Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
Clin Radiol. 2021 Feb;76(2):157.e11-157.e18. doi: 10.1016/j.crad.2020.10.003. Epub 2020 Nov 1.
To evaluate the technical and clinical success of embolisation in patients with life-threatening spontaneous retroperitoneal haematoma (SRH) and to assess predictors of clinical outcome.
Thirty patients (mean age: 71.9±9.8 years) with SRH underwent digital subtraction angiography (DSA). All patients received anticoagulant or antiplatelet medication or a combination of both at the time the SRH occurred.
Pre-interventional computed tomography angiography (CTA) revealed active retroperitoneal bleeding in 28 of 30 (93.3%) patients. DSA identified active haemorrhage in 22 of 30 patients (73.3%). Twenty-nine of 30 (96.7%) patients underwent embolisation. n-Butyl-2-cyanoacrylate (NBCA) was used in 15 patients (51.7%), coils were used in 10 patients (34.5%), and both embolic agents were used in four patients (13.8%). The technical success rate was 100%. Pre-interventional haemoglobin levels increased significantly after embolotherapy from 70.9±16.1 g/l to 87±11.3 g/l (p<0.001), whereas partial thromboplastin time decreased from 58±38 to 30±9 seconds (p<0.001) after embolotherapy. The need for transfusion of concentrated red cells decreased from 3±2.2 to 1±1.1 units (p<0.001) after the intervention. Clinical success was achieved in 19 of 29 (65.5%) patients. No major procedure-related complications occurred. Seven patients (24.1%) died within 30 days after the procedure.
Embolotherapy in patients with life-threatening SRH leads to a high technical success rate and is a safe therapeutic option. The clinical success rate was acceptable and influenced by pre-interventional coagulation status and by the amount of transfused concentrated red cells.
评估对有生命危险的自发性腹膜后血肿（SRH）患者进行栓塞治疗的技术和临床成功率，并评估临床结果的预测因素。
30 例（平均年龄：71.9±9.8 岁）有 SRH 的患者接受了数字减影血管造影（DSA）检查。所有患者在发生 SRH 时均接受抗凝或抗血小板药物治疗或两者联合治疗。
术前 CT 血管造影（CTA）显示 30 例患者中有 28 例（93.3%）存在活动性腹膜后出血。DSA 在 30 例患者中发现 22 例（73.3%）有活动性出血。30 例患者中有 29 例（96.7%）接受了栓塞治疗。15 例（51.7%）患者使用 n-丁基-2-氰基丙烯酸酯（NBCA），10 例（34.5%）患者使用弹簧圈，4 例（13.8%）患者同时使用两种栓塞剂。技术成功率为 100%。栓塞治疗后，血红蛋白水平从术前的 70.9±16.1g/l 显著升高至 87±11.3g/l（p<0.001），而部分凝血活酶时间从 58±38 秒降至 30±9 秒（p<0.001）。介入治疗后浓缩红细胞的输注量从 3±2.2 单位减少至 1±1.1 单位（p<0.001）。29 例患者中有 19 例（65.5%）获得临床成功。没有发生与手术相关的严重并发症。7 例（24.1%）患者在术后 30 天内死亡。
对有生命危险的 SRH 患者进行栓塞治疗可获得较高的技术成功率，是一种安全的治疗选择。临床成功率是可以接受的，并且受到介入前凝血状态和浓缩红细胞输注量的影响。
