From the Department of Abdominal and Interventional Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, APHP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France (M.B., P.S., A.D.); Université Paris Descartes, Sorbonne Paris-Cité-Paris V, Paris, France (M.B., P.S., A.D.); Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hopitaux de Paris, APHP, Paris, France (O.P., M.S.); and Department of Interventional Radiology, McGill University Health Centre, Montréal, Canada (V.T.T., B.G., L.M.B., D.V.).
Radiology. 2019 Apr;291(1):250-258. doi: 10.1148/radiol.2018181187. Epub 2019 Jan 8.
Purpose To evaluate the safety and efficacy of percutaneous transarterial embolization (PTAE) for the treatment of spontaneous soft-tissue hematomas (SSTHs) and identify variables predictive of short-term outcome. Materials and Methods Between 2011 and 2017, the outcome was retrospectively analyzed for 112 patients (mean age ± standard deviation, 72 years ± 14; range, 28-92 years), including 65 women (mean age, 73 years ± 12.7; range, 39-92 years) and 47 men (mean age, 70 years ± 14.9; range, 28-91 years), with SSTH treated with PTAE. Thirty-day mortality, technical and clinical success, simplified acute physiology score (SAPS) II, anticoagulation, embolic agent, hematoma volume and location, serum hemoglobin level, hemodynamic instability, and presence of active bleeding at CT and/or angiography were recorded. Clinical success was defined as cessation of bleeding as determined by hemodynamic stability and/or serum hemoglobin level stabilization after PTAE. Univariable and multivariable analyses were performed by using a Cox model to identify variables associated with time to death. Results Mortality rate was 26.8% (30 of 112 patients), angiographic success rate was 95.5% (107 of 112 patients), and clinical success rate was 83% (93 of 112 patients). For surviving patients, mean SAPS II was 19.6 ± 7.1 (range, 13-31) and mean hematoma volume was 862 cm ± 618 (range, 238-1887 cm). For deceased patients, mean SAPS II was 42 ± 13.2 (range, 18-63) and mean hematoma volume was 1419 cm ± 788 (range, 251-3492 cm). SAPS II (P < .001), hematoma volume (P = .01), and retroperitoneal location (P = .01) were independently associated with fatal outcome. Conclusion Percutaneous transarterial embolization is effective for the emergency treatment of spontaneous soft-tissue hematomas. Simplified acute physiology score II, hematoma volume, and retroperitoneal location are predictors of short-term outcome. © RSNA, 2019 Online supplemental material is available for this article.
目的 评估经皮动脉内栓塞术（PTAE）治疗自发性软组织血肿（SSTH）的安全性和疗效，并确定预测短期预后的变量。
材料与方法 2011 年至 2017 年间，回顾性分析了 112 例患者（平均年龄±标准差，72 岁±14 岁；年龄范围 28-92 岁）的结局，包括 65 例女性（平均年龄 73 岁±12.7 岁；年龄范围 39-92 岁）和 47 例男性（平均年龄 70 岁±14.9 岁；年龄范围 28-91 岁），这些患者均采用 PTAE 治疗 SSTH。记录 30 天死亡率、技术和临床成功率、简化急性生理学评分（SAPS）Ⅱ、抗凝、栓塞剂、血肿体积和位置、血清血红蛋白水平、血流动力学不稳定、CT 和（或）血管造影时存在活动性出血。临床成功定义为 PTAE 后通过血流动力学稳定和（或）血清血红蛋白水平稳定来确定止血。采用 Cox 模型进行单变量和多变量分析，以确定与死亡时间相关的变量。
结果 死亡率为 26.8%（112 例患者中有 30 例），血管造影成功率为 95.5%（112 例患者中有 107 例），临床成功率为 83%（112 例患者中有 93 例）。对于存活患者，平均 SAPSⅡ为 19.6±7.1（范围 13-31），平均血肿体积为 862cm±618cm（范围 238-1887cm）。对于死亡患者，平均 SAPSⅡ为 42±13.2（范围 18-63），平均血肿体积为 1419cm±788cm（范围 251-3492cm）。SAPSⅡ（P＜0.001）、血肿体积（P=0.01）和腹膜后位置（P=0.01）与致命结局独立相关。
结论 PTAE 是治疗自发性软组织血肿的有效急诊治疗方法。简化急性生理学评分Ⅱ、血肿体积和腹膜后位置是短期预后的预测因素。
