The utility of transarterial embolization and computed tomography for life-threatening spontaneous retroperitoneal hemorrhage
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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).
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.
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).
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.
KeywordsRetroperitoneal hemorrhage Anticoagulation Computed tomography Arterial embolization
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.
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.
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