Emergency Transarterial Embolization Research Articles

Transarterial embolization to treat hemodynamically unstable trauma patients with splenic injuries: A retrospective multicenter observational study

PurposeWe described clinical outcomes for patients with blunt splenic injuries treated with transarterial embolization (TAE) based on their hemodynamic status. Materials and MethodsThis is a retrospective two-center study of adult patients with splenic injuries who underwent emergency TAE between January 2011 and December 2022. Patients were divided into two groups; hemodynamically unstable (HDU) and hemodynamically stable (HDS) patients. HDU patients were defined as transient- or non-responders to fluid resuscitation and HDS as responders. When immediate laparotomy was not possible for HDU patients, angiography and embolization were performed. The primary outcome was the survival discharge rate. Rebleeding and splenectomy rate was also investigated. ResultsOf 38 patients underwent emergency TAE for splenic trauma, 17 were HDU patients and 21 were HDS patients. The survival discharge rate was 88.2 % (15/17) in the HDU- and 100 % in HDS patients (p = 0.193). Rebleeding rate was 23.5 % (4/17) in HDU- and 5.0 % (1/21) in HDS patients (p = 0.15). Splenectomy was required for one HDU patient (5.9 %) for rebleeding. ConclusionThe survival discharge rate of TAE for splenic trauma in HDU patients was acceptable with a low rate of splenectomy. Further comparative studies of TAE versus operative management in HDU patients are needed to prove the usefulness of TAE.

Transarterial embolization followed by staged hepatectomy versus emergency hepatectomy for ruptured HCC: a meta-analysis.

To compare the efficacy and safety between emergency hepatectomy (EH) and emergency transarterial embolization (TAE) followed by staged hepatectomy (SH) in the treatment of spontaneous ruptured hepatocellular carcinoma (rHCC). Databases (PubMed, EMBASE, Web of science, Cochrane Library, ClinicalTrial.gov, CNKI, Wanfang and VIP) were searched for all relevant comparative studies from January 2000 to October 2020. Odds ratio (OR) and mean difference (MD) with 95% confidence interval (CI) were pooled for dichotomous and continuous variables, respectively. Subgroup analyses based on the kind of embolization were conducted. RevMan 5.3 software was adopted for meta-analysis. Eighteen studies with 871 patients were finally included in this meta-analysis, 448 in EH group and 423 in TAE + SH group. No significant difference was observed in successful hemostasis (P = 0.42), postoperative hospital stay (P = 0.12), complication rate (P = 0.08) between EH and TAE + SH group. However, TAE + SH group was associated with shorter operating time (P < 0.00001), fewer perioperative blood loss (P = 0.007), fewer blood transfusion (P = 0.003), lower in-hospital mortality (P < 0.00001) and higher 1-year survival as well as 3-year survival (P < 0.0001; P = 0.003) compared with EH group. Compared with EH, TAE + SH could reduce perioperative operating time, blood loss, blood transfusion, mortality rate and increase the long-term survival rate of the rHCC patients, which may be a better treatment for resectable rHCC.

Transarterial Embolization for Spontaneous Soft-Tissue Hematomas: Predictive Factors for Early Death.

The aim of this retrospective monocentric study was to assess the safety and efficacy of spontaneous soft-tissue hematoma transarterial embolization (TAE) and to evaluate predictive factors for early mortality (≤30 days) after TAE for spontaneous soft-tissue hematoma (SSTH). Between January 2010 and March 2022, all patients referred to our hospital for spontaneous soft-tissue hematoma and treated by emergency TAE were reviewed. Inclusion criteria were patients: ≥18-year-old, with active bleeding shown on preoperative multidetector row computed tomography, with spontaneous soft-tissue hematoma, and treated by TAE. Exclusion criteria were patients with soft-tissue hematomas of traumatic, iatrogenic, or tumoral origin. Clinical, biological, and imaging records were reviewed. Imaging data included delimitation of hematoma volume and presence of fluid level. Univariate and multivariate analyses were performed to check for associations with early mortality. Fifty-six patients were included. Median age was 75.5 [9-83] ([Q1-Q3] years and 23 (41.1%) were males. Fifty-one patients (91.1%) received antiplatelet agent and/or anticoagulant therapy. All 56 patients had active bleeding shown on a preoperative CT scan. Thirty-seven (66.0%) hematomas involved the retroperitoneum. Median hemoglobin level was 7.6 [4.4-8.2] g/dL. Gelatine sponge was used in 32/56 (57.1%) procedures. Clinical success was obtained in 48/56 (85.7%) patients and early mortality occurred in 15/56 (26.8%) patients. In univariate and multivariate analysis, retroperitoneal location and volume of hematoma were associated with early mortality. Retroperitoneal location and volume of hematoma seem to be risk factors for early death in the context of TAE for spontaneous soft-tissue hematoma. Larger multicenter studies are necessary to identify others predictive factors for early mortality and to anticipate which patients may benefit from an interventional strategy with TAE.

