,

Kitagawa³

et al. 2021

Intern. Med.

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We experienced a case of acute multiple organ ischemia and multiple organ failure due to atypical aortic coarctation (AAC).Since the patient's hemodynamics were too unstable to perform surgical revascularization, we performed urgent endovascular therapy (EVT) with a stent. Eventually, the patient achieved remission from multiple organ failure and a satisfactory clinical outcome.We feel that EVT for AAC is a sufficiently effective treatment option if the purpose of EVT is to save a patient's life in the acute phase.In the present case, spontaneous retroperitoneal bleeding (SRB) occurred after EVT of AAC, but this is a rare incident, although noteworthy in the clinical course.

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The utility of transarterial embolization and computed tomography for life-threatening spontaneous retroperitoneal hemorrhage

Cited by 18 publications

References 22 publications

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

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

Coagulopathy-related soft tissue hematoma: a comparison between computed tomography findings and clinical severity

Atypical Aortic Coarctation in a Patient with an Acute Exacerbation of Multiple Organ Failure: Successful Endovascular Therapy and Spontaneous Retroperitoneal Bleeding

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