Nozawa Yosuke, Michimoto Kenkichi, Ashida Hirokazu, Baba Akira, Fukuda Takeshi, Ojiri Hiroya
Department of Radiology, Jikei University Hospital, Jikei University, 3-19-18, Nishishinbashi, Minato-ku, Tokyo, Japan.
Radiol Med. 2022 Dec;127(12):1412-1419. doi: 10.1007/s11547-022-01564-8. Epub 2022 Oct 8.
Transcatheter arterial embolization (TAE) for colonic diverticular bleeding (CDB), an established procedure for hemostasis, is sometimes complicated by spontaneous hemostasis and unclear bleeding site on angiography despite active arterial bleeding on preoperative computed tomography angiography (CTA). Therefore, to investigate and increase the feasibility of TAE, this retrospective study evaluates the clinical and radiological features related to positive extravasation on angiography.
Sixty CDB patients with extravasation on CTA underwent TAE between January 2011 and February 2021 and were divided into extravasation-positive (P-group; n = 25) and -negative groups (N-group; n = 35) based on the superior or inferior mesenteric angiography. Patient characteristics, laboratory findings, the diameter of the inferior vena cava (IVCD), the diameter of superior and inferior mesenteric veins, and technical outcomes were evaluated.
TAE was successful in 24 patients in the P-group (96%) and 14 in the N-group (40%) (p < 0.001). Univariate analysis revealed "usage of anticoagulant" (p < 0.05) and "larger IVCD (p < 0.05) on preoperative CTA" to be significant predictors of positive extravasation. In the multivariate analysis, IVCD remained significant with an adjusted odds ratio of 1.17. The IVCD cutoff value was 13.6 mm (area under the curve = 0.72, sensitivity = 84.0%, specificity = 54.3%). There were no significant differences in other parameters.
Measurement of IVCD in CDB with the cutoff value of 13.6 mm can be a simple and useful indicator to predict the detectability of extravasation following TAE procedures.
经导管动脉栓塞术（TAE）用于治疗结肠憩室出血（CDB）是一种已确立的止血方法，但有时会出现自发止血，且尽管术前计算机断层血管造影（CTA）显示有活动性动脉出血，但血管造影时出血部位仍不明确。因此，为了研究并提高TAE的可行性，本回顾性研究评估了与血管造影上造影剂外渗阳性相关的临床和放射学特征。
2011年1月至2021年2月期间，60例CTA显示有造影剂外渗的CDB患者接受了TAE治疗，并根据肠系膜上或下血管造影分为造影剂外渗阳性组（P组；n = 25）和阴性组（N组；n = 35）。评估了患者特征、实验室检查结果、下腔静脉直径（IVCD）、肠系膜上和下静脉直径以及技术结果。
P组24例患者TAE成功（96%），N组14例成功（40%）（p < 0.001）。单因素分析显示“使用抗凝剂”（p < 0.05）和“术前CTA上较大的IVCD（p < 0.05）”是造影剂外渗阳性的显著预测因素。多因素分析中，IVCD仍然显著，调整后的优势比为1.17。IVCD临界值为13.6毫米（曲线下面积 = 0.72，敏感性 = 84.0%，特异性 = 54.3%）。其他参数无显著差异。
测量CDB患者的IVCD，临界值为13.6毫米，可作为预测TAE术后造影剂外渗可检测性的简单且有用的指标。