Clinical impact of surgical treatment for the spontaneously ruptured resectable hepatocellular carcinoma: A single institution experience

Spontaneously ruptured hepatocellular carcinoma (srHCC) is a fatal complication of hepatocellular carcinoma (HCC). In addition, emergency treatment is frequently fraught with difficulties. This study aimed to investigate the prognosis and recurrence pattern in patients undergoing hepatectomy for the srHCC. This retrospective study included 11 patients with srHCC treated using either emergency hepatectomy or emergency transarterial embolization (TAE) followed by staged hepatectomy between January 2015 and December 2019. The patients visited the emergency room because of a sudden rupture of HCC without being diagnosed with HCC. We analyzed the prognosis, recurrence rate, and survival in these patients after hepatectomy. Four of the 11 patients in this study were classified as Child–Pugh class A and 7 as Child–Pugh class B. Nine patients visited for sudden onset of abdominal pain, and 2 for sudden onset of shock. The median hemoglobin level at the time of the visit was 11.5 g/dL (interquartile range: 9.8–12.7). Five patients underwent one-stage hepatectomy and 6 underwent emergency TAE hemostasis followed by staged hepatectomy. Median overall survival and recurrence-free survivals were 23 and 15 months, respectively. Recurrence occurred in 7 patients (4 in the one-stage group and 3 in the staged group). Among patients with recurrence, 6 had intrahepatic recurrence and 3 peritoneal metastases. Patients with srHCC who undergo staged hepatectomy can achieve a relatively good prognosis. The most common sites of recurrence after hepatectomy are intrahepatic and peritoneal. Peritoneal metastases are more likely to occur after one-stage hepatectomy.

Retroperitoneal Hematoma Caused by Lumbar Artery Injury during Percutaneous Disc Nucleoplasty: Successful Treatment Using Emergent Transarterial Embolization.

Although minimally invasive percutaneous disc nucleoplasty (PDN) has been widely used for discogenic back pain or soft-disc herniation of the lumbar spine, complications can occur. Although rare, iatrogenic vascular injuries during PDN are serious complications that can be fatal without rapid diagnosis and effective management. Here, we present the case of a 38-year-old male patient with an injury to the right fifth lumbar artery that occurred during PDN, which was successfully treated using emergent transarterial embolization. To the best of our knowledge, this is the first report of successful transarterial embolization without open hematoma evacuation for a lumbar artery injury that occurred during PDN.

Safety and efficacy of emergency transarterial embolization for mesenteric bleeding

BackgroundPatients with spontaneous or traumatic active mesenteric bleeding cannot be treated endoscopically. Transarterial embolization can serve as a potential alternative to emergency surgery. Literature on transarterial embolization for mesenteric bleeding remains very scarce. The objective of this study was to evaluate the safety and efficacy of transarterial embolization for mesenteric bleeding. We reviewed all consecutive patients admitted for mesenteric bleeding to the interventional radiology department, in a tertiary center, between January 2010 and March 2021. Mesenteric bleeding was defined as mesenteric hematoma and contrast extravasation and/or pseudoaneurysm visible on pre-operative CT scan. We evaluated technical success, clinical success, and complications.ResultsAmong the 17 patients admitted to the interventional department for mesenteric bleeding, 15 presented with active mesenteric bleeding requiring transarterial embolization with five patients with hemodynamic instability. Mean age was 67 ± 14 years, including 12 (70.6%) males. Technical success was achieved in 14/15 (93.3%) patients. One patient with technical failure was treated by percutaneous embolization with NBCA-Lipiodol mixture. Three patients (20%) had early rebleeding: two were treated by successful repeat embolization and one by surgery. One patient (6.7%) had early death within 30 days and two patients (13.3%) had late death after 30 days. Mean length of hospitalization was 12.8 ± 7 days. There were no transarterial embolization-related ischemic complications.ConclusionTransarterial embolization is a safe and effective technique for treating mesenteric bleeding even in patients with hemodynamic instability. Transarterial embolization doesn’t close the door to surgery and could be proposed as first intention in case of mesenteric bleeding.

