University Hospitals of Leicester NHS Trust, Leicestershire, United Kingdom.
University of Leicester, Leicestershire, United Kingdom.
Br J Radiol. 2023 Mar 1;96(1144):20211351. doi: 10.1259/bjr.20211351. Epub 2023 Mar 3.
Evaluate clinical outcomes in transarterial embolisation (TAE) for acute gastrointestinal bleeding (GIB) and determine risk factors for 30-day reintervention for rebleeding and mortality.
TAE cases were retrospectively reviewed between March 2010 and September 2020 at our tertiary centre. Technical success (angiographic haemostasis following embolisation) was measured. Uni- and multivariate logistic regression analysis were performed to identify risk factors for clinical success (absence of 30-day reintervention or mortality) following embolisation for active GIB or empirical embolisation for suspected bleeding.
TAE was conducted in 139 patients (92 (66.2%) male; median age:73, range: 20-95 years) for acute upper GIB ( = 88) and lower GIB ( = 51). TAE was technically successful in 85/90 (94.4%) and clinically successful in 99/139 (71.2%); with 12 (8.6%) reintervention cases for rebleeding (median interval 2 days) and 31 (22.3%) cases of mortality (median interval 6 days). Reintervention for rebleeding was associated with haemoglobin drop > 40 g l from baseline based on univariate analysis ( = 0.047). 30-day mortality was associated with pre-intervention platelet count < 150×10 l ( < 0.001, OR 7.35, 95% CI 3.05-17.71) and INR > 1.4 ( < 0.001, OR 4.75, 95% CI 2.03-11.09) on multivariate logistic regression analysis. No associations were found for patient age, gender, antiplatelet/anticoagulation prior to TAE, or when comparing upper and lower GIB with 30-day mortality.
TAE had excellent technical success for GIB with relatively high (1-in-5) 30-day mortality. INR > 1.4 and platelet count < 150×10 l were individually associated with TAE 30-day mortality, and pre-TAE > 40 g l haemoglobin decline with rebleeding requiring reintervention.
Recognition and timely reversal of haematological risk factors may improve TAE periprocedural clinical outcomes.
评估急性胃肠道出血（GIB）经动脉栓塞术（TAE）的临床结果，并确定 30 天内再干预以防止再出血和死亡的风险因素。
回顾性分析 2010 年 3 月至 2020 年 9 月在我们的三级中心进行的 TAE 病例。测量技术成功（栓塞后血管造影止血）。采用单变量和多变量逻辑回归分析，确定在急性上 GIB（n=88）和下 GIB（n=51）患者中，栓塞治疗活动性 GIB 或经验性栓塞治疗疑似出血的临床成功（30 天内无再干预或死亡）的风险因素。
139 例患者（92 例（66.2%）为男性；中位年龄：73 岁，范围：20-95 岁）接受了 TAE 治疗急性上 GIB（n=88）和下 GIB（n=51）。90/90（94.4%）例 TAE 技术成功，139/139（71.2%）例 TAE 临床成功；12 例（8.6%）因再出血而再次介入（中位间隔 2 天），31 例（22.3%）死亡（中位间隔 6 天）。基于单变量分析，再出血的再干预与基线时血红蛋白下降>40g/l 有关（=0.047）。30 天死亡率与介入前血小板计数<150×10/l（<0.001，OR 7.35，95%CI 3.05-17.71）和 INR>1.4（<0.001，OR 4.75，95%CI 2.03-11.09）相关。多变量逻辑回归分析发现，患者年龄、性别、TAE 前抗血小板/抗凝治疗、上 GIB 与下 GIB 与 30 天死亡率之间无相关性。
TAE 治疗 GIB 的技术成功率非常高（1/5），但 30 天死亡率相对较高。INR>1.4 和血小板计数<150×10/l 与 TAE 30 天死亡率单独相关，而 TAE 前>40g/l 的血红蛋白下降与需要再次介入的再出血相关。
识别和及时逆转血液学危险因素可能会改善 TAE 围手术期的临床结果。
