Yonemitsu Takafumi, Kawai Nobuyuki, Sato Morio, Tanihata Hirohiko, Takasaka Isao, Nakai Motoki, Minamiguchi Hiroki, Sahara Shinya, Iwasaki Yasuhiro, Shima Yukihiro, Shinozaki Maki, Naka Toshio, Shinozaki Masahiro
Department of Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8510, Japan.
J Vasc Interv Radiol. 2009 Sep;20(9):1176-87. doi: 10.1016/j.jvir.2009.06.005. Epub 2009 Jul 30.
To evaluate the outcome of transcatheter arterial embolization with gelatin sponge particles, microcoils, and N-butyl cyanoacrylate (NBCA) for acute arterial hemorrhage in the setting of coagulopathy.
Coagulopathy is defined by a platelet count less than 5 x 10(4)/microL and/or International Normalized Ratio (INR) greater than 1.5. Forty-six patients (31 male patients; mean age, 62 years) with acute arterial hemorrhage in a coagulopathic condition were treated by transcatheter arterial embolization with gelatin sponge particle, microcoils, and NBCA.
Because of failure of hemostasis or recurrent hemorrhage, 10 patients who underwent gelatin sponge particle embolization also received transcatheter arterial embolization with microcoils or NBCA embolization and two patients who underwent microcoil embolization also received transcatheter arterial embolization with NBCA. The gelatin sponge particle group consisted of 27 hemorrhagic arteries in 25 patients, the microcoil group had 20 in 20 patients, and the NBCA group had 16 in 13 patients. The mean platelet count and mean INR value were 5.8 x 10(4)/microL +/- 3.5 and 1.81 +/- 0.50, respectively. The primary hemostatic rate, recurrent hemorrhage rate, and mean treatment time for the gelatin sponge particle, microcoil, and NBCA groups were 67%, 23%, and 25 minutes +/- 10; 80%, 0%, and 37 min +/- 19; and 100%, 0%, and 9 min +/- 4, respectively. Primary and secondary hemostasis were achieved in 50 (80%) and 60 (95%) of the 63 hemorrhagic arteries, respectively. Three hemorrhagic arteries in which transcatheter arterial embolization failed were treated with surgical repair.
Although transcatheter arterial embolization with microcoils took a greater amount of time, transcatheter arterial embolization with NBCA or microcoils was more effective and feasible than that with gelatin sponge particle in terms of hemostasis and prevention of recurrent hemorrhage in a coagulopathic condition.
评估使用明胶海绵颗粒、微线圈和氰基丙烯酸正丁酯（NBCA）进行经导管动脉栓塞术治疗凝血功能障碍患者急性动脉出血的疗效。
凝血功能障碍定义为血小板计数低于5×10⁴/μL和/或国际标准化比值（INR）大于1.5。46例（31例男性患者；平均年龄62岁）凝血功能障碍伴急性动脉出血的患者接受了使用明胶海绵颗粒、微线圈和NBCA的经导管动脉栓塞术治疗。
由于止血失败或再次出血，10例行明胶海绵颗粒栓塞术患者还接受了微线圈或NBCA栓塞的经导管动脉栓塞术，2例行微线圈栓塞术患者也接受了NBCA的经导管动脉栓塞术。明胶海绵颗粒组包括25例患者的27条出血动脉，微线圈组20例患者有20条，NBCA组13例患者有16条。平均血小板计数和平均INR值分别为5.8×10⁴/μL±3.5和1.81±0.50。明胶海绵颗粒组、微线圈组和NBCA组的首次止血率、再次出血率和平均治疗时间分别为67%、23%和25分钟±10；80%、0%和37分钟±19；100%、0%和9分钟±4。63条出血动脉中分别有50条（80%）和60条（95%）实现了初次和二次止血。3条经导管动脉栓塞术失败的出血动脉接受了手术修复。
尽管使用微线圈进行经导管动脉栓塞术耗时较长，但在凝血功能障碍情况下，就止血和预防再次出血而言，使用NBCA或微线圈进行经导管动脉栓塞术比使用明胶海绵颗粒更有效且可行。
