Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Jpn J Radiol. 2019 Apr;37(4):328-335. doi: 10.1007/s11604-019-00815-5. Epub 2019 Jan 30.
To assess the safety and efficacy of transarterial embolization (TAE) and to evaluate the utility of contrast-enhanced computed tomography (CE-CT) for life-threatening spontaneous retroperitoneal hemorrhage (SRH).
Nineteen patients underwent TAE following CE-CT for life-threatening SRH. CE-CT and angiographic findings, technical successes, and clinical successes were evaluated. The diagnostic performance of CE-CT for the detection of active bleeding arteries was also assessed by two independent readers.
Active extravasation of contrast material was accurately observed in 78.9‒84.2% of the patients on CE-CT. Angiograms revealed active extravasation in 37 arteries of 15 patients (78.9%), and 4 patients showed no sign of active bleeding. Sensitivity, positive predictive value, and accuracy rate of CE-CT for the detection of active bleeding vessels was 59.5%, 62.9‒71.0% and 55.6‒60.0% respectively. The successful embolization of 48 intended arteries was achieved in all the patients, including empirical TAE in four patients. Hemodynamic stabilization was achieved in 17 patients (89.5%) with a significant decrease in transfusion (p < 0.001).
TAE is a technically safe and clinically effective treatment method for life-threatening SRH. CE-CT has moderate capability for accurate identification of active bleeding arteries. TAE including arteries that potentially distribute anatomic territory of the hematoma is essential.
评估经动脉栓塞术（TAE）的安全性和有效性，并评估对比增强计算机断层扫描（CE-CT）在危及生命的自发性腹膜后出血（SRH）中的应用价值。
19 例因危及生命的 SRH 而行 CE-CT 检查后行 TAE。评估 CE-CT 和血管造影的结果、技术成功率和临床成功率。还由两位独立的读者评估 CE-CT 对检测活动性出血动脉的诊断性能。
CE-CT 可准确观察到 78.9%-84.2%的患者有造影剂外渗。血管造影显示 15 例患者的 37 条动脉有活动性外渗（78.9%），4 例患者无活动性出血征象。CE-CT 检测活动性出血血管的敏感性、阳性预测值和准确性分别为 59.5%、62.9%-71.0%和 55.6%-60.0%。所有患者均成功栓塞了 48 条预期的血管，包括 4 例经验性 TAE。17 例患者（89.5%）的血流动力学稳定，输血明显减少（p<0.001）。
TAE 是治疗危及生命的 SRH 的一种技术安全且临床有效的方法。CE-CT 对于准确识别活动性出血动脉具有中等能力。TAE 包括潜在分布血肿解剖区域的动脉是必不可少的。