Impact of emergency physician-staffed ambulances on preoperative time course and survival among injured patients requiring emergency surgery or transarterial embolization: A retrospective cohort study at a community emergency department in Japan.

Injured patients requiring definitive intervention, such as surgery or transarterial embolization (TAE), are an extremely time-sensitive population. The effect of an emergency physician (EP) patient care delivery system in this important trauma subset remains unclear. We aimed to clarify whether the preoperative time course and mortality among injured patients differ between ambulances staffed by EPs and those staffed by emergency life-saving technicians (ELST). This was a retrospective cohort study at a community emergency department (ED) in Japan. We included all injured patients requiring emergency surgery or TAE who were transported directly from the ED to the operating room from January 2002 to December 2019. The primary exposure was dispatch of an EP-staffed ambulance to the prehospital scene. The primary outcome measures were preoperative time course including prehospital length of stay (LOS), ED LOS, and total time to definitive intervention. The other outcome of interest was in-hospital mortality. One-to-one propensity score matching was performed to compare these outcomes between the groups. Of the 1,020 eligible patients, 353 (34.6%) were transported to the ED by an EP-staffed ambulance. In the propensity score-matched analysis with 295 pairs, the EP group showed a significant increase in median prehospital LOS (71.0 min vs. 41.0 min, P < 0.001) and total time to definitive intervention (189.0 min vs. 177.0 min, P = 0.002) in comparison with the ELST group. Conversely, ED LOS was significantly shorter in the EP group than in the ELST group (120.0 min vs. 131.0 min, P = 0.043). There was no significant difference in mortality between the two groups (8.8% vs.9.8%, P = 0.671). At a community hospital in Japan, EP-staffed ambulances were found to be associated with prolonged prehospital time, delay in definitive treatment, and did not improve survival among injured patients needing definitive hemostatic procedures compared with ELST-staffed ambulances.

MELD-Na > 16 is associated with high peri-procedural and short-term mortality in patients with ruptured hepatocellular carcinoma treated with emergent transarterial embolization.

To evaluate prognostic factors associated with peri-procedural (30days) and short-term (90days) mortality in the United States cohort of patients following emergent transarterial embolization for ruptured hepatocellular carcinoma. Patients with ruptured hepatocellular carcinoma treated with emergent TAE between January 2001 and December 2019 were retrospectively identified (n = 24). Average age was 62years (range, 23-78year); 15 (62.5%) were men. Univariate and Cox proportional hazard modeling were used to determine independent predictors of overall survival (OS) following TAE. OS stratified by Model for End-Stage Liver Disease-Sodium score was assessed using Kaplan-Meier analysis. Twenty-one patients (88%) died during a mean clinical follow-up period of 328 ± 139days. MELD-Na score (HR 1.22 per 1-unit increase; 95% CI 1.06-1.46; p = 0.005) and pre-rupture ECOG PS score (HR 8.1; 95% CI 1.28-51.2; p = 0.026) were independent predictors of decreased overall survival. There was no significant association between overall survival and presence of cardiovascular co-morbidities (p = 0.60), hemorrhagic shock on presentation (p = 0.16), portal vein thrombus (p = 0.08), vasopressor support required (p = 0.79), intubation required (p = 0.40), acute kidney injury (p = 0.58), and number of packed red blood cell transfusions (p = 0.22). The median OS was 64days. Median OS was significantly greater in patients with a MELD-Na score ≤ 16 as compared to those with a MELD-Na score > 16 (166.5days vs 9days, p = 0.011). Cumulative OS rates in those with a MELD-Na score ≤ 16 at 30, 60, 90, and 360days were 79%, 64%, 64%, and 25%, respectively, vs 33%, 33%, 11%, and 0%, respectively, in those with a MELD-Na score > 16. MELD-Na > 16 is associated with very high peri-procedural (67% at 30days) and short-term (89% at 90days) mortality in patients with ruptured HCC treated with emergent transarterial embolization. A better understanding of these prognostic factors may help guide treatment decisions and provide realistic expectations when counseling patients and their families.

