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Erschienen in: La radiologia medica 2/2014

01.02.2014 | Vascular and Interventional Radiology

Endovascular treatment of spontaneous extraperitoneal haemorrhage: immediate and long-term clinical efficiency

verfasst von: Giuseppe Guzzardi, Rita Fossaceca, Paolo Cerini, Marco De Bonis, Emanuele Malatesta, Ignazio Divenuto, Mariangela Lombardi, Alessandro Carriero

Erschienen in: La radiologia medica | Ausgabe 2/2014

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Abstract

Purpose

This study aimed to evaluate the effectiveness of transcatheter embolisation in the treatment of spontaneous extraperitoneal haemorrhage (SEH).

Materials and methods

We retrospectively evaluated the technical and clinical success in terms of immediate and long-term mortality in a series of patients who underwent endovascular treatment of SEH from January 2005 to December 2010. A statistical comparison of pre- and postoperative transfusion requirements was performed by using the Student’s t test, with statistical significance set at p < 0.005.

Results

In the period considered, 30 patients (16 women and 14 men; mean age, 73.3 years ±15.6) with SEH underwent endovascular treatment. Technical success was obtained in all cases (100 %), and a statistically significant reduction in blood transfusion requirements was observed (mean preoperative requirement: 7.5 U/day ±3; mean postoperative requirement 2.8 U/day) (p < 0.005). We observed a postoperative mortality of 10 % (3/30 patients) and mortality at 6 and 12 months was 14.8 % (4/27 patients) and 26 % (6/23 patients), respectively.

