Stampfl Ulrike, Sommer Christof-Matthias, Bellemann Nadine, Kortes Nikolas, Gnutzmann Daniel, Mokry Theresa, Gockner Theresa, Schmitz Anne, Ott Katja, Kauczor Hans-Ulrich, Radeleff Boris
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany,
Emerg Radiol. 2014 Dec;21(6):565-70. doi: 10.1007/s10140-014-1231-3. Epub 2014 May 8.
To evaluate embolotherapy for the emergency management of acute bleeding from intercostal arteries. Between October 2003 and August 2012, 19 consecutive patients with hemorrhage from intercostal arteries were scheduled for emergency embolization. The primary study endpoints were technical and clinical success, which were defined as angiographic cessation of bleeding, and cessation of clinical signs of hemorrhage. The secondary study endpoints were periprocedural complications and 30-day mortality rate. In most patients (74 %), hemorrhage was caused by iatrogenic procedures with subsequent intercostal artery laceration. One of the patients was treated twice for recurrent hemothorax caused by a new intercostal artery pseudoaneurysm 7.5 years after the initial procedure. Thus, 20 procedures were performed in these 19 patients. Overall technical success was 85 %. In six patients, no embolization of the "backdoor" was feasible, and in two of these patients additional embolization of other intercostal arteries was necessary to prevent hemorrhage via collateral vessels. Clinical signs of hemorrhage ceased after embolotherapy in 16 of 20 procedures (clinical success 80 %). The mean follow-up was 358.7 ± 637.1 days. One minor procedure-related complication occurred. The 30-day mortality rate was 21 %, however, this was unrelated to intercostal artery hemorrhage. Embolotherapy is an effective emergency therapy for patients with acute hemorrhage from intercostal arteries. Especially if embolization of the backdoor is not feasible, collateral supply via other intercostal arteries should be either ruled out or embolized to prevent ongoing hemorrhage. Despite successful embolotherapy, a majority of patients underwent surgery during follow-up to remove the symptomatic hematoma.
评估栓塞疗法在急诊处理肋间动脉急性出血中的应用。2003年10月至2012年8月期间,19例连续的肋间动脉出血患者被安排进行急诊栓塞治疗。主要研究终点为技术成功和临床成功,分别定义为血管造影显示出血停止以及出血的临床症状消失。次要研究终点为围手术期并发症和30天死亡率。在大多数患者(74%)中,出血是由医源性操作导致肋间动脉撕裂引起的。其中1例患者在初次手术后7.5年因新的肋间动脉假性动脉瘤导致复发性血胸而接受了两次治疗。因此,这19例患者共进行了20次手术。总体技术成功率为85%。6例患者无法对“后门”进行栓塞,其中2例患者需要额外栓塞其他肋间动脉以防止通过侧支血管出血。20次手术中有16次在栓塞治疗后出血的临床症状消失(临床成功率80%)。平均随访时间为358.7±637.1天。发生了1例轻微的手术相关并发症。30天死亡率为21%,然而,这与肋间动脉出血无关。栓塞疗法是治疗肋间动脉急性出血患者有效的急诊治疗方法。特别是如果对“后门”进行栓塞不可行,应排除或栓塞通过其他肋间动脉的侧支供血以防止持续出血。尽管栓塞治疗成功,但大多数患者在随访期间仍接受了手术以清除有症状的血肿。