Patidar Yashwant, Srinivasan Shyam V, Singh Jitender, Patel Ranjan K, Chandel Karamvir, Mukund Amar, Sharma Manoj K, Sarin Shiv K
Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India.
Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India.
J Clin Exp Hepatol. 2022 Mar-Apr;12(2):353-361. doi: 10.1016/j.jceh.2021.07.014. Epub 2021 Aug 26.
To evaluate the clinical outcomes of transcatheter arterial embolization (TAE) with n-butyl-2-cyanoacrylate (NBCA) for treatment of bleeding in cirrhotic patients.
A total of 35 cirrhotic patients (26 men, 9 women; mean age, 48.4 ± 11.1) who underwent TAE with NBCA for bleeding from January 2011 to December 2020 were retrospectively analysed. Only cirrhotic patients with active arterial bleeding confirmed on computed tomography (CT) were included. Fifteen patients were hemodynamically unstable before embolization procedure, and coagulopathy was observed in 32 patients. The mean MELD score and Child Pugh score were 24 ± 9.9 and 9.9 ± 2.2, respectively. The mean haemoglobin level and mean number of RBC units transfused before embolization were 7.4 ± 1.4 g/dL and 10.2 ± 4, respectively. The technical, clinical success rate and 30-day mortality rate were evaluated.
Technical success and clinical success rates were achieved in 100% and 82.8% of patients, respectively. Overall 30-day mortality rate was 48%. No major complications related to the embolization procedure was seen. Only the greater number of RBC units transfused before the embolization procedure (OR = 1.81, 95% CI = 1.17-2.80, = 0.007) was significantly associated with clinical failure. Greater number of RBC units transfused (OR = 1.53, 95% CI: 1.00-2.34, = 0.004) and higher Child Pugh score (OR 2.44, 95% CI 1.26-4.71, = 0.008) were significantly associated with higher 30-day mortality rate.
Transcatheter arterial embolization using NBCA can be used as the effective treatment option for bleeding in cirrhotic patients which has a high technical and clinical success despite the grave prognosis associated with cirrhosis.
评估用氰基丙烯酸正丁酯（NBCA）经导管动脉栓塞术（TAE）治疗肝硬化患者出血的临床疗效。
回顾性分析2011年1月至2020年12月期间共35例行TAE联合NBCA治疗出血的肝硬化患者（26例男性，9例女性；平均年龄48.4±11.1岁）。仅纳入经计算机断层扫描（CT）证实有活动性动脉出血的肝硬化患者。15例患者在栓塞术前血流动力学不稳定，32例患者观察到凝血功能障碍。平均终末期肝病模型（MELD）评分和Child-Pugh评分分别为24±9.9和9.9±2.2。栓塞术前平均血红蛋白水平和平均红细胞输注单位数分别为7.4±1.4g/dL和10.2±4。评估技术成功率、临床成功率和30天死亡率。
技术成功率和临床成功率分别为100%和82.8%。30天总死亡率为48%。未观察到与栓塞术相关的严重并发症。仅栓塞术前输注较多红细胞单位数（比值比[OR]=1.81，95%置信区间[CI]=1.17-2.80，P=0.007）与临床失败显著相关。输注较多红细胞单位数（OR=1.53，95%CI：1.00-2.34，P=0.004）和较高的Child-Pugh评分（OR 2.44，95%CI 1.26-4.71，P=0.008）与较高的30天死亡率显著相关。
尽管肝硬化预后严重，但使用NBCA的经导管动脉栓塞术可作为肝硬化患者出血的有效治疗选择，具有较高的技术和临床成功率。
