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The utility of transarterial embolization and computed tomography for life-threatening spontaneous retroperitoneal hemorrhage

  • Ryuichiro Tani
  • Keitaro SofueEmail author
  • Koji Sugimoto
  • Naoto Katayama
  • Mostafa A. S. Hamada
  • Koji Maruyama
  • Hiroki Horinouchi
  • Tomoyuki Gentsu
  • Koji Sasaki
  • Eisuke Ueshima
  • Yutaka Koide
  • Takuya Okada
  • Masato Yamaguchi
  • Takamichi Murakami
Original Article
  • 18 Downloads

Abstract

Purpose

To assess the safety and efficacy of transarterial embolization (TAE) and to evaluate the utility of contrast-enhanced computed tomography (CE-CT) for life-threatening spontaneous retroperitoneal hemorrhage (SRH).

Methods

Nineteen patients underwent TAE following CE-CT for life-threatening SRH. CE-CT and angiographic findings, technical successes, and clinical successes were evaluated. The diagnostic performance of CE-CT for the detection of active bleeding arteries was also assessed by two independent readers.

Results

Active extravasation of contrast material was accurately observed in 78.9‒84.2% of the patients on CE-CT. Angiograms revealed active extravasation in 37 arteries of 15 patients (78.9%), and 4 patients showed no sign of active bleeding. Sensitivity, positive predictive value, and accuracy rate of CE-CT for the detection of active bleeding vessels was 59.5%, 62.9‒71.0% and 55.6‒60.0% respectively. The successful embolization of 48 intended arteries was achieved in all the patients, including empirical TAE in four patients. Hemodynamic stabilization was achieved in 17 patients (89.5%) with a significant decrease in transfusion (p < 0.001).

Conclusion

TAE is a technically safe and clinically effective treatment method for life-threatening SRH. CE-CT has moderate capability for accurate identification of active bleeding arteries. TAE including arteries that potentially distribute anatomic territory of the hematoma is essential.

Keywords

Retroperitoneal hemorrhage Anticoagulation Computed tomography Arterial embolization 

