Transcatheter Arterial Embolization for Acute Arterial Extravasation with Hematoma Formation: Classified the Group as Cause and Their Clinical Outcomes

Boram Kim; Young Min Han; Gong Yong Jin

doi:10.3348/jksr.2018.78.2.120

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Kim, Han, and Jin: Transcatheter Arterial Embolization for Acute Arterial Extravasation with Hematoma Formation: Classified the Group as Cause and Their Clinical Outcomes

Original Article

J Korean Soc Radiol 2018;78(2):120-129.

Published online: 20 January 2018

DOI: https://doi.org/10.3348/jksr.2018.78.2.120

Transcatheter Arterial Embolization for Acute Arterial Extravasation with Hematoma Formation: Classified the Group as Cause and Their Clinical Outcomes

Boram Kim, MD¹, Young Min Han, MD^1,^2,^3,^∗, Gong Yong Jin, MD^1,²

¹Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea

²Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea

³Institute of Cardiovascular Research, Chonbuk National University Medical School and Hospital, Jeonju, Korea

^∗Corresponding author: Young Min Han, MD Department of Radiology, Research Institute of Clinical Medicine, Institute of Cardiovascular Research, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea. Tel. 82-63-250-1176 Fax. 82-63-272-0481 E-mail: ymhan@jbnu.ac.kr

Received 30 April 2017 Revised 7 July 2017 Accepted 11 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To present our experience in transcatheter arterial embolization (TAE) for hematoma formation related to variable causes. We analyzed the factors that could affect clinical outcomes.

Materials and Methods

A retrospective study was conducted on 50 patients (24 men, 36 women; mean age, 63.8 years) who were treated for a TAE to control bleeding. Computed tomography (CT) scans showed the formation of hematomas. We classified the patients into three groups depending on the underlying cause of the hematoma i.e., spontaneous, traumatic or iatrogenic groups. We evaluated relevant factors such as sex, age, hematoma size and liquefaction, extravasation on CT, injured artery, onset to procedure time, embolization material, hospital day.

Results

TAE was successfully performed in all patients. The proportions of patients in the spontaneous, traumatic, and iatrogenic bleeding groups were 36% (18/50), 42% (21/50), and 22% (11/50), respectively. Using the Mann Whitney U test, the international normalized ratio (INR) was statistically different for the spontaneous bleeding group (p = 0.013). In addition, the INR (p = 0.038) and platelet count (p = 0.004) were significant different for the traumatic group. Also, the platelet counts were related to clinical successes (p = 0.046).

Conclusion

Based our experience, TAE is a safe and effective treatment option for the management of hematoma formation. Furthermore, the interventional radiologist should consider the cause of hematoma formation in order to perform proper treatment.

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Keywords: Index terms Bleeding Hematoma Therapeutic Embolization

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Fig. 1.

A 59-year old woman received heparin to treat an acute pulmonary thromboembolism. The patient exhibited a retroperitoneal hematoma and intramuscular hemorrhage at the iliopsoas muscle. A. Hematoma formation is seen at the left retroperitoneal space and the iliopsoas muscle (arrow). B, C. Acute extravasations are present in the retroperitoneum and the iliopsoas muscle (arrows). D. Subtle focal staining of left iliolumbar artery is seen following selective angiography. E. Hematoma is decreased in the follow-up CT performed after 6 months.

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Fig. 2.

An 80-year old woman with anterior chest wall hematoma due to traffic accident. A. Multiple aneurysmal sac (black arrows) with extravasation at right posterior humerus circumferential artery and humerus comminuted fracture are present in the CT. B, C. At selective angiography, multiple aneurysmal sacs are seen.

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Fig. 3.

A 75-year old woman with anterior chest wall hematoma due to complications of central line insertion. A. Huge anterior chest wall hematoma with about 18-cm-sized longest diameter. B. Acute extravasation and an aneurysmal sac like lesion are shown in an arterial phase CT. C. Contrast media extravasation at the right scapula subclavian artery branch is discovered during a selective angiography. D. Complete devascularization of the aneurysm is noted after coil embolization.

