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Incidence and endovascular treatment of severe spontaneous non-cerebral bleeding: a single-institution experience

  • Stavros Spiliopoulos
  • Georgios Festas
  • Antonios Theodosis
  • Konstantinos Palialexis
  • Lazaros Reppas
  • Chysostomos Konstantos
  • Elias Brountzos
Interventional
  • 25 Downloads

Abstract

Objectives

To investigate the incidence and endovascular treatment of severe spontaneous non-cerebral hemorrhage (SSNCH) in a high-volume, tertiary university hospital.

Methods

All patients diagnosed with SSNCH between January 2016 and June 2017 were retrospectively analyzed. Endovascular treatment (group EVT) was offered only in patients demonstrating active bleeding at CT angiography (CTA). In cases without active bleeding at CTA, conservative management was decided (group CM). Outcome measures included the incidence of SSNCH, 6-month rebleeding, and survival rates in the two groups as well as EVT technical success and related complications.

Results

Within the 18-month period, 44 SSNCH cases were identified, resulting in an annual incidence of 29.3 cases. In 37/44 cases (84.1%), bleeding was attributed to the antithrombotic therapy. In total, 19/44 patients underwent EVT (43.2%), and 25/44 patients (56.8%) were managed conservatively. Two patients who were initially treated conservatively finally underwent EVT due to rebleeding (7.4%). The technical success of EVT was 100%, while rebleeding occurred in 1 case (5.2%) following lumbar artery embolization and was successfully re-embolized. According to the Kaplan-Meier analysis, the 1-, 3-, and 6-month survival rates were 68.4%, 63.2%, and 42.1% for group EVT and 87.5%, 75.0%, and 58.3% for group CM, respectively. There were no EVT-related complications.

Conclusions

The annual incidence of SSNCH in our institution is substantial. EVT resulted in uncomplicated, high bleeding control rates. The mortality rate was similarly high following either EVT or conservative treatment and was mainly attributed to severe comorbidities.

Key Points

• This study demonstrates that the incidence of severe spontaneous non-cerebral hemorrhage (SSNCH) in our institution is substantial.

• Endovascular treatment was offered only in patients with clinical signs of ongoing hemorrhage and active bleeding at CT angiography and resulted in effective and uncomplicated, minimal invasive hemostasis, in a population with severe comorbidities.

• This is the first study to evaluate the outcomes of both endovascular hemostasis and conservative management. Rebleeding following either conservative or endovascular treatment was minimal.

Keywords

Hemorrhage Therapeutic embolization Anticoagulant drugs 

Abbreviations

CFA

Common femoral artery

CM

Conservative treatment

DSA

Digital subtraction angiography

EVT

Endovascular treatment

Hb

Hemoglobin

HU

Hounsfield units

LMWH

Low molecular weight heparin

MDCTA

Multi-detector computerized tomography angiography.

NOACs

New oral anticoagulants

NSAIDs

Non-steroid anti-inflammatory drugs

PFA

Profunda femoralis artery

SSNCH

Severe, spontaneous, non-cerebral hemorrhage

TAE

Trans-arterial embolization

vWF

von Willebrand factor

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Professor Elias Brountzos.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Case-control study

• Performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.2nd Department of Radiology, Division of Interventional RadiologyAttikon University Hospital, School of Medicine, National and Kapodistrian University of AthensAthensGreece

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