Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany.
Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland.
Br J Radiol. 2020 Jun;93(1110):20190413. doi: 10.1259/bjr.20190413. Epub 2020 Mar 12.
Iatrogenic hemorrhages occur in 0.5-16% of medical procedures. A retrospective study was conducted to analyze technical and clinical outcome of transarterial embolization (TAE) used for acute iatrogenic hemorrhage and to identify factors predicting outcome.
All patients undergoing TAE for acute iatrogenic bleeding from 2006 to 2013 were retrospectively analyzed. Primary end points were technical and clinical success or failure and 30 day mortality.
A total of 153 patients underwent 182 TAEs. Factors associated with clinical failure were lower blood hemoglobin concentration, use of higher number of units of red blood cell concentrate, TAE performed at night or weekend, embolization of more than one vessel, shock state before digital subtraction angiography (DSA), and intensive care before TAE. In multivariate analysis, independent factors for clinical success were hemoglobin concentration, number of units of red blood cell concentrate, and TAE of more than one vessel. Technical failure was associated with female gender, failure to detect signs of bleeding in DSA, TAE of more than one vessel, and shock state before DSA. Bleeding related to anticoagulation medication resulted in a significantly higher mortality rate compared with bleeding due to the remaining causes (30% 15%, < 0.05).
Despite excellent technical success, the mortality rate was significant. The only factors affecting clinical success were bleeding intensity and extent of injury. Bleeding attributed to anticoagulation is related to high mortality and therefore requires special attention.
This study gives insights into morbidity and mortality of iatrogenic bleedings and the technical and clinical success rates of TAE in a large study population.
医源性出血在 0.5-16%的医疗操作中发生。本回顾性研究旨在分析用于治疗急性医源性出血的经动脉栓塞术（TAE）的技术和临床结果，并确定预测结果的因素。
回顾性分析了 2006 年至 2013 年期间因急性医源性出血而行 TAE 的所有患者。主要终点是技术和临床成功或失败以及 30 天死亡率。
共 153 例患者行 182 次 TAE。与临床失败相关的因素包括较低的血红蛋白浓度、使用更多单位的红细胞浓缩液、夜间或周末进行 TAE、栓塞超过一条血管、DSA 前休克状态以及 TAE 前进入重症监护病房。多变量分析显示，临床成功的独立因素是血红蛋白浓度、红细胞浓缩液单位数和 TAE 超过一条血管。技术失败与女性性别、DSA 未能检测到出血迹象、TAE 超过一条血管以及 DSA 前休克状态有关。与抗凝药物相关的出血与剩余原因引起的出血相比，死亡率显著更高（30% 比 15%，<0.05）。
尽管技术上成功率很高，但死亡率仍很高。唯一影响临床成功的因素是出血的强度和损伤的程度。归因于抗凝的出血与高死亡率有关，因此需要特别注意。
本研究深入了解了医源性出血的发病率和死亡率，以及 TAE 在大型研究人群中的技术和临床成功率。