Comparing spatiotemporal gait parameters between overground walking and self-paced treadmill walking in persons after stroke

A 21-year-old male presented to our hospital for life-threatening pelvic fracture, mandating emergent transarterial embolization of the right internal pudendal artery. At five-month post-injury, penile arterial flow was severely impaired, thus penile revascularization surgery were planned, before attempting urethroplasty for a 2-cm gap in the posterior urethra. However, reevaluation angiography results obtained two months later revealed spontaneous recovery of penile arterial flow. Excision and primary anastomosis urethroplasty was successfully performed without signs of bulbar ischemia. This case suggests that the timing of urethroplasty following pelvic injury should be tailored according to recovery of penile arterial flow.

Transarterial Embolization for Bleeding in Patients with Head and Neck Cancer: Who Benefits?

The present study aimed to investigate the efficacy of transarterial embolization (TAE) for bleeding in patients with head and neck cancer (HNC) and to evaluate the prognostic factors after TAE. Outcome study. This retrospective study included 31 consecutive patients (27 men and 4 women; median age, 61 years) who presented uncontrollable hemorrhage associated with HNC and underwent emergency TAE at our institution during a 10-year period (January 2011-December 2020). This corresponded to 40 TAE procedures, including 27 cases with an unstable status (circulatory and/or respiratory insufficiency) and 10 cases with carotid blowout syndrome. The technical success rate and adverse events were analyzed on a per-procedure basis. The rebleeding and overall survival (OS) rates were analyzed on a per-patient basis, and the factors related to OS were evaluated. The technical success rate was 100%. As an adverse event, cerebral infarction was found in three cases with carotid blowout syndrome. The rebleeding rate at 30 days after TAE and in the follow-up period (range, 9-3,004 days) was 17.2% and 35.5%, respectively. The median survival time was 263 days (95% confidence interval: 124.0-402.0 days). In the log-rank test, complete remission (CR) of the primary cancer at the time of the first TAE was identified as a significant influencing factor of survival. TAE is effective for the treatment of hemorrhage associated with HNC even in patients with an unstable status. Patients with CR can gain a long life span. 4 Laryngoscope, 131:E2777-E2783, 2021.

Woman with Epigastric Pain

A 67-year-old woman presented to the emergency department with several hours of epigastric pain. She had a history of pancreatitis complicated by a pseudocyst 5 years before. On physical examination, she was afebrile, with a blood pressure of 205/110 mm Hg and pulse rate of 83 beats/min. She had marked tenderness without muscle guarding over the epigastric area. Laboratory investigations revealed a normal hemoglobin level and an elevated lipase level (111 IU/L). Although pancreatitis was suspected, the emergency physician performed point-of-care ultrasonography (Figure 1) and confirmed the diagnosis with a computed tomographic (CT) scan (Figure 2).Figure 2CT image of the abdomen showing a cystic mass (arrowhead) in the pancreatic tail with a hemorrhagic component and contrast extravasation (arrow).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Pancreatic pseudocyst with intracystic hemorrhage. Emergency transarterial embolization of the posterior pancreatic artery was performed, and she was discharged uneventfully from the hospital. Pancreatic pseudocyst is a common complication of pancreatitis, but intracystic hemorrhage is a rare and potentially life-threatening condition with a mortality rate ranging from 15% to 50%.1Chiang K.C. Chen T.H. Hsu J.T. Management of chronic pancreatitis complicated with a bleeding pseudoaneurysm.World J Gastroenterol. 2014; 20: 16132-16137Crossref PubMed Scopus (28) Google Scholar Clinical manifestations include abdominal pain, anemia, and melena.2Chiu H.H. Chen C.M. Wang K.C. et al.Pancreatic pseudocyst bleeding associated with massive intraperitoneal hemorrhage.Am J Surg. 2006; 192: 87-88Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar Delayed diagnosis may lead to complications such as rupture of the hemorrhagic pseudocyst, which can cause hemoperitoneum and shock. Angiographic embolization of the culprit artery is the mainstay of management,3Gambiez L.P. Ernst O.J. Merlier O.A. et al.Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis.Arch Surg. 1997; 132: 1016-1021Crossref PubMed Scopus (115) Google Scholar with surgical intervention reserved for refractory cases.

