Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
J Vasc Interv Radiol. 2012 Jul;23(7):910-916.e1. doi: 10.1016/j.jvir.2012.04.005. Epub 2012 May 19.
To assess retrospectively technical and clinical outcomes after transcatheter embolization in patients presenting with soft tissue bleeding associated with antithrombotic therapy and to determine factors potentially affecting the clinical outcomes after embolization.
There were 42 patients who underwent embolization for soft tissue bleeding associated with antithrombotic therapy. Principal clinical symptoms were hemodynamic shock (n = 21), abdominal pain (n = 9), back pain (n = 7), and buttock or thigh pain (n = 5). Ultrasound or computed tomography (CT) or both were performed in 40 patients (95%); 2 patients (5%) were immediately referred for angiography. Several laboratory and radiographic factors were analyzed to determine if any influenced the clinical outcome.
A hematoma was identified in the anterior abdominal wall (n = 18 [43%]), in the retroperitoneum (n = 18 [43%]), or in the thigh or gluteal region (n = 6 [14%]). Embolization was successful in all patients; early recurrent bleeding with a fatal outcome was recorded in one patient (2%). In nine patients (22%), secondary surgical drainage of the hematoma was performed to manage a compartment syndrome. During follow-up (mean, 37.9 months; range, 0.03-85.28 months), 11 patients (26%) died; death was related to the bleeding in 6 patients (14%). Both activated partial thromboplastin time (aPTT) and prothrombin time (PT) were correlated with hematoma size. Prolonged aPTT before embolization was associated with a higher risk of bleeding-related mortality (P = .04).
Transcatheter embolization was very effective in stopping soft tissue bleeding associated with antithrombotic therapy. However, there was still considerable morbidity and mortality after successful embolization. aPTT prolongation emerged as a risk factor for bleeding-related deaths.
回顾性评估抗栓治疗相关软组织出血患者行经导管栓塞治疗的技术和临床疗效，并确定可能影响栓塞治疗后临床结局的因素。
共 42 例接受抗栓治疗相关软组织出血栓塞治疗的患者。主要临床表现为血流动力学不稳定（n=21）、腹痛（n=9）、背痛（n=7）和臀部或大腿痛（n=5）。40 例（95%）患者行超声或 CT 或两者检查；2 例（5%）患者直接行血管造影检查。分析多种实验室和影像学因素，以确定是否有任何因素影响临床结局。
前腹壁（n=18[43%]）、后腹膜（n=18[43%]）或大腿或臀部区域（n=6[14%]）发现血肿。所有患者栓塞均成功；1 例（2%）患者早期再次出血并死亡。9 例（22%）患者行继发性血肿切开引流以治疗筋膜间室综合征。随访（平均 37.9 个月；范围 0.03-85.28 个月）期间，11 例（26%）患者死亡；6 例（14%）与出血相关。活化部分凝血活酶时间（aPTT）和凝血酶原时间（PT）均与血肿大小相关。栓塞前 aPTT 延长与出血相关死亡率升高相关（P=0.04）。
经导管栓塞治疗抗栓治疗相关软组织出血非常有效。然而，栓塞成功后仍有相当高的发病率和死亡率。aPTT 延长是出血相关死亡的危险因素。