Conclusion

According to our experience and to the literature, transcatheter arterial embolisation represents the treatment of choice in patients with SEH, as it ensures complete therapeutic success.
Literatur
1.
Zurück zum Zitat Pode D, Caine M (1992) Spontaneous retroperitoneal hemorrhage. J Urol 147:311–318PubMed Pode D, Caine M (1992) Spontaneous retroperitoneal hemorrhage. J Urol 147:311–318PubMed
2.
Zurück zum Zitat Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. The Columbus Investigators. N Engl J Med 1997; 337:657–662 Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. The Columbus Investigators. N Engl J Med 1997; 337:657–662
3.
Zurück zum Zitat Friedberg EB, Stock JR, Husted JW, Westby GR (1996) Transcatheter embolization for retroperitoneal hemorrhage secondary to acquired cystic kidney disease. J Vasc Interv Radiol 7:291–294PubMedCrossRef Friedberg EB, Stock JR, Husted JW, Westby GR (1996) Transcatheter embolization for retroperitoneal hemorrhage secondary to acquired cystic kidney disease. J Vasc Interv Radiol 7:291–294PubMedCrossRef
4.
Zurück zum Zitat Chan YC, Morales JP, Reidy JF, Taylor PR (2008) Management of spontaneous and iatrogenic retroperitoneal hemorrhage: conservative management, endovascular intervention or open surgery? Int J Clin Pract 62:1604–1613PubMedCrossRef Chan YC, Morales JP, Reidy JF, Taylor PR (2008) Management of spontaneous and iatrogenic retroperitoneal hemorrhage: conservative management, endovascular intervention or open surgery? Int J Clin Pract 62:1604–1613PubMedCrossRef
6.
Zurück zum Zitat Seccia A, Tos P, Ravera R, Faletti C (2001) Flexor sheath hemorrhage of the hand during anticoagulant therapy: CT and MR. Radiol Med 101(3):195–196PubMed Seccia A, Tos P, Ravera R, Faletti C (2001) Flexor sheath hemorrhage of the hand during anticoagulant therapy: CT and MR. Radiol Med 101(3):195–196PubMed
7.
Zurück zum Zitat Fitzmaurice DA, Blann AD, Lip G (2002) Bleeding risks of antithrombotic therapy. BMJ 325:828–831PubMedCrossRef Fitzmaurice DA, Blann AD, Lip G (2002) Bleeding risks of antithrombotic therapy. BMJ 325:828–831PubMedCrossRef
8.
Zurück zum Zitat Virjo I, Mäkelä K, Aho J et al (2010) Who receives anticoagulant treatment with warfarin and why? A population-based study in Finland. Scand J Prim Health Care 28:237–241PubMedCentralPubMedCrossRef Virjo I, Mäkelä K, Aho J et al (2010) Who receives anticoagulant treatment with warfarin and why? A population-based study in Finland. Scand J Prim Health Care 28:237–241PubMedCentralPubMedCrossRef
9.
Zurück zum Zitat Winkelmayer WC, Patrick AR, Liu J et al (2011) The increasing prevalence of atrial fibrillation among hemodialysis patients. J Am Soc Nephrol 22:349–357PubMedCrossRef Winkelmayer WC, Patrick AR, Liu J et al (2011) The increasing prevalence of atrial fibrillation among hemodialysis patients. J Am Soc Nephrol 22:349–357PubMedCrossRef
10.
Zurück zum Zitat Fitzgerald JEF, Fitzgerald LA, Anderson FE, Acheson AG (2009) The changing nature of rectus sheath haematoma: case series and literature review. Int J Surg 7:150–154PubMedCrossRef Fitzgerald JEF, Fitzgerald LA, Anderson FE, Acheson AG (2009) The changing nature of rectus sheath haematoma: case series and literature review. Int J Surg 7:150–154PubMedCrossRef
11.
Zurück zum Zitat Donaldson J, Knowles CH, Clark SK et al (2007) Rectus sheath haematoma associated with low molecular weight heparin: a case series. Ann R Coll Surg Engl 89:309–312PubMedCentralPubMedCrossRef Donaldson J, Knowles CH, Clark SK et al (2007) Rectus sheath haematoma associated with low molecular weight heparin: a case series. Ann R Coll Surg Engl 89:309–312PubMedCentralPubMedCrossRef
12.
Zurück zum Zitat Luhmann A, Williams EV (2006) Rectus sheath hematoma: a series of unfortunate events. World J Surg 30:2050–2055PubMedCrossRef Luhmann A, Williams EV (2006) Rectus sheath hematoma: a series of unfortunate events. World J Surg 30:2050–2055PubMedCrossRef
13.
Zurück zum Zitat Palareti G, Leali N, Coccheri S et al (1996) Bleeding complications of oral anticoagulant treatment: an inception cohort prospective collaboration study. Lancet 348:423–428PubMedCrossRef Palareti G, Leali N, Coccheri S et al (1996) Bleeding complications of oral anticoagulant treatment: an inception cohort prospective collaboration study. Lancet 348:423–428PubMedCrossRef
14.
Zurück zum Zitat Van-Der-Meer FJ, Rosendaal FR, Vandenbroucke JP et al (1993) Bleeding complications in oral anticoagulant therapy: an analysis of risk factors. Arch Intern Med 153:1557–1562PubMedCrossRef Van-Der-Meer FJ, Rosendaal FR, Vandenbroucke JP et al (1993) Bleeding complications in oral anticoagulant therapy: an analysis of risk factors. Arch Intern Med 153:1557–1562PubMedCrossRef
15.
Zurück zum Zitat Milutinovich J, Follette WC, Scribner BH (1977) Spontaneous retroperitoneal bleeding in patients on chronic hemodialysis. Ann Intern Med 86:189–192PubMedCrossRef Milutinovich J, Follette WC, Scribner BH (1977) Spontaneous retroperitoneal bleeding in patients on chronic hemodialysis. Ann Intern Med 86:189–192PubMedCrossRef
