Ces radiol. 2020, 74(2):122-130 | DOI: 10.55095/CesRadiol2020/022

Endovascular treatment of spontaneous bleeding in anticoagulated patientsOriginal article

Ondřej Renc¹, Jan Raupach¹, Vendelín Chovanec¹, Miroslav Lojík¹, Petr Hoffmann¹, Petr Dvořák¹, Radovan Malý², Igor Guňka³, Antonín Krajina¹

¹ Radiologická klinika LF UK a FN, Hradec Králové

² I. interní kardioangiologická klinika LF UK a FN, Hradec Králové

³ Chirurgická klinika LF UK a FN, Hradec Králové

Aim: The aim of the study is to retrospectively assess the effectivity of endovascular embolization in anticoagulated patients with hemodynamically significant retroperitoneal, anterior abdominal wall or chest wall bleeding.

Methods: Between June 2014 and March 2018, totally 26 embolization procedures in 25 patients (12 males, 13 females, age range between 62-86 years) with spontaneous bleeding due to ongoing anticoagulation treatment were performed in one center. Indication for procedure was hemodynamically significant bleeding requiring fluid resuscitation and signs of dynamic contrast media extravasation on CT angiography. The procedure itself was performed by selective or superselective embolization of bleeding artery using various embolization agents: acrylate glue, polyvinylalcohol or gelatine foam.

Results: Sixteen patients with retroperitoneal bleeding, six patients with rectus sheath hematomas, one patient with bleeding to both retroperitoneal and abdominal wall compartment and two patients with chest wall bleeding were treated in our department. All the patients proved signs of contrast media extravasation on CT angiography, digital subtraction angiography showed contrast media extravasation in 73,1% (19/26 procedures). Technical success rate was 96,1% (25/26 procedures), clinical success rate was 80,1% (21/26 procedures). Total follow-up was 1 day-33 months (median 4 months), 4 patients died during follow-up, 30-day mortality was 16%. Surgical procedure following endovascular treatment had to be performed in 20% of cases (5 patients - in 3 cases due to ongoing bleeding, in 2 cases to evacuate large hematoma).

Conclusion: Endovascular embolization in anticoagulated patients with spontaneous bleeding is an effective method which enables to replace the more invasive surgical procedure especially in higher age patients with several serious diseases.

Keywords: anticoagulation treatment, embolization, bleeding

Accepted: April 6, 2020; Published: June 1, 2020  Show citation