Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Diagn Interv Radiol. 2023 Nov 7;29(6):819-825. doi: 10.4274/dir.2023.232253. Epub 2023 Aug 31.
To evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in controlling hemodynamically unstable bleeding following a percutaneous transthoracic needle biopsy (PTNB).
A total of seven patients (four men and three women; mean age, 62 ± 12 years) who received TAE for post-PTNB bleeding between May 2007 and March 2022 were included. The observed types of bleeding were hemothorax (n = 3), hemoptysis (n = 2), and a combination of both (n = 2). In patients with active bleeding, the technical success of TAE was defined as superselective embolization of the target artery with no active bleeding visible on post-TAE angiography. Clinical success was defined as sustained cessation of bleeding without hemodynamic instability, requirement of repeat TAE, or the need for post-TAE hemostatic surgery during the initial admission. The metrics analyzed included technical and clinical success rates, complications, and 30-day mortality.
All seven patients achieved technical success, with a clinical success rate of 86% (6/7). Six patients were discharged alive, while one patient died of respiratory failure accompanied by hemothorax 19 days post-biopsy. The angiographic findings associated with bleeding were contrast media extravasation or pseudoaneurysm (n = 3) and vascular hypertrophy with tortuosity (n = 2). The implicated bleeding arteries included the intercostal artery (n = 2), bronchial artery (n = 2), and internal thoracic artery (n = 1). In two cases, no clear bleeding foci were identified; nonetheless, prophylactic embolization was performed on the right intercostal artery (n = 1) and right intercostobronchial trunk (n = 1). The embolic agents utilized included microcoils (n = 1), gelatin sponge particles (n = 2), polyvinyl alcohol (PVA) with gelatin sponge particles (n = 1), PVA with microcoils (n = 1), microcoils with gelatin sponge particles (n = 1), and microcoils with n-butyl-2-cyanoacrylate and gelatin sponge particles (n = 1). The 30-day mortality rate was 14% (1/7). No ischemic complications related to TAE were observed.
The study suggests that TAE is safe and effective for controlling hemodynamically unstable bleeding following a PTNB.
评估经皮经胸穿刺活检（PTNB）后经导管动脉栓塞术（TAE）控制血流动力学不稳定出血的安全性和疗效。
2007 年 5 月至 2022 年 3 月期间，共有 7 例（4 名男性和 3 名女性；平均年龄 62±12 岁）因 PTNB 后出血接受 TAE 治疗。观察到的出血类型包括血胸（n=3）、咯血（n=2）和两者兼有（n=2）。对于活动性出血患者，TAE 的技术成功定义为目标动脉的超选择性栓塞，TAE 后血管造影未见活动性出血。临床成功定义为出血持续停止，无血流动力学不稳定，无需重复 TAE 或初始入院期间需要 TAE 后止血手术。分析的指标包括技术和临床成功率、并发症和 30 天死亡率。
7 例患者均达到技术成功，临床成功率为 86%（6/7）。6 例患者存活出院，1 例患者活检后 19 天因血胸合并呼吸衰竭死亡。与出血相关的血管造影发现包括造影剂外渗或假性动脉瘤（n=3）和血管肥大伴迂曲（n=2）。涉及的出血动脉包括肋间动脉（n=2）、支气管动脉（n=2）和内乳动脉（n=1）。在 2 例中，未明确发现出血灶；然而，仍对右侧肋间动脉（n=1）和右侧肋间支气管干（n=1）进行了预防性栓塞。使用的栓塞剂包括微线圈（n=1）、明胶海绵颗粒（n=2）、聚乙烯醇（PVA）联合明胶海绵颗粒（n=1）、PVA 联合微线圈（n=1）、微线圈联合明胶海绵颗粒（n=1）和微线圈联合正丁基-2-氰基丙烯酸酯和明胶海绵颗粒（n=1）。30 天死亡率为 14%（1/7）。未观察到与 TAE 相关的缺血性并发症。
该研究表明，TAE 是控制 PTNB 后血流动力学不稳定出血的安全有效方法。
