2012 SIR Annual Scientific Meeting edition:38 location:San Francisco date:24-29 March 2012
Purpose: To retrospectively assess the midterm outcome of transcatheter embolotherapy in patients presenting with severe, anticoagulation-induced soft tissue-bleeding and to determine factors potentially affecting the clinical outcome after embolotherapy.
Materials and methods: 42 patients underwent embolization for anticoagulation-induced soft-tissue bleeding. Principal clinical symptoms were hemodynamic shock (n=21), abdominal pain (n=9), back pain (n=7), buttock or thigh pain (n=5). Ultrasound and/or computed tomography were performed in 40 patients (95%); 2 patients (5%) were immediately referred to angiography. Several biochemical and radiological factors were analyzed for potentially affecting the clinical outcome.
Results: A bleeding hematoma was identified in the anterior abdominal wall (n=18, 43%), in the retroperitoneum (n=18; 43%) or in the thigh or gluteal region (n=6; 14%). Embolization was succesful in all patients; recurrent, lethal bleeding was noted in one patient (2%). In 9 patients (22%) additional surgical drainage of the hematoma was performed to manage a compartment syndrome. 11 patients (26%) died during follow-up (mean 37.9 months; range: 0.03-85.28 months); in 6 patients death was related to the bleeding. Overall survival after 6 and 12 months demonstrates an estimated survival of respectively 85.5% and 82.2%. Patients that died as a result of the bleeding demonstrated a significantly larger activated prothrombin time (aPTT) (p=0.04).
Conclusion: Transcatheter embolotherapy is very effective in stopping an anticoagulation-induced soft tissue bleeding. However, considerable morbidity and mortality may occur after succesful embolotherapy. Larger average aPTT is found in patients that died as a result of the bleeding.