Notes

Funding

This study was not supported by any funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Mant MJ, O'Brien BD, Thong KL, Hammond GW, Birtwhistle RV, Grace MG. Haemorrhagic complications of heparin therapy. Lancet. 1977;1(8022):1133–5.CrossRefGoogle Scholar
  2. 2.
    Pode D, Caine M. Spontaneous retroperitoneal hemorrhage. J Urol. 1992;147(2):311–8.CrossRefGoogle Scholar
  3. 3.
    González C, Penado S, Llata L, Valero C, Riancho JA. The clinical spectrum of retroperitoneal hematoma in anticoagulated patients. Medicine. 2003;82(4):257–62.Google Scholar
  4. 4.
    Ivascu FA, Janczyk RJ, Bair HA, Bendick PJ, Howells GA. Spontaneous retroperitoneal hemorrhage. Am J Surg. 2005;189(3):345–7.CrossRefGoogle Scholar
  5. 5.
    Sunga KL, Bellolio MF, Gilmore RM, Cabrera D. Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. J Emerg Med. 2012;43(2):e157–161.CrossRefGoogle Scholar
  6. 6.
    Shah RD, Nagar S, Shanley CJ, Janczyk RJ. Factors affecting the severity of spontaneous retroperitoneal hemorrhage in anticoagulated patients. Am J Surg. 2008;195(3):410–2.CrossRefGoogle Scholar
  7. 7.
    Bozeman MC, Cannon RM, Trombold JM, Smith JW, Franklin GA, Miller FB, et al. Use of computed tomography findings and contrast extravasation in predicting the need for embolization with pelvic fractures. Am Surg. 2012;78(8):825–30.Google Scholar
  8. 8.
    Hallinan JT, Tan CH, Pua U. Emergency computed tomography for acute pelvic trauma: where is the bleeder? Clin Radiol. 2014;69(5):529–37.CrossRefGoogle Scholar
  9. 9.
    Chan YC, Morales JP, Reidy JF, Taylor PR. Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery? Int J Clin Pract. 2008;62(10):1604–13.CrossRefGoogle Scholar
  10. 10.
    Papakostidis C, Kanakaris N, Dimitriou R, Giannoudis PV. The role of arterial embolization in controlling pelvic fracture haemorrhage: a systematic review of the literature. Eur J Radiol. 2012;81(5):897–904.CrossRefGoogle Scholar
  11. 11.
    Park SW, Ko SY, Yoon SY, Choe WH, Yun IJ, Chang SH, et al. Transcatheter arterial embolization for hemoperitoneum: unusual manifestation of iatrogenic injury to abdominal muscular arteries. Abdom Imaging. 2011;36(1):74–8.CrossRefGoogle Scholar
  12. 12.
    Isokangas JM, Perala JM. Endovascular embolization of spontaneous retroperitoneal hemorrhage secondary to anticoagulant treatment. Cardiovasc Interv Radiol. 2004;27(6):607–11.CrossRefGoogle Scholar
  13. 13.
    Pathi R, Voyvodic F, Thompson WR. Spontaneous extraperitoneal haemorrhage: computed tomography diagnosis and treatment by selective arterial embolization. Australas Radiol. 2004;48(2):123–8.CrossRefGoogle Scholar
  14. 14.
    Sharafuddin MJ, Andresen KJ, Sun S, Lang E, Stecker MS, Wibbenmeyer LA. Spontaneous extraperitoneal hemorrhage with hemodynamic collapse in patients undergoing anticoagulation: management with selective arterial embolization. J Vasc Interv Radiol. 2001;12(10):1231–4.CrossRefGoogle Scholar
  15. 15.
    Farrelly C, Fidelman N, Durack JC, Hagiwara E, Kerlan RK Jr. Transcatheter arterial embolization of spontaneous life-threatening extraperitoneal hemorrhage. J Vasc Interv Radiol. 2011;22(10):1396–402.CrossRefGoogle Scholar
  16. 16.
    Dohan A, Sapoval M, Chousterman BG, di Primio M, Guerot E, Pellerin O. Spontaneous soft-tissue hemorrhage in anticoagulated patients: safety and efficacy of embolization. AJR Am J Roentgenol. 2015;204(6):1303–10.CrossRefGoogle Scholar
  17. 17.
    Cardella JF, Kundu S, Miller DL, Millward SF, Sacks D. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2009;20(7 Suppl):S189–191.CrossRefGoogle Scholar
  18. 18.
    Angle JF, Siddiqi NH, Wallace MJ, Kundu S, Stokes L, Wojak JC, et al. Quality improvement guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol. 2010;21(10):1479–86.CrossRefGoogle Scholar
  19. 19.
    Yonemitsu T, Kawai N, Sato M, Tanihara H, Takasaka I, Nakai M, et al. Evaluation of transcatheter arterial embolization with gelatin sponge particles, microcoils, and n-butyl cyanoacrylate for acute arterial bleeding in a coagulopathic condition. J Vasc Interv Radiol. 2009;20:1176–87.CrossRefGoogle Scholar
  20. 20.
    Takeuchi Y, Morishita H, Sato Y, Hamaguchi S, Sakamoto N, Tokue H, et al. Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition. Jpn J Radiol. 2014 ;32:500-517.Google Scholar

Copyright information

© Japan Radiological Society 2019

Authors and Affiliations

  • Ryuichiro Tani
    • 1
  • Keitaro Sofue
    • 1
    Email author
  • Koji Sugimoto
    • 1
  • Naoto Katayama
    • 1
  • Mostafa A. S. Hamada
    • 1
  • Koji Maruyama
    • 1
  • Hiroki Horinouchi
    • 1
  • Tomoyuki Gentsu
    • 1
  • Koji Sasaki
    • 1
  • Eisuke Ueshima
    • 1
  • Yutaka Koide
    • 1
  • Takuya Okada
    • 1
  • Masato Yamaguchi
    • 1
  • Takamichi Murakami
    • 1
  1. 1.Department of RadiologyKobe University Graduate School of MedicineKobeJapan

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