J Korean Soc Radiol.  2018 Feb;78(2):120-129. 10.3348/jksr.2018.78.2.120.

Transcatheter Arterial Embolization for Acute Arterial Extravasation with Hematoma Formation: Classified the Group as Cause and Their Clinical Outcomes

• Kim B
• Han YM
• Jin GY

• KMID: 2408262
• DOI: http://doi.org/10.3348/jksr.2018.78.2.120

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.

MeSH Terms

Arteries
Embolization, Therapeutic
Female
Hematoma*
Hemorrhage
Humans
International Normalized Ratio
Male
Platelet Count
Retrospective Studies

Figure

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  Fig. 1. A 59-year old woman received heparin to treat an acute pulmonary thromboembolism. The patient exhibited a retroperitoneal hematoma and intramuscular hemorrhage at the iliopsoas muscle. A. Hematoma formation is seen at the left retroperitoneal space and the iliopsoas muscle (arrow). B, C. Acute extravasations are present in the retroperitoneum and the iliopsoas muscle (arrows). D. Subtle focal staining of left iliolumbar artery is seen following selective angiography. E. Hematoma is decreased in the follow-up CT performed after 6 months.

• 

  Fig. 2. An 80-year old woman with anterior chest wall hematoma due to traffic accident. A. Multiple aneurysmal sac (black arrows) with extravasation at right posterior humerus circumferential artery and humerus comminuted fracture are present in the CT. B, C. At selective angiography, multiple aneurysmal sacs are seen.

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  Fig. 3. A 75-year old woman with anterior chest wall hematoma due to complications of central line insertion. A. Huge anterior chest wall hematoma with about 18-cm-sized longest diameter. B. Acute extravasation and an aneurysmal sac like lesion are shown in an arterial phase CT. C. Contrast media extravasation at the right scapula subclavian artery branch is discovered during a selective angiography. D. Complete devascularization of the aneurysm is noted after coil embolization.

Reference

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