Transcatheter embolization of the marginal artery of drummond as treatment for life-threatening retroperitoneal hemorrhage complicating heparin therapy

Abstract

We report a case in which life-threatening retroperitoneal hemorrhage complicated heparin therapy. The bleeding originated from the marginal artery of Drummond which was catheterized with a 3-Fr coaxial catheter system (Tracker-18 catheter) and embolized with microcoils. Bleeding stopped and no ischemic complications developed for 3 years after embolization.

Spontaneous Soft-Tissue Hemorrhage in Anticoagulated Patients: Safety and Efficacy of Embolization

“…The classic view that anticoagulation-related soft-tissue bleeding was an angiographically occult diffuse microvascular condition, in which catheter angiography had no diagnostic or therapeutic role, has been challenged by several case reports [5,6,[9][10][11][12][13][14][15][16][17][18][19][20]. In our daily clinical experience with this specific clinical situation, we have noticed that the visualization of active bleeding on MDCTA calls for more urgent management [18,23,[32][33][34][35].…”

Successful embolization of a large superior gluteal artery pseudoaneurysm emerging during anticoagulant therapy

“…There is no prior report of hemorrhage in the gluteal region. Usually hemorrhagic complications in patients receiving anticoagulant therapy result from small artery rupture [9]. In our patient, the proximal portion of the superior gluteal artery had ruptured and a large pseudoaneurysm formed, extending from the pelvic cavity to the gluteal region through the greater ischiatic foramen.…”

“…When spontaneous retroperitoneal hemorrhage occurs, signs and symptoms may be ambiguous and diagnosis may be delayed [2]. There are reports of approximately 30 cases of spontaneous retroperitoneal hemorrhage during oral anticoagulant therapy [2][3][4]9]. There is no prior report of hemorrhage in the gluteal region.…”

“…The incidence of major hemorrhage is 3%-10% [1,2]. Bleeding sites include the urinary tract, gastrointestinal tract, brain, peritoneal cavity, pericardium, thoracic cavity, mediastinum, rectus sheath, and retroperitoneum [1][2][3][4][5][6][7][8][9]. We present one patient with a large gluteal artery pseudoaneurysm associated with anticoagulant therapy and treated with transcatheter embolization.…”

Transcatheter Arterial Embolization as Treatment for a Life-Threatening Retroperitoneal Hemorrhage Complicating Heparin Therapy

“…Surgical intervention has been considered the only option for uncontrollable hemodynamic collapse. Reports of transcatheter arterial embolization in anticoagulant-related RPH are very scarce, and a review of the literature revealed very few reports of successful cases [8,9]. But Zissin et al [10] reported that this therapeutic option seemed relevant in anticoagulated patients with large soft tissue hematomas that typically occur spontaneously and are difficult to either predict or prevent.…”