Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Transcatheter Arterial Embolization for Acute Arterial Extravasation with Hematoma Formation: Classified the Group as Cause and Their Clinical Outcomes

혈종형성에 대한 경동맥색전술: 원인과 임상적 결과로 분류한 그룹에 대한 분석

  • Kim, Boram (Department of Radiology, Chonbuk National University Medical School and Hospital) ;
  • Han, Young Min (Department of Radiology, Chonbuk National University Medical School and Hospital) ;
  • Jin, Gong Yong (Department of Radiology, Chonbuk National University Medical School and Hospital)
  • 김보람 (전북대학교 의학전문대학원 전북대학교병원 영상의학과) ;
  • 한영민 (전북대학교 의학전문대학원 전북대학교병원 영상의학과) ;
  • 진공용 (전북대학교 의학전문대학원 전북대학교병원 영상의학과)
  • Received : 2017.04.30
  • Accepted : 2017.07.11
  • Published : 2018.02.01
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Abstract

Purpose: To present our experience in transcatheter arterial embolization (TAE) for hematoma formation related to variable causes. We analyzed the factors that could affect clinical outcomes. Materials and Methods: A retrospective study was conducted on 50 patients (24 men, 36 women; mean age, 63.8 years) who were treated for a TAE to control bleeding. Computed tomography (CT) scans showed the formation of hematomas. We classified the patients into three groups depending on the underlying cause of the hematoma i.e., spontaneous, traumatic or iatrogenic groups. We evaluated relevant factors such as sex, age, hematoma size and liquefaction, extravasation on CT, injured artery, onset to procedure time, embolization material, hospital day. Results: TAE was successfully performed in all patients. The proportions of patients in the spontaneous, traumatic, and iatrogenic bleeding groups were 36% (18/50), 42% (21/50), and 22% (11/50), respectively. Using the Mann Whitney U test, the international normalized ratio (INR) was statistically different for the spontaneous bleeding group (p = 0.013). In addition, the INR (p = 0.038) and platelet count (p = 0.004) were significant different for the traumatic group. Also, the platelet counts were related to clinical successes (p = 0.046). Conclusion: Based our experience, TAE is a safe and effective treatment option for the management of hematoma formation. Furthermore, the interventional radiologist should consider the cause of hematoma formation in order to perform proper treatment.

목적: 혈종형성을 동반한 급성동맥출혈 환자에서 출혈의 원인별로 관련된 유의한 인자와, 임상적 결과에 따른 위험인자를 분석하고자 하였다. 대상과 방법: 2007년 4월부터 2014년 12월까지 급성동맥출혈로 경동맥색전술을 시행한 환자 50명(남자: 24, 여자 36, 평균연령: 63.8세)을 대상으로 연구하였다. 출혈 원인에 따라 자발성 출혈군과, 외상에 의한 출혈군, 의원성 출혈군으로 분류하였다. 세 군에서 성별, 연령, 혈종의 크기와 액화의 유무, 전산화단층촬영상 혈관 외 유출의 여부, 유출을 보이는 동맥의 개수, 출혈부터 시술시작까지의 시간, 색전물질, 입원일수를 비교 분석하였다. 결과: 모든 색전술은 성공적으로 시행하였다. 자발성 출혈군은 약 36%(18/50)였으며, 외상에 의한 출혈군은 42%(21/50), 의원성 출혈군은 22%(11/50)였다. Mann Whitney U test에서는 자발성 출혈군에서 국제정상화비율(p = 0.013)이, 외상성 출혈군에서는 국제정상화비율(p = 0.038)과 혈소판(p = 0.004)이 출혈군별로 유의한 차이를 보였다. 역시, 임상적 성공에 영향을 미치는 요인으로는 혈소판(p = 0.046)이 있었다. 결론: 혈종형성을 동반한 급성동맥출혈환자에서 경동맥색전술은 안전하고 효과적인 치료이며, 출혈 원인을 고려하여 관련된 인자를 알고 적합한 치료방향을 선택해야 한다.

