Mukund Amar, Kumar Dp Vinay, Condati Naveen Kumar, Bhadoria Ajeet Singh, Sarin Shiv Kumar
1 Department of Interventional Radiology , Institute of Liver and Biliary Sciences , New Delhi, India.
2 Department of Clinical Research , Institute of Liver and Biliary Sciences , New Delhi, India.
Br J Radiol. 2018 Jan;91(1081):20170259. doi: 10.1259/bjr.20170259. Epub 2017 Nov 8.
To compare the safety and efficacy of ultrasound guided percutaneous glue (N-butyl-2-cyanoacrylate) embolization with transarterial embolization in the management of iatrogenically injured arteries while performing paracentesis or thoracocentesis in patients with chronic liver disease.
Hospital database was searched for cirrhotic patients having abdominal/thoracic wall haemorrhage following paracentesis/thoracocentesis procedure from January 2011 to June 2016. Doppler ultrasound and/or CT angiography were used to localize the site of haemorrhage and patients were treated by transarterial embolization or ultrasound-guided percutaneous glue embolization. Technical success was defined as cessation of haemorrhage as evidenced by angiography/Doppler ultrasound and clinical success was evaluated in terms of stabilization of the vital signs without the need for further transfusion or pressors, and survival. In both groups, the time to "imaging diagnosis of haemorrhage" and "successful embolization" with the outcome was analysed.
23 cirrhotic patients had bleeding following a percutaneous procedure, 8 (Group 1) of them underwent transarterial embolization while 15 (Group 2) underwent ultrasound-guided percutaneous glue embolization. Mean time needed for embolization in Group 1 was 41 min while in Group 2 was 9 min (p < 0.001). Technical success was achieved in all but one case requiring repeat glue embolization. Initial clinical improvement was noted in all cases but the 30-day mortality owing to all causes was not significantly different between treatment groups.
The study and its outcome suggest that ultrasound guided percutaneous glue embolization is a quick and effective treatment for iatrogenic haemorrhage following paracentesis/thoracocentesis in cirrhotic patients with comparable results to transarterial embolotherapy. Advances in knowledge: This study details an innovative technique of ultrasound guided percutaneous glue embolization of the iatrogenically injured vessel in the management of active extravasation and pseudoaneurysm developing after paracentesis/thoracocentesis in patients with cirrhosis.
比较超声引导下经皮注射胶水（N-丁基-2-氰基丙烯酸酯）栓塞术与经动脉栓塞术在慢性肝病患者进行腹腔穿刺或胸腔穿刺时医源性动脉损伤处理中的安全性和有效性。
检索医院数据库，查找2011年1月至2016年6月期间在腹腔穿刺/胸腔穿刺术后发生腹壁/胸壁出血的肝硬化患者。使用多普勒超声和/或CT血管造影定位出血部位，患者接受经动脉栓塞术或超声引导下经皮胶水栓塞术治疗。技术成功定义为血管造影/多普勒超声证实出血停止，临床成功根据生命体征稳定、无需进一步输血或使用升压药以及生存情况进行评估。分析两组中“出血的影像学诊断时间”和“成功栓塞时间”及结果。
23例肝硬化患者在经皮操作后出血，其中8例（第1组）接受经动脉栓塞术，15例（第2组）接受超声引导下经皮胶水栓塞术。第1组栓塞平均所需时间为41分钟，第2组为9分钟（p<0.001）。除1例需要重复胶水栓塞的病例外，其余均取得技术成功。所有病例均有初始临床改善，但各治疗组因各种原因导致的30天死亡率无显著差异。
该研究及其结果表明，超声引导下经皮胶水栓塞术是肝硬化患者腹腔穿刺/胸腔穿刺后医源性出血的一种快速有效的治疗方法，其效果与经动脉栓塞治疗相当。知识进展：本研究详细介绍了一种创新技术，即超声引导下经皮胶水栓塞医源性损伤血管，用于处理肝硬化患者腹腔穿刺/胸腔穿刺后发生的活动性出血和假性动脉瘤。
