Department of Radiology, 8945Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, London, UK.
School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK.
Vasc Endovascular Surg. 2021 Apr;55(3):221-227. doi: 10.1177/1538574420980576. Epub 2020 Dec 14.
Symptomatic rectus muscle sheath hematoma may be the result of bleeding originating from the inferior epigastric artery. We report the technique and the results from a series of consecutive patients treated by transcatheter embolization, evaluating both ipsilateral and contralateral retrograde approaches.
This was a retrospective study including patients with verified rectus muscle sheath hematoma as a result of active extravasation from the inferior epigastric artery referred for transcatheter embolization. Technical success, clinical success and major complications were calculated. In addition, minor complications, blood transfusions required after a technically successful embolization, length of stay, peri-procedural and 30-day mortality and overall survival at 6 months were obtained. All statistical analysis was performed using SPSS.
Twenty-one patients (mean age = 59.67 ± 19.51 years old) were included. The cause of the bleeding in the vast majority was iatrogenic trauma (n = 12/21, 57.14%). Both contralateral (n = 12/21, 57.14%%) and ipsilateral (n = 9/21, 42.86%) retrograde approaches were used. Embolic materials included micro-coils (n = 13/20, 65%), microspheres (PVA) (n = 1/20, 5%), a combination of PVA and micro-coils (n = 5/20, 25%) and gel-foam (n = 1/20, 5%). Overall technical success was 95.2% (n = 20/21) while clinical success was achieved in all but one of the technically successful cases 95% (n = 19/20). One patient died peri-procedurally due to profound hemodynamic shock. There were no other major complications. Additional transfusion was necessary in 7 patients (n = 7/21, 33.33%). There was a significant increase in the hemoglobin levels after the embolization (7.03 ± 1.78 g/dL pre-procedure Vs 10.91 ± 1.7 g/dL post-procedure, p = 0.048). The median hospital stay was 8 days. The peri-procedure and 30-day mortality was 4.8% (n = 1/21) and 28.6% (n = 6/21) respectively. The 6-month survival was 61.9% (13/21).
Percutaneous embolization of the inferior epigastric artery is a minimally invasive method with satisfactory results. Both ipsilateral and contralateral retrograde approaches are feasible.
症状性腹直肌鞘血肿可能是由于发自腹壁下动脉的出血引起的。我们报告了一系列连续接受经导管栓塞治疗的患者的技术和结果，评估了同侧和对侧逆行入路。
这是一项回顾性研究，纳入了因腹壁下动脉外渗而导致腹直肌鞘血肿的患者，这些患者因主动出血而被转诊接受经导管栓塞治疗。计算了技术成功率、临床成功率和主要并发症。此外，还获得了轻微并发症、技术成功栓塞后需要输血、住院时间、围手术期和 30 天死亡率以及 6 个月时的总生存率。所有统计分析均使用 SPSS 进行。
共纳入 21 例患者（平均年龄=59.67±19.51 岁）。绝大多数出血的原因是医源性创伤（n=12/21，57.14%）。均采用同侧（n=9/21，42.86%）和对侧（n=12/21，57.14%）逆行入路。栓塞材料包括微线圈（n=13/20，65%）、微球（PVA）（n=1/20，5%）、PVA 和微线圈的组合（n=5/20，25%）和凝胶海绵（n=1/20，5%）。总体技术成功率为 95.2%（n=20/21），除 1 例技术成功病例（95%，n=19/20）外，临床成功率均达到 100%。1 例患者在围手术期因严重的血流动力学休克而死亡。无其他重大并发症。7 例患者（n=7/21，33.33%）需要额外输血。栓塞后血红蛋白水平显著升高（术前 7.03±1.78 g/dL 与术后 10.91±1.7 g/dL，p=0.048）。中位住院时间为 8 天。围手术期和 30 天死亡率分别为 4.8%（n=1/21）和 28.6%（n=6/21）。6 个月生存率为 61.9%（n=13/21）。
经导管栓塞腹壁下动脉是一种微创方法，具有令人满意的结果。同侧和对侧逆行入路均可行。
