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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
Results
Superselective hepatic arteriography was performed in 20 patients(15 patients to stop bleedings after percutaneous transhepatic cholangial drainage (PTCD) and 5 patients with liver trauma).
Out of 20 patients,
2 were diagnosed with hepatic arterio-biliary fistula,
5 were diagnosed with pseudoaneurysm,
and 13 was diagnosed with biliary-portal vein fistula.
For the 2 patients with arterio-biliary fistula and the 5 patients with pseudoaneurysm,
gelatin sponge and detachable platinum coils were used to embolize the proximal and distal ends,
respectively,
of the targeted bleeding vessel through superselective catheterization.
No recurrent hemobilia was detected 30 days later in patients with bleedings after percutaneous transhepatic cholangial drainage (PTCD)(Table 1)(Figure 1,2,3).
Angiography showed that another small branch adjacent to the pseudoaneurysm was responsible for the rebleeding in 2 patients with liver trauma who underwent subsequent partial hepatectomy(Table 1).
In 8 patients with angiodysplasia spread between the colon and the small bowel,
4 cases were treated with gelatin sponge at the level of distal arterial branches with subsequent proximal release of coils,
and 4 were treated with only gelatin sponge and subsequent surgery(Table 1).
Gelatin sponge was also used for treating 4 patients suffering of bleedings due to anticoagulation therapy with good hemostasis in the follow-up(Table 1).
Only coils were used in 6 patients with GI iatrogenic surgical bleedings with good hemostasis control in 3 patients with pancreatic head tumors and in 1 patients with coloncarcinoma; 2 cases with coloncarcinoma had partial colon ischemia,
bleeding and underwent subsequent surgery(Table 1).
8 patients with ginecological emergencies were treated with gelatin sponge and subsequent proximal release of coils with good hemostasis control in all patients; the 2 cases of ectopic pregnancy were underwent to subsequent surgery(Table 1).
Coils and gelatin sponge were used in treating bleedings occurred in 6 patients with pelvic organs trauma,
in 7 with sacrum fractures and in 10 patients with pelvis fractures involving ileo and ischiopubic branches with good hemostasis control.
In other 2 cases of sacral fractures were needed further treatment with coil; 3 female with associated pelvic organs injuries underwent hysteroannessiectomy(Table 1).
Through superselective catheterization all the materials used in this procedures to embolize respectively the distal ends and proximal branches arteries were gelatin sponge (Gelfoam,
Pfizer,
New York,
NY) and detachable platinum coils (GDC,
Boston Scientific) for stopping bleeding vessel.