使用改良的氰基丙烯酸正丁酯胶水经导管动脉栓塞治疗抗凝患者自发性髂腰肌和腹直肌鞘血肿的疗效
Outcomes of Transcatheter Arterial Embolization with a Modified N-Butyl Cyanoacrylate Glue for Spontaneous Iliopsoas and Rectus Sheath Hematomas in Anticoagulated Patients.
作者信息
Jawhari Rany, Chevallier Olivier, Falvo Nicolas, d'Athis Philippe, Gehin Sophie, Charles Pierre-Emmanuel, Midulla Marco, Loffroy Romaric
机构信息
Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079 Dijon, France.
Department of Epidemiology and Biostatistics, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079 Dijon, France.
出版信息
J Vasc Interv Radiol. 2018 Feb;29(2):210-217. doi: 10.1016/j.jvir.2017.08.006. Epub 2017 Oct 19.
PURPOSE
To assess the efficacy and safety of n-butyl cyanoacrylate methacryloxy sulfolane (NBCA-MS) transcatheter arterial embolization for anticoagulation-related soft-tissue bleeding and to evaluate predictive factors of clinical success and 30-day mortality.
MATERIALS AND METHODS
A retrospective review of 50 anticoagulated patients (25 male; mean age, 71.7 y ± 14.2; range, 19-87 y) who underwent emergent Glubran 2 NBCA-MS embolization for iliopsoas hematomas (IPHs; n = 38), rectus sheath hematomas (n = 11), or both (n = 1) between 2011 and 2016 was performed. Inclusion criteria were active bleeding on computed tomography (CT) and anticoagulation. The mean number of red blood cell (RBC) units transfused was 4.8 ± 3.2 (range, 0-14), median hemoglobin level before embolization was 9.7 g/dL (range, 6.2-18 g/dL), and median "mean blood pressure" (MBP) was 62.5 mm Hg (range, 58.3-75 mm Hg). Mean International Normalized Ratio before intervention was 2.5 ± 1.5 (range, 1.0-6.9). Angiograms revealed extravasation in 44 of 50 patients (88%). Mean hematoma volume was 1,119.2 cm ± 863.5 (range, 134.0-3,589.0 cm).
RESULTS
Technical success was achieved in 100% of patients, and 30-day clinical success was achieved in 66% of patients. Recurrent bleeding and mortality rates within 30 days of embolization were 34% and 44%, respectively. No complications related to the embolization procedure occurred. Lower MBP (P = .003), greater number of RBC units transfused (P = .003), greater volume of hematoma (P = .04), and IPH location (P = .02) were associated with decreased clinical success. Clinical failure (P = .00002), lower MBP (P = .004), greater number of RBC units transfused (P = .002), and IPH location (P = .01) were significantly associated with higher 30-day mortality rates.
CONCLUSIONS
Transcatheter arterial embolization with NBCA-MS is safe and effective in treating refractory soft-tissue bleeding in anticoagulated patients despite the high mortality rates associated with this patient population.
目的
评估氰基丙烯酸正丁酯-甲基丙烯酰氧基环丁砜（NBCA-MS）经导管动脉栓塞术治疗抗凝相关软组织出血的疗效和安全性，并评估临床成功和30天死亡率的预测因素。
材料与方法
回顾性分析2011年至2016年间50例接受抗凝治疗的患者（25例男性；平均年龄71.7岁±14.2岁；范围19 - 87岁），这些患者因髂腰肌血肿（IPH；n = 38）、腹直肌鞘血肿（n = 11）或两者皆有（n = 1）接受了紧急Glubran 2 NBCA-MS栓塞术。纳入标准为计算机断层扫描（CT）显示有活动性出血且正在接受抗凝治疗。红细胞（RBC）单位的平均输注量为4.8±3.2（范围0 - 14），栓塞术前血红蛋白水平中位数为9.7 g/dL（范围6.2 - 18 g/dL），“平均血压”（MBP）中位数为62.5 mmHg（范围58.3 - 75 mmHg）。干预前国际标准化比值（INR）平均为2.5±1.5（范围1.0 - 6.9）。血管造影显示50例患者中有44例（88%）有造影剂外渗现象。血肿平均体积为1119.2 cm³±863.5（范围134.0 - 3589.0 cm³）。
结果
100%的患者技术成功，66%的患者30天临床成功。栓塞术后30天内再出血率和死亡率分别为34%和44%。未发生与栓塞术相关的并发症。较低的MBP（P = 0.003）、较多的RBC单位输注量（P = 0.003）、较大的血肿体积（P = 0.04）和IPH位置（P = 0.02）与临床成功率降低相关。临床失败（P = 0.00002）、较低的MBP（P = 0.004）、较多的RBC单位输注量（P = 0.002）和IPH位置（P = 0.01）与较高的30天死亡率显著相关。
结论
尽管该患者群体死亡率较高，但NBCA-MS经导管动脉栓塞术治疗抗凝患者难治性软组织出血是安全有效的。
Zotero 插件