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Keywords:
Interventional vascular, Abdomen, Trauma, Catheter arteriography, CT-Angiography, PACS, Angioscopy, Arterial access, Embolisation, Acute, Haemorrhage, Outcomes
Authors:
M. Perri, A. V. Giordano, S. Carducci, M. Varrassi, C. Marsecano, G. Michelini, L. Sacchetti, M. Gallucci, C. Masciocchi; L'Aquila/IT
DOI:
10.1594/ecr2015/C-1820
Methods and materials
We manually evaluated the archives of our PACS to identify all patients who had undergone superselective embolization of traumatic and non traumatic abdominal arterial bleedings at our interventional radiology department between July 2005 and September 2014.
All patients were examined and treated as part of routine care and gave informed consent.
Our institutional review board did not require its approval or informed consent for this study.
A total of 74 patients (age range 14-81 years old) were included.
40 were male(54%) and 34(46%) were female.
The abdominal arterial bleedings were traumatic or non-traumatic,
distributed some in the intraperitoneal and retroperitoneal space,
others involving endoabdominal organs.
The etiologies were as follows: 14 patients had GI bleeding and in particular 8 patients with angiodysplasia spread between the colon and the small bowel (including 5 males and 3 females) and 6 patients with iatrogenic surgical bleeding (4 males and 2 females),
including 3 with coloncarcinoma and 3 patients after removal of pancreatic head tumors.
4 (3%) on 74 patients had abdominal bleedings due to anticoagulation therapy for various diseases; in particular 2 males with atrial fibrillation and 2 females after prophylaxis of deep vein thrombosis in pulmonary thromboembolism.
15 patients (9 males and 6 females) had hemobilia after percutaneous transhepatic cholangial drainage (PTCD) including 8 patients with diffuse bleeding at the intraperitoneal periepatic and perisplenic spaces.
8 females had ginecological emergencies; in particular 6 females presented postpartum bleeding and 2 females with abdominal bleeding due to ectopic pregnancy.
33 polytrauma had intrabdominal bleeding(9 male with sacrum fractures,
10 male with branches ischio and ileopubic fractures and 14 female.
Among these 5 had lesions of the organs associated with vertebral and rib fractures and 9 only organ injuries.
Common clinical presentations of all patients included recurrent abdominal pain,
intermittent massive hemorrhagic bile from the drainage tube after PTCD and no alleviation of jaundice.
Additional signs included recurrent high fever and chills,
in particular observed in 5 patient with severe biliary tract infection.
7 polytrauma patients were able to tolerate a surgical removal of the spleen despite poor general condition.