16.
Zurück zum Zitat Isokangas JM, Perala JM (2004) Endovascular embolization of spontaneous retroperitoneal hemorrhage secondary to anticoagulant treatment. Cardiovasc Intervent Radiol 27:607–611PubMedCrossRef Isokangas JM, Perala JM (2004) Endovascular embolization of spontaneous retroperitoneal hemorrhage secondary to anticoagulant treatment. Cardiovasc Intervent Radiol 27:607–611PubMedCrossRef
17.
Zurück zum Zitat Rimola J, Perendreu J, Falco J et al (2007) Percutaneous arterial embolization in the management of rectus sheath hematoma. AJR Am J Roentgenol 188:W497–W502PubMedCrossRef Rimola J, Perendreu J, Falco J et al (2007) Percutaneous arterial embolization in the management of rectus sheath hematoma. AJR Am J Roentgenol 188:W497–W502PubMedCrossRef
18.
Zurück zum Zitat Basile A, Medina JG, Mundo E et al (2004) Transcatheter arterial embolization of concurrent spontaneous hematomas of the rectus sheath and psoas muscle in patients undergoing anticoagulation. Cardiovasc Intervent Radiol 27:659–662PubMedCrossRef Basile A, Medina JG, Mundo E et al (2004) Transcatheter arterial embolization of concurrent spontaneous hematomas of the rectus sheath and psoas muscle in patients undergoing anticoagulation. Cardiovasc Intervent Radiol 27:659–662PubMedCrossRef
19.
Zurück zum Zitat Zissin R, Gayer G, Kots E et al (2007) Transcatheter arterial embolisation in anticoagulant related haematoma—a current therapeutic option: a report of four patients and review of the literature. Int J Clin Pract 61:1321–1327PubMedCrossRef Zissin R, Gayer G, Kots E et al (2007) Transcatheter arterial embolisation in anticoagulant related haematoma—a current therapeutic option: a report of four patients and review of the literature. Int J Clin Pract 61:1321–1327PubMedCrossRef
20.
Zurück zum Zitat Pathi R, Voyvodic F, Thompson WR (2004) Spontaneous extraperitoneal hemorrhage: computed tomography diagnosis and treatment by selective arterial embolization. Australas Radiol 48:123–128PubMedCrossRef Pathi R, Voyvodic F, Thompson WR (2004) Spontaneous extraperitoneal hemorrhage: computed tomography diagnosis and treatment by selective arterial embolization. Australas Radiol 48:123–128PubMedCrossRef
21.
Zurück zum Zitat Surani S, Estement B, Manchandan S et al (2011) Spontaneous extraperitoneal lumbar artery hemorrhage. J Emerg Med 40(6):e111–e114PubMedCrossRef Surani S, Estement B, Manchandan S et al (2011) Spontaneous extraperitoneal lumbar artery hemorrhage. J Emerg Med 40(6):e111–e114PubMedCrossRef
22.
Zurück zum Zitat Angle JF, Siddiqi NH, Wallace MJ et al (2010) Quality improvement guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 21:1479–1486PubMedCrossRef Angle JF, Siddiqi NH, Wallace MJ et al (2010) Quality improvement guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 21:1479–1486PubMedCrossRef
23.
Zurück zum Zitat Panetta T, Sclafani SJ, Goldstein AS et al (1985) Percutaneous transcatheter embolization for massive bleeding from pelvic fractures. J Trauma 25:1021–1029PubMed Panetta T, Sclafani SJ, Goldstein AS et al (1985) Percutaneous transcatheter embolization for massive bleeding from pelvic fractures. J Trauma 25:1021–1029PubMed
24.
Zurück zum Zitat Illescas FF, Baker ME, McCann R et al (1986) CT evaluation of retroperitoneal hemorrhage associated with femoral arteriography. AJR 146:1289–1292PubMedCrossRef Illescas FF, Baker ME, McCann R et al (1986) CT evaluation of retroperitoneal hemorrhage associated with femoral arteriography. AJR 146:1289–1292PubMedCrossRef
25.
Zurück zum Zitat Sclafani SJ, Florence LO, Phillips TF et al (1987) Lumbar arterial injury: radiologic diagnosis and management. Radiology 165:709–714PubMed Sclafani SJ, Florence LO, Phillips TF et al (1987) Lumbar arterial injury: radiologic diagnosis and management. Radiology 165:709–714PubMed
26.
Zurück zum Zitat Bhasin HK, Dana CL (1978) Spontaneous retroperitoneal hemorrhage in chronically hemodialyzed patients. Nephron 22:322–327PubMedCrossRef Bhasin HK, Dana CL (1978) Spontaneous retroperitoneal hemorrhage in chronically hemodialyzed patients. Nephron 22:322–327PubMedCrossRef
27.
Zurück zum Zitat Park SH, Lee SW, Jeon U et al (2011) Transcatheter arterial embolization as treatment for a life-threatening retroperitoneal hemorrhage complicating heparin therapy. Korean J Intern Med 26(3):352–355PubMedCentralPubMedCrossRef Park SH, Lee SW, Jeon U et al (2011) Transcatheter arterial embolization as treatment for a life-threatening retroperitoneal hemorrhage complicating heparin therapy. Korean J Intern Med 26(3):352–355PubMedCentralPubMedCrossRef
28.
Zurück zum Zitat Pozzi-Mucelli F, Medeot A, Cernic S et al (2011) Multimodal approach to the endovascular treatment of embolisation or exclusion of the renal arteries and their distal and/or polar branches: personal experience. Radiol Med 116(6):945–959PubMedCrossRef Pozzi-Mucelli F, Medeot A, Cernic S et al (2011) Multimodal approach to the endovascular treatment of embolisation or exclusion of the renal arteries and their distal and/or polar branches: personal experience. Radiol Med 116(6):945–959PubMedCrossRef