S2720 Hemorrhagic Shock as Initial Presentation of Hepatocellular Carcinoma: A Case Series

INTRODUCTION: Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide. In the United States (US) Texas has the highest HCC incidence rate in 2015 (13.2/100,000 individuals), 45% higher than national average. Hemorrhagic shock due to tumor rupture is a rare, life-threatening presentation that requires acute intervention. Given its rare presentation, this has been documented through small case series. As such, the true impact of HCC tumor rupture on outcomes has been difficult to ascertain in different populations. CASE DESCRIPTION/METHODS: Case 1 81-year-old Hispanic man with medical history of CAD and atrial fibrillation presents to the hospital for severe right upper quadrant (RUQ) pain for 1 day. Vitals significant for BP 60/40 mmHg. On exam he is in distress with findings of acute abdomen. Hb noted at 11.4 mg/dL. CT abdomen shows a 4.1 cm mass at the posterior segment of the right lobe of the liver with perihepatic and peri-splenic fluid. Patient was initially resuscitated with normal saline and PRBCs, however he required norepinephrine and emergent trans-arterial embolization (TAE). After the procedure patient had US-guided paracentesis with 1.8 L serosanguineous fluid removal. Case 2 55-year-old Hispanic woman with Hepatitis C comes to the hospital for sudden onset severe RUQ pain. Vitals are stable, on exam has RUQ tenderness. Laboratory showed Hb 8.8 mg/dL. CT Angiography abdomen reports 3.5 cm right lobe liver mass and peri-hepatic moderate complex fluid collection. Patient received 1 unit of PRBC and went for emergent TAE of ruptured HCC. DISCUSSION: The pathogenesis behind tumor rupture remains unclear, some studies report tumor location, growth and vessels friability with high intra-tumoral pressure as a cause of bleeding and rupture. Patients present with acute abdominal pain and hypovolemic/hemorrhagic shock in 33–99% of cases. Diagnosis can be made with abdominal CT or US showing tumor location/size and hemoperitoneum if present. Paracentesis can show sanguineous peritoneal fluid. Acute management is focused on patient’s hemodynamic stabilization and bleeding control with TAE. If bleeding persists, emergency liver resection is indicated with post-operative mortality rate of 16-100%. This case series demonstrates an uncommon and life-threatening initial presentation of HCC. The high incidence of HCC among Texas-based Hispanic population warrants early recognition of this dreadful complication.Figure 1.: Case 1.CT abdomen showing 4.1 cm mass at the posterior segment of the right lobe of the liver.Figure 2.: Case 2. CT Angiography Abdominal showing arterial enhancing of a 3.5 × 3.5 cm right lobe liver mass adjacent to the lateral capsular surface. Hemoperitoneum noted.

Embolization of an Arc of Riolan Artery Aneurysm

A 46-year-old female without prior underlying disease presented with 3 days of abdominal pain. Her blood pressure was 123/78 mm Hg, and her heart rate was 105 beats/min. Laboratory data revealed elevated white blood cell count of 23.8 (1,000 cells/μL) and C-reactive protein level of 11.66 (mg/L). Computed tomography (CT) angiography revealed hemoperitoneum and an aneurysm at the left side of the abdomen (Fig 1). Emergent transarterial embolization was planned. The angiography showed an 8.8-mm saccular aneurysm located at the arc of Riolan artery connecting the left colic artery to the superior mesenteric artery (Figs 2, 3). Coil embolization using a sandwich technique was successfully performed (Fig 4). Symptoms subsided, and no abdominal complications or discomfort were noted during her 18-month follow-up. However, no subsequent laboratory or clinical workup for the underlying cause was performed by the physician. Figure 2Angiography from the superior mesenteric artery shows an enlarged and tortuous course of bridging artery (arrow). View Large Image Figure Viewer Download Hi-res image Figure 3Angiography from the inferior mesenteric artery shows the arc of Riolan artery (arrow) and a saccular aneurysm (dashed arrow). View Large Image Figure Viewer Download Hi-res image Figure 4Post-coil embolization of an aneurysm (arrow) at the arc of Riolan artery. View Large Image Figure Viewer Download Hi-res image

