Tiralongo Francesco, Giurazza Francesco, Di Pietro Stefano, Lucatelli Pierleone, Mosconi Cristina, Contegiacomo Andrea, Vacirca Francesco, Ciaglia Simone, Cocozza Maria Adriana, Castiglione Davide Giuseppe, Falsaperla Daniele, Ini' Corrado, Zanghì Guido Nicola, Granata Antonio, Venturini Massimo, Basile Antonio
Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy.
Interventional Radiology Department, Cardarelli Hospital of Naples, 80131 Naples, Italy.
J Clin Med. 2023 Jul 19;12(14):4779. doi: 10.3390/jcm12144779.
Endovascular management of abdominal wall hematomas (AWHs) is now the primary treatment option in hemodynamically stable patients, and it is often preferred to surgical interventions. The purpose of this multicentric study was to assess the safety, technical, and clinical success of percutaneous transarterial embolization (PTAE) of spontaneous AWHs to evaluate the efficacy of blind or empiric embolization compared to targeted embolization and to compare the outcome of the endovascular treatment approach in patients affected by COVID-19 and non-COVID-19 patients. We retrospectively enrolled 112 patients with spontaneous AWHs who underwent PTAE, focusing on signs of bleeding at pre-procedural CTA and DSA. Patients were separated into two groups depending on whether a blind or targeted embolization approach was used. We also divided patients into COVID-19 and non-COVID-19 groups. The mean age of the study population was 68.6 ± 15.8 years. CTA and DSA revealed signs of active bleeding in 99 and 88 patients, respectively. In 21 patients, blind embolization was performed. The overall technical success rate was 99%. Clinical success was obtained in 96 patients (86%), while 16 (14%) re-bled within 96 h. One patient reported a major peri-procedural complication. The comparison between blind and targeted embolization approaches showed no statistically significant differences in the characteristics of groups and technical and clinical success rates. No significant differences were found in the procedural outcome between COVID-19 and non-COVID-19 groups. Our study confirmed that PTAE is effective for treating spontaneous AWHs, even in COVID-19 patients. It suggests that the efficacy and safety of blind embolization are comparable to targeted embolization.
腹壁血肿（AWH）的血管内治疗目前是血流动力学稳定患者的主要治疗选择，通常比手术干预更受青睐。这项多中心研究的目的是评估自发性AWH经皮经动脉栓塞术（PTAE）的安全性、技术成功率和临床成功率，以评估盲目或经验性栓塞与靶向栓塞相比的疗效，并比较COVID-19患者和非COVID-19患者的血管内治疗方法的结果。我们回顾性纳入了112例行PTAE的自发性AWH患者，重点关注术前CTA和DSA的出血迹象。根据是否采用盲目或靶向栓塞方法将患者分为两组。我们还将患者分为COVID-19组和非COVID-19组。研究人群的平均年龄为68.6±15.8岁。CTA和DSA分别显示99例和88例患者有活动性出血迹象。21例患者进行了盲目栓塞。总体技术成功率为99%。96例患者（86%）获得临床成功，而16例（14%）在96小时内再次出血。1例患者报告了严重的围手术期并发症。盲目栓塞与靶向栓塞方法的比较显示，两组特征、技术成功率和临床成功率在统计学上无显著差异。COVID-19组和非COVID-19组的手术结果无显著差异。我们的研究证实，PTAE对治疗自发性AWH有效，即使在COVID-19患者中也是如此。这表明盲目栓塞的疗效和安全性与靶向栓塞相当。