29.
Zurück zum Zitat Franco F, Monaco D, Volpi A et al (2011) The role of arterial embolization in blunt splenic injury. Radiol Med 116(3):454–465PubMedCrossRef Franco F, Monaco D, Volpi A et al (2011) The role of arterial embolization in blunt splenic injury. Radiol Med 116(3):454–465PubMedCrossRef
30.
Zurück zum Zitat Nistri M, Acquafresca M, Pratesi A et al (2008) Bronchial artery embolization with detachable coils for the treatment of haemoptysis. Preliminary experience. Radiol Med 113(3):452–460CrossRef Nistri M, Acquafresca M, Pratesi A et al (2008) Bronchial artery embolization with detachable coils for the treatment of haemoptysis. Preliminary experience. Radiol Med 113(3):452–460CrossRef
31.
Zurück zum Zitat Ferro C, Petrocelli F, Rossi UG et al (2007) Vascular percutaneous transcatheter embolisation with a new device: Amplatzer vascular plug. Radiol Med 112(2):239–251PubMedCrossRef Ferro C, Petrocelli F, Rossi UG et al (2007) Vascular percutaneous transcatheter embolisation with a new device: Amplatzer vascular plug. Radiol Med 112(2):239–251PubMedCrossRef
32.
Zurück zum Zitat Basile A, Certo A, Ascenti G et al (2003) Interventional radiology in the preoperative management of stromal tumors causing intestinal bleeding. Radiol Med 106(4):376–381PubMed Basile A, Certo A, Ascenti G et al (2003) Interventional radiology in the preoperative management of stromal tumors causing intestinal bleeding. Radiol Med 106(4):376–381PubMed
33.
Zurück zum Zitat Sharafuddin MJ, Andresen KJ, Sun S et al (2001) Spontaneous extraperitoneal hemorrhage with hemodynamic collapse in patients undergoing anticoagulation: management with selective arterial embolization. J Vasc Interv Radiol 12(10):1231–1234PubMedCrossRef Sharafuddin MJ, Andresen KJ, Sun S et al (2001) Spontaneous extraperitoneal hemorrhage with hemodynamic collapse in patients undergoing anticoagulation: management with selective arterial embolization. J Vasc Interv Radiol 12(10):1231–1234PubMedCrossRef
34.
Zurück zum Zitat Moreno Gallego A, Aguayo JL, Flores B et al (1997) Ultrasonography and computed tomography reduce unnecessary surgery in abdominal rectus sheath hematoma. Br J Surg 84:1295–1297PubMedCrossRef Moreno Gallego A, Aguayo JL, Flores B et al (1997) Ultrasonography and computed tomography reduce unnecessary surgery in abdominal rectus sheath hematoma. Br J Surg 84:1295–1297PubMedCrossRef
35.
Zurück zum Zitat Grimm MR, Vrahas MS, Thomas KA (1998) Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum. J Trauma 44:454–459PubMedCrossRef Grimm MR, Vrahas MS, Thomas KA (1998) Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum. J Trauma 44:454–459PubMedCrossRef
36.
Zurück zum Zitat Franco F, Monaco D, Volpi A et al (2011) The role of arterial embolization in blunt splenic injury. Radiol Med 116(3):454–465PubMedCrossRef Franco F, Monaco D, Volpi A et al (2011) The role of arterial embolization in blunt splenic injury. Radiol Med 116(3):454–465PubMedCrossRef
37.
Zurück zum Zitat Basile A, Lupattelli T, Giulietti G et al (2005) Interventional treatment of iatrogenic lesions and hepatic arteries. Radiol Med 11:88–96 Basile A, Lupattelli T, Giulietti G et al (2005) Interventional treatment of iatrogenic lesions and hepatic arteries. Radiol Med 11:88–96
38.
Zurück zum Zitat Pieri S, Agresti P, Morucci M et al (2004) Percutaneous management of hemorrhages in pelvic fractures. Radiol Med 107:241–251PubMed Pieri S, Agresti P, Morucci M et al (2004) Percutaneous management of hemorrhages in pelvic fractures. Radiol Med 107:241–251PubMed
39.
Zurück zum Zitat Florio F, Nardella M, Balzano S et al (1999) Arterial embolization: present role of an old method of interventional radiology in the treatment of hemorrhages. Radiol Med 97(3):107–115PubMed Florio F, Nardella M, Balzano S et al (1999) Arterial embolization: present role of an old method of interventional radiology in the treatment of hemorrhages. Radiol Med 97(3):107–115PubMed
40.
Zurück zum Zitat Farrelly C, Fidelman N, Durack JC et al (2011) Transcatheter arterial embolization of spontaneous life-threatening extraperitoneal hemorrhage. J Vasc Interv Radiol 22:1396–1402PubMedCrossRef Farrelly C, Fidelman N, Durack JC et al (2011) Transcatheter arterial embolization of spontaneous life-threatening extraperitoneal hemorrhage. J Vasc Interv Radiol 22:1396–1402PubMedCrossRef
Metadaten
Titel
Endovascular treatment of spontaneous extraperitoneal haemorrhage: immediate and long-term clinical efficiency
verfasst von
Giuseppe Guzzardi
Rita Fossaceca
Paolo Cerini
Marco De Bonis
Emanuele Malatesta
Ignazio Divenuto
Mariangela Lombardi
Alessandro Carriero
Publikationsdatum
01.02.2014
Verlag
Springer Milan
Erschienen in
La radiologia medica / Ausgabe 2/2014
Print ISSN: 0033-8362
Elektronische ISSN: 1826-6983
DOI
https://doi.org/10.1007/s11547-013-0321-8

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