Department of Radiology, University of California San Francisco, San Francisco, CA 94143, USA.
J Vasc Interv Radiol. 2011 Oct;22(10):1396-402. doi: 10.1016/j.jvir.2011.06.008. Epub 2011 Jul 21.
To determine the outcomes of patients with spontaneous extraperitoneal hemorrhage (SEH) referred for endovascular therapy.
A retrospective analysis included 25 patients (13 male) with 28 spontaneous bleeding events that occurred during the period 1998-2009. All patients had a computed tomography (CT) scan showing extraperitoneal hematoma before angiography. Hematoma location, presence of contrast extravasation or hematocrit level on CT, angiographic findings, vessels that received embolization, angiographic outcome, transfusion requirements, and mortality were recorded. Patients' medications, lowest measured hemoglobin levels, serologic coagulation parameters, and comorbidities were also noted. Mean follow-up was 37.4 months (range 2-132 mo).
Patients had received anticoagulation therapy before 20 of 28 bleeding events. Angiography showed contrast extravasation in 22 (79%) of 28 cases. Angiographic cessation of bleeding with embolization was achieved in all 22 cases. There was extravasation from more than one site in 17 (61%) of 28 cases. There was bleeding in more than one vascular territory in eight (29%) cases. Empiric embolization was performed in three cases. In the 48 hours following angiography, transfusion requirements decreased in 27 (96%) of 28 cases, and there were no deaths. All-cause mortality at 30 days was 29%, at 90 days was 32%, and at 12 months was 43%.
Multiple bleeding sites are typical in SEH. Transcatheter embolization is a safe and effective treatment; however, mortality is high in the time around angiography.
确定接受血管内治疗的自发性腹膜外出血（SEH）患者的治疗结果。
回顾性分析了 1998 年至 2009 年间的 25 例（13 例男性）28 例自发性出血事件患者。所有患者均在血管造影前进行 CT 扫描，显示腹膜外血肿。记录血肿位置、CT 上是否有造影剂外渗或血细胞比容水平、血管造影结果、接受栓塞的血管、血管造影结果、输血需求和死亡率。还记录了患者的药物、最低测量血红蛋白水平、血清凝血参数和合并症。平均随访时间为 37.4 个月（范围 2-132 个月）。
28 次出血事件中有 20 次发生在 28 次出血事件前接受抗凝治疗。28 例中 22 例（79%）造影显示造影剂外渗。22 例均通过栓塞实现了血管造影止血。28 例中有 17 例（61%）有多个部位外渗。8 例（29%）有多个血管区域出血。3 例进行了经验性栓塞。血管造影后 48 小时内，28 例中有 27 例（96%）输血需求减少，无死亡病例。30 天全因死亡率为 29%，90 天死亡率为 32%，12 个月死亡率为 43%。
SEH 中常出现多个出血部位。经导管栓塞是一种安全有效的治疗方法；然而，血管造影前后的死亡率很高。
