Transcatheter Arterial Embolization of Spontaneous Life-Threatening Extraperitoneal Hemorrhage

Abstract

Purpose To determine the outcomes of patients with spontaneous extraperitoneal hemorrhage (SEH) referred for endovascular therapy. Materials and Methods A retrospective analysis included 25 patients (13 male) with 28 spontaneous bleeding events that occurred during the period 1998–2009. All patients had a computed tomography (CT) scan showing extraperitoneal hematoma before angiography. Hematoma location, presence of contrast extravasation or hematocrit level on CT, angiographic findings, vessels that received embolization, angiographic outcome, transfusion requirements, and mortality were recorded. Patients' medications, lowest measured hemoglobin levels, serologic coagulation parameters, and comorbidities were also noted. Mean follow-up was 37.4 months (range 2–132 mo). Results Patients had received anticoagulation therapy before 20 of 28 bleeding events. Angiography showed contrast extravasation in 22 (79%) of 28 cases. Angiographic cessation of bleeding with embolization was achieved in all 22 cases. There was extravasation from more than one site in 17 (61%) of 28 cases. There was bleeding in more than one vascular territory in eight (29%) cases. Empiric embolization was performed in three cases. In the 48 hours following angiography, transfusion requirements decreased in 27 (96%) of 28 cases, and there were no deaths. All-cause mortality at 30 days was 29%, at 90 days was 32%, and at 12 months was 43%. Conclusions Multiple bleeding sites are typical in SEH. Transcatheter embolization is a safe and effective treatment; however, mortality is high in the time around angiography.