Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy.
Department of Radiology, Desio Hospital, ASST Brianza, Via Giuseppe Mazzini 1, Desio, 20832 Monza, Italy.
Tomography. 2023 May 28;9(3):1083-1093. doi: 10.3390/tomography9030089.
The aim of this study is to report the authors' experience of percutaneous transarterial embolization (TAE) in patients with spontaneous soft tissue hematomas (SSTH) and active bleeding with anticoagulation impairment. The study retrospectively identified 78 patients who received a diagnosis of SSTH by CT scan and underwent TAE between 2010 and 2019 in a single trauma center. The patients were stratified using Popov classification into categories: 2A, 2B, 2C, and 3. The patient's 30-day survival after TAE was considered the primary outcome; immediate technical success, the need for additional TAE, and TAE-related complications were considered secondary outcomes. Immediate technical success, complication rate, and risk factors for death were analyzed. Follow-up stopped on day 30 from TAE. 27 patients (35%) fell into category 2A, 8 (10%) into category 2B, 4 (5%) into category 2C, and 39 (50%) into category 3. Immediate technical success was achieved in 77 patients (98.7%). Complications included damage at the arterial puncture site (2 patients, 2.5%) and acute kidney injury (24 patients, 31%). Only 2 patients (2.5%) had been discharged with a new diagnosis of chronic kidney disease. The 30-day overall mortality rate was 19% (15 patients). The mortality rate was higher in hemodynamically unstable patients, in Popov categories 2B, 2C, and 3, and in patients with an initial eGFR < 30 mL/min × 1.73 m. The study demonstrated a higher mortality risk for categories 2B, 2C, and 3 compared to category 2A. Nonetheless, TAE has proven effective and safe in type 2A patients. Even though it is unclear whether type 2A patients could benefit from conservative treatment rather than TAE, in the authors' opinion, a TAE endovascular approach should be promptly considered for all patients in ACT with active bleeding demonstrated on CT scans.
本研究旨在报告作者在抗凝功能受损合并自发性软组织血肿（SSTH）和活动性出血的患者中经皮经动脉栓塞（TAE）的经验。本研究回顾性分析了 2010 年至 2019 年期间在一家创伤中心接受 CT 扫描诊断为 SSTH 并接受 TAE 的 78 例患者。根据 Popov 分类，将患者分为以下几类：2A、2B、2C 和 3。TAE 后 30 天患者的生存情况作为主要结局；即刻技术成功率、需要额外 TAE 以及 TAE 相关并发症作为次要结局。分析即刻技术成功率、并发症发生率和死亡的危险因素。随访时间截止到 TAE 后第 30 天。27 例（35%）患者归入 2A 类，8 例（10%）归入 2B 类，4 例（5%）归入 2C 类，39 例（50%）归入 3 类。77 例（98.7%）患者即刻技术成功。并发症包括动脉穿刺部位损伤（2 例，2.5%）和急性肾损伤（24 例，31%）。仅有 2 例（2.5%）患者出院时被新诊断为慢性肾脏病。30 天总死亡率为 19%（15 例）。血流动力学不稳定患者、Popov 2B、2C 和 3 类以及初始 eGFR<30mL/min×1.73m 的患者死亡率更高。本研究表明，与 2A 类相比，2B、2C 和 3 类患者的死亡风险更高。尽管尚不清楚 2A 类患者是否可以从保守治疗而不是 TAE 中获益，但作者认为，对于所有在 CT 扫描上显示有活动性出血的 ACT 患者，应迅速考虑采用 TAE 血管内方法。