Spontaneous Abdominal Wall Hematoma

A 56-year-old woman presented to our emergency department because of sudden onset of severe left lower abdominal pain. She suffered a severe cough for 2 weeks and denied using anticoagulation agents. Physical examination showed some purple-bluish lesions in her left abdominal wall (Figure A). A big tender mass was palpated in her left lower abdomen. Her hemoglobin level was 10.1 g/dL. Abdominal ultrasound showed a 7-cm hyperechoic mass in the left abdominal wall (Figure B). Abdominal computed tomography showed a large hematoma with contrast extravasation in the left lateral abdominal wall (Figure C, arrow). Emergency transarterial embolization was performed and her abdominal wall bleeding was halted. She underwent a debridement for hematoma and was discharged uneventfully. Spontaneous abdominal wall hematoma is an unusual entity and its most common presentations are acute abdominal pain, vomiting, and fever. Physical examination showed cutaneous ecchymosis and an abdominal palpable mass. Predisposing factors of this disease include severe cough, vomiting, or use of anticoagulants. Abdominal ultrasound and computed tomography are useful modalities to evaluate active bleeding from ruptured arteries. Conservative treatment is acceptable for patients with stable hemodynamics, but surgery is restricted for patients with complications (rupture, infection, or hematoma progression). Angiography with embolization can control bleeding and avoid surgical intervention.

Emergent angio-embolization with elective nephrectomy in ruptured Angiomyolipoma: A case report

Renal Angiomyolipoma is a common tumour in clinical practice and mostly follows a benign course. Angiomyolipoma is the most common renal neoplasm associated with spontaneous retroperitoneal haemorrhage due to rupture of micro and macro-aneurysms. Urgent trans-catheter angio-embolization of the bleeding vessel is very effective in patients suffering from life threatening hemorrhage secondary to rupture of Angiomyolipoma. Elective surgery is usually indicated to avoid re-bleeding or abscess formation. We report a case of Spontaneous Rupture of Angiomyolipoma of Right kidney in 63 years old female. The female underwent emergent Trans-arterial Embolization followed by elective nephrectomy.

FRI-456-MELD score is the only predictor for 30-day mortality in patients with ruptured hepatocellular carcinoma treated by emergent transarterial embolization

FRI-456-MELD score is the only predictor for 30-day mortality in patients with ruptured hepatocellular carcinoma treated by emergent transarterial embolization

Vagal Nerve Palsy After Transarterial Embolization of Transverse-Sigmoid Dural Arteriovenous Fistula Using Onyx

ObjectiveWe report a case of a 70-year-old man who developed a transverse-sigmoid dural arteriovenous fistula (TS-DAVF) that was successfully treated by transarterial embolization (TAE) with Onyx. Case PresentationThe patient presented with sudden and progressive disturbance of consciousness and left hemiparesis. Magnetic resonance imaging (MRI) revealed venous infarction and hemorrhagic changes with brain swelling in the right parietal lobe. Angiography revealed a right TS-DAVF and multiple occlusions with retrograde leptomeningeal venous drainage into the cortical veins. The TS-DAVF was graded as Borden type III and Cognard type IIa+b. Because of its progressive clinical nature and wide distribution of DAVF in the occluded sinus wall, he underwent emergent TAE with liquid embolic materials including n-butyl cyanoacrylate and Onyx under informed consent by his family. Complete obliteration of the TS-DAVF was achieved, leading to a marked amelioration of symptoms, and MRI after treatment confirmed a decrease in the brain swelling. However, he suffered transient dysphagia due to right vagal nerve palsy caused by occlusion of vasa nervorum of ascending pharyngeal artery. He returned home 5 months later with a modified Rankin Scale of 1. ConclusionsTAE with Onyx appears to be effective for aggressive TS-DAVF with a widely distributed shunt. However, the blood supply to the cranial nerves and potentially dangerous anastomoses between the external-internal carotid artery and vertebral artery should be taken into account to avoid serious complications.