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Table 1.

Clinical Information of Three Groups of Hematomas

	Spontaneous (n = 18)	Traumatic (n = 21)	Iatrogenic (n = 11)	All Patient (n = 50)	p-Value
Age (years)^∗	67.44	64.95	55.07	63.80	0.087
Systolic blood pressure (mm Hg)^∗	108.44 ± 27.82	91.14 ± 29.48	95.36 ± 21.39	98.30 ± 27.90	0.144
Hemoglobin (g/dL)^∗	7.24 ± 2.20	7.90 ± 2.68	7.00 ± 1.66	7.46 ± 2.31	0.512
Bleeding tendency^∗
PLT (× 10⁹/L)	206.39 ± 268.51	134.19 ± 181.65	138.18 ± 96.80	161.06 ± 203.90	0.508
INR	4.22 ± 10.72	1.69 ± 1.10	1.57 ± 0.64	2.57 ± 6.48	0.412
aPTT (s)	87.20 ± 60.88	57.95 ± 36.74	61.05 ± 45.41	69.16 ± 49.46	0.152
Hematoma size (mm)^∗	122.22 ± 46.87	119.62 ± 55.78	114.45 ± 47.54	119.42 ± 50.02	0.924
Patient with medication affected bleeding tendency (n)^∗	9	3	3	15	0.051
Onset to procedure time (hours)^∗	357.50 ± 524.92	80.86 ± 117.15	197.27 ± 222.52	206.06 ± 355.61	0.050
Active extravasation on pre-intervention image^∗	16/18	18/21	7/9	43/50	0.512
Hospital days^∗	34.28 ± 26.78	34.14 ± 47.31	25.73 ± 11.82	32.34 ± 34.69	0.781
Injured artery (n)^∗	1.50 ± 0.86	2.19 ± 1.69	1.55 ± 0.82	1.80 ± 1.29	0.194
Patient with liquefacted hematoma (n)^∗	7	0	2	9	0.005
Patient with hematoma drainage (n)^∗	9	6	3	18	0.315
Clinical success (%)^∗	16/18 (89)	14/21 (67)	9/11 (82)	39/50 (78)	0.244

^∗ One way analysis of variance test. aPTT = activated partial thromboplastin time, INR = international normalized ratio, PLT = platelet count

Table 2.

Sites of Hematoma Formation

Sites of Hematoma Formation	n = 50
Retroperitoneum	14
Intramuscular area	26
Abdominal cavity	2
Pelvic cavity	3
Bladder	3
Thoracic cavity	1
Subclavian area	1

Table 3.

Factors Associated with Result (Clinical Success or Clinical Failure) with Univariate Logistic Regression Analysis

	p-Value	Exp (B)
Age	0.663	1.830
Sex	0.099	0.290
Systolic blood pressure (mm Hg)	0.074	1.024
Hb (g/dL)	0.116	1.306
PLT (× 10⁹/L)	0.033	1.014
INR	0.084	0.551
aPTT (s)	0.776	0.998
Hematoma size (mm)	0.931	1.001
Onset to procedure time (hour)	0.816	1.000
Extravasation on CT	0.488	0.457
Hospital days (day)	0.326	1.016
Injured artery (n)	0.463	1.265
Liquefacted hematoma	0.986	0.984
Hematoma drainage	0.462	0.600

aPTT = activated partial thromboplastin time, INR = international normalized ratio, PLT = platelet count

Table 4.

Factors Associated with Result (Clinical Success or Clinical Failure) with Multivariate Logistic Regression Analysis

	p-Value	Exp (B)
Sex	0.070	0.168
PLT (× 10⁹/L)	0.046	1.015
INR	0.130	0.468
Injured artery (n)	0.070	0.168
Systolic blood pressure (mm Hg)	0.149	2.146

INR = international normalized ratio, PLT = platelet count

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