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Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms

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Abstract

Purpose

To assess the role and effectiveness of percutaneous arterial embolization (TAE) in patients with hemodynamic instability due to hypovolemic shock secondary to ruptured splanchnic artery pseudoaneurysms (SAPA).

Materials and Methods

Seventeen patients (11 men, 6 women; mean age, 53 years) with hemodynamic instability (systolic blood pressure <90 mmHg) due to hypovolemic shock secondary to ruptured SAPA were treated by TAE. Clinical files, multidetector row computed tomography angiography, and angiographic examinations along with procedure details were reviewed.

Results

Seventeen SAPAs were present, predominantly located on gastroduodenal or pancreatic arteries (9/17; 53 %). Angiography showed extravasation of contrast medium from SAPA in 15/17 patients (88 %). Technical success rate of TAE was 100 %. TAE was performed using metallic coils in all patients (100 %), in association with gelatin sponge in 5/17 patients (29 %). TAE allowed controlling the bleeding and returning to normal hemodynamic status in 16/17 patients (94 %). In 1/17 patient (6 %), surgery was needed to definitively control the bleeding. The mortality and morbidity rate of TAE at 30 days were 0 and 12 %, respectively. Morbidity consisted in coil migration in 1/17 patient (6 %) and transient serum liver enzyme elevation in 1/17 patient (6 %).

Conclusion

TAE is an effective and safe treatment option for ruptured SAPA in hemodynamically unstable patients, with a success rate of 94 %. Our results suggest that TAE should be the favored option in patients with hemodynamic instability due to ruptured SAPA.

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Conflict of interest

Anthony Dohan, Clarisse Eveno, Raphael Dautry, Youcef Guerrache, Marine Camus, Mourad Boudiaf, Etienne Gayat, Olivier Le Dref, Marc Sirol, Philippe Soyer declare that they have no conflicts of interest.

Statement of Informed Consent

“Informed consent was obtained from all individual participants included in the study.”

Statement of Human Rights

“All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”

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Authors and Affiliations

  1. Department of Abdominal and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France

    Anthony Dohan, Raphael Dautry, Youcef Guerrache, Mourad Boudiaf, Olivier Le Dref, Marc Sirol & Philippe Soyer

  2. Department of Abdominal and Interventional Imaging, Hôpital Lariboisière - APHP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France

    Philippe Soyer

  3. Université Paris-Diderot, Sorbonne Paris Cité, 10 rue de Verdun, 75010, Paris, France

    Anthony Dohan, Clarisse Eveno, Raphael Dautry, Youcef Guerrache, Marine Camus, Etienne Gayat & Philippe Soyer

  4. Department of Gastroenterology and Endoscopy, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France

    Clarisse Eveno

  5. Department of Anesthesiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France

    Marine Camus

  6. Department of Anesthesiology and Intensive Care Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France

    Etienne Gayat

Authors
  1. Anthony Dohan
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  2. Clarisse Eveno
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  3. Raphael Dautry
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  4. Youcef Guerrache
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  5. Marine Camus
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  6. Mourad Boudiaf
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  7. Etienne Gayat
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  8. Olivier Le Dref
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  9. Marc Sirol
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  10. Philippe Soyer
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Corresponding author

Correspondence to Philippe Soyer.

Additional information

Splanchnic artery pseudoaneurysms are safely and effectively treated by arterial embolization in hemodynamically unstable patients.

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Dohan, A., Eveno, C., Dautry, R. et al. Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms. Cardiovasc Intervent Radiol 38, 862–870 (2015). https://doi.org/10.1007/s00270-014-1002-2

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  • DOI: https://doi.org/10.1007/s00270-014-1002-2

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