Emergency Transarterial Embolization in Postoperative Hip Bleeding: Indications, Techniques, and Results in a Retrospective Cohort

BackgroundThe aim of this study is to report the results of transarterial embolization (TAE) in the setting of postoperative bleeding after hip surgery. MethodsWe retrospectively evaluated 40 patients (male:female = 15:25, median age = 68 years) who underwent TAE from 2006 to 2016: 77.5% underwent total hip arthroplasty, 20% open reduction internal fixation, and 2.5% external fixation. Preangiographic multidetector computed tomography angiography was performed in 20 (49%) cases, and 9 of them showed arterial extravasation. Twenty-seven TAEs were performed within a week from surgery; active bleeding was seen in 33 (80.5%) angiograms. Gelatin sponge, microparticles, coils, n-butyl cyanoacrylate, and combinations of them were used as embolic materials. ResultsBleeding was controlled in all cases. The most frequently embolized arteries were branches of the deep femoral artery (n = 17). Permanent embolization agents (microparticles, coils, n-2-butyl-cyanoacrylate) were used in 88% of cases; temporary agents (gelfoam) in 12%. One procedure was complicated by arterial dissection. Hospital discharge averaged 20 days post-TAE (median = 17, range = 3-104). One-month survival rate was 97.5%. One patient died of ischemic bowel perforation. ConclusionTAE is safe and effective in stopping the bleeding of the hip region and should be performed early, to avoid irreversible ischemic damage. Multidetector computed tomography angiography can be used to confirm doubtful evidence of ongoing bleeding. Several embolic materials can be used, each one offering different advantages. Low complication and mortality rates were observed. TAE seems to be the ideal first-line intervention when postoperative bleeding of the operated hip is detected.

Pancreaticoduodenal arcades as salvage route for transarterial embolization of life-threatening hepatic hemorrhage in patients with severe celiac axis stenosis: Case series

IntroductionVarious transarterial embolotherapies for different hepatic etiologies are performed through the celiac axis (CA). However, this pathway is not always patent due to the extensive stenosis or occlusion of the origin of CA. In such situations, the pancreaticoduodenal arcades (PDAs) catheterization is the main alternative to gain access to the hepatic arteries as demonstrated in clinical studies. Presentation of caseWe report two cases of life-threating hepatic hemorrhage indicated for emergency transarterial embolization (TAE). DiscussionThe massive hemorrhage was due to spontaneous rupture of hepatocellular carcinoma (HCC) in the first case and due to post liver blunt trauma in the second case. Owing to severe stenosis of the origin of CA, PDAs were used as a salvage alternative route for emergency TAE of hepatic arteries. ConclusionEndovascular management of massive hepatic hemorrhage in cases of inaccessibility to hepatic arteries through CA is a highly challenging situation in which the technical success depends on the operator experience, choice of the material and anatomical knowledge of hepatic arterial collateral supply.

Efficacy of emergency transarterial embolization in acute lower gastrointestinal bleeding: A single-center experience

The purpose of this study was to assess the safety and efficacy of transcatheter arterial embolization (TAE) in the treatment of acute lower gastrointestinal bleeding (LGIB) and to determine the potential factors that influence treatment outcome. A total of 38patients with acute LGIB who were treated by TAE were retrospectively included. There were 24 men and 14 women, with a mean age of 61years (range: 9-84years). Patient characteristics, laboratory findings, treatments, causes of bleeding, angiographic findings, and outcomes were reviewed. Active contrast extravasation was observed in 26/38 patients (68.4%) and was the most frequent angiographic finding, followed by abnormal mucosal staining (8/38; 21.1%) and tumor staining (4/38; 10.5%). Technical success of TAE was obtained in 35/38 patients (92%) whereas technical failure was observed in 3/38 patients (8%). Clinical success rate following TAE was 63%. Bowel ischemia occurred in 5/38 patients (13%) following TAE; mild ischemia without sequelae was observed in 3 patients and severe ischemias with bowel perforation requiring surgery in 2 patients. No variables were identified as significant predictive factors of failed TAE. TAE is a safe and effective treatment to control massive acute LGIB, especially in the emergency setting with a clinical success rate of 63%.