Popov Milen, Sotiriadis Charalampos, Gay Frederique, Jouannic Anne-Marie, Lachenal Yann, Hajdu Steven D, Doenz Francesco, Qanadli Salah D
Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Cardio-Thoracic and Vascular Unit, Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Cardiovasc Intervent Radiol. 2017 Apr;40(4):537-545. doi: 10.1007/s00270-017-1590-8. Epub 2017 Feb 7.
To report our experience using a multilevel patient management algorithm to direct transarterial embolization (TAE) in managing spontaneous intramuscular hematoma (SIMH).
From May 2006 to January 2014, twenty-seven patients with SIMH had been referred for TAE to our Radiology department. Clinical status and coagulation characteristics of the patients are analyzed. An algorithm integrating CT findings is suggested to manage SIMH. Patients were classified into three groups: Type I, SIMH with no active bleeding (AB); Type II, SIMH with AB and no muscular fascia rupture (MFR); and Type III, SIMH with MFR and AB. Type II is furthermore subcategorized as IIa, IIb and IIc. Types IIb, IIc and III were considered for TAE. The method of embolization as well as the material been used are described. Continuous variables are presented as mean ± SD. Categorical variables are reported as percentages. Technical success, clinical success, complications and 30-day mortality (d30 M) were analyzed.
Two patients (7.5%) had Type IIb, four (15%) Type IIc and 21 (77.5%) presented Type III. The detailed CT and CTA findings, embolization procedure and materials used are described. Technical success was 96% with a complication rate of 4%. Clinical success was 88%. The bleeding-related thirty-day mortality was 15% (all with Type III).
TAE is a safe and efficient technique to control bleeding that should be considered in selected SIMH as soon as possible. The proposed algorithm integrating CT features provides a comprehensive chart to select patients for TAE.
报告我们使用多级患者管理算法指导经动脉栓塞术（TAE）治疗自发性肌肉内血肿（SIMH）的经验。
2006年5月至2014年1月，27例SIMH患者被转诊至我院放射科接受TAE治疗。分析患者的临床状况和凝血特征。提出一种整合CT表现的算法来管理SIMH。患者分为三组：I型，无活动性出血（AB）的SIMH；II型，有AB且无肌肉筋膜破裂（MFR）的SIMH；III型，有MFR和AB的SIMH。II型进一步细分为IIa、IIb和IIc。IIb、IIc和III型考虑行TAE治疗。描述了栓塞方法及所用材料。连续变量以平均值±标准差表示。分类变量以百分比报告。分析技术成功率、临床成功率、并发症和30天死亡率（d30 M）。
2例（7.5%）为IIb型，4例（15%）为IIc型，21例（77.5%）为III型。描述了详细的CT和CTA表现、栓塞过程及所用材料。技术成功率为96%，并发症发生率为4%。临床成功率为88%。出血相关的30天死亡率为15%（均为III型）。
TAE是一种安全有效的控制出血技术，对于选定的SIMH应尽早考虑。所提出的整合CT特征的算法为选择TAE患者提供了一个全面的图表。
4级。