Keywords

References

  1. Hyers TM. Management of venous thromboembolism: past, present, and future. Arch Intern Med 2003;163:759-768 https://doi.org/10.1001/archinte.163.7.759
  2. Boccardo P, Remuzzi G, Galbusera M. Platelet dysfunction in renal failure. Semin Thromb Hemost 2004;30:579-589 https://doi.org/10.1055/s-2004-835678
  3. Kaw D, Malhotra D. Platelet dysfunction and end-stage renal disease. Semin Dial 2006;19:317-322 https://doi.org/10.1111/j.1525-139X.2006.00179.x
  4. Sunga KL, Bellolio MF, Gilmore RM, Cabrera D. Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. J Emerg Med 2012;43:e157-e161 https://doi.org/10.1016/j.jemermed.2011.06.006
  5. Palatucci V, Lombardi G, Lombardi L, Giglio F, Giordano F, Lombardi D. Spontaneous muscle haematomas: management of 10 cases. Transl Med UniSa 2014;10:13-17
  6. Minokadeh A, Pinsky MR. Postoperative hemodynamic instability and monitoring. Curr Opin Crit Care 2016;22:393-400 https://doi.org/10.1097/MCC.0000000000000320
  7. Gando S, Hayakawa M. Pathophysiology of trauma-induced coagulopathy and management of critical bleeding requiring massive transfusion. Semin Thromb Hemost 2016;42:155-165
  8. Ko HK, Lee DY, Shim WH, Jang BC, Yoon CS, Won JH, et al. Endovascular treatment of abdominal aortic aneurysm by bifurcated stent graft. J Korean Radiol Soc 1999;41:909-914 https://doi.org/10.3348/jkrs.1999.41.5.909
  9. Li WH, Cheuk EC, Kowk PC, Cheung MT. Survival after transarterial embolization for spontaneous ruptured hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 2009;16: 508-512 https://doi.org/10.1007/s00534-009-0094-6
  10. Canton G, Levy DI, Lasheras JC, Nelson PK. Flow changes caused by the sequential placement of stents across the neck of sidewall cerebral aneurysms. J Neurosurg 2005;103:891-902 https://doi.org/10.3171/jns.2005.103.5.0891
  11. Strate LL, Gralnek IM. ACG Clinical Guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol 2016;111:459-474 https://doi.org/10.1038/ajg.2016.41
  12. Vaidya S, Tozer KR, Chen J. An overview of embolic agents. Semin Intervent Radiol 2008;25:204-215 https://doi.org/10.1055/s-0028-1085930
  13. Del Cura JL, Zabala R, Cotra I. [Ultrasound-guided interventional procedures in the musculoskeletal system]. Radiologia 2010;52:525-533 https://doi.org/10.1016/j.rx.2010.07.004
  14. Song JS, Kwak HS, Han YM. Transarterial embolization of arterial bleeding in patients with pelvic bone fractures. J Korean Soc Radiol 2009;61:311-318 https://doi.org/10.3348/jksr.2009.61.5.311
  15. Akpinar E, Peynircioglu B, Turkbey B, Cil BE, Balkanci F. Endovascular management of life-threatening retroperitoneal bleeding. ANZ J Surg 2008;78:683-687 https://doi.org/10.1111/j.1445-2197.2008.04148.x
  16. Jain V, Ganpule A, Vyas J, Muthu V, Sabnis RB, Rajapurkar MM, et al. Management of non-neoplastic renal hemorrhage by transarterial embolization. Urology 2009;74:522-526 https://doi.org/10.1016/j.urology.2008.11.062
  17. Beaujeux R, Saussine C, al-Fakir A, Boudjema K, Roy C, Jacqmin D, et al. Superselective endo-vascular treatment of renal vascular lesions. J Urol 1995;153:14-17 https://doi.org/10.1097/00005392-199501000-00007
  18. Alesawi AM, El-Hakim A, Zorn KC, Saad F. Radiation-induced hemorrhagic cystitis. Curr Opin Support Palliat Care 2014;8: 235-240 https://doi.org/10.1097/SPC.0000000000000073
  19. Dutta S, Sanjay P, Jones ML. Diagnosis and treatment of giant lateral abdominal wall haematoma after blunt trauma: a case report. Cases J 2009;2:9358 https://doi.org/10.1186/1757-1626-2-9358
  20. Park JY, Yim NY, Kim JK, Kim HO, Kang YJ, Jung HD, et al. Embolization of trauma-associated pelvic hemorrhage: feasibility of super-selective catheterization in heavily injured patients as a damage control for life-threatening pelvic bleeding. J Korean Soc Radiol 2016;74:236-244 https://doi.org/10.3348/jksr.2016.74.4.236
  21. Cho YH, Lee HS, Kim HC, Kim SG, Chung TW, Kim YH, et al. Transcatheter arterial embolizations of arterial bleeding in patients with pelvic bone fracture. J Korean Radiol Soc 1999; 41:903-908 https://doi.org/10.3348/jkrs.1999.41.5.903
  22. Zissin R, Gayer G, Kots E, Ellis M, Bartal G, Griton I. 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 2007;61:1321-1327 https://doi.org/10.1111/j.1742-1241.2006.01207.x
  23. Lai BM, Shum JS, Chu CY, Lo SS, Lau KY. Predictors of the success and failure of emergency pelvic artery embolisation for primary postpartum haemorrhage: a 12-year review. Singapore Med J 2017;58:272-278 https://doi.org/10.11622/smedj.2016079
  24. Agolini SF, Shah K, Jaffe J, Newcomb J, Rhodes M, Reed JF 3rd. Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma 1997; 43:395-399 https://doi.org/10.1097/00005373-199709000-00001