Percutaneous artery embolization of bleeding rectus sheath hematomas in hemodynamically unstable patients: Outcomes of 43 patients in a tertiary referral hospital


Submitted: 15 April 2017
Accepted: 25 May 2017
Published: 7 November 2017
Abstract Views: 1049
PDF: 588
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

  • Alberto Cereda Cardiology IV, Cardiotoracovascular A. De Gasperis Department, Niguarda Cà Granda Hospital, Milan; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
  • Paolo Aseni Emergency Department, Niguarda Cà granda Hospital, Milan, Italy.
  • Lucio De Capitani Department of Statistics and Quantitative Methods, Bicocca University, Milan, Italy.
  • Marco Cereda Emergency Department, Niguarda Cà granda Hospital, Milan, Italy.
  • Ruggero Vercelli Interventional Radiology, Niguarda Cà Granda Hospital, Milan, Italy.
  • Cristina Giannattasio Cardiology IV, Cardiotoracovascular A. De Gasperis Department, Niguarda Cà Granda Hospital, Milan; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
  • Antonio Gaetano Rampoldi Interventional Radiology, Niguarda Cà Granda Hospital, Milan, Italy.
Rectus sheath hematoma (RSH) is an uncommon cause of abdominal pain that can lead to life-threatening bleeding, particularly in elderly patients receiving anticoagulation therapy. Type III RSHs, based on computer tomography (CT) evaluation, is characterized by active bleeding with intramuscular or intraperitoneal extension and hemodynamic instability. Medical contemporary knowledge of this condition is contentious and overall 20% of acute mortality has been reported. The purpose of this study was to retrospectively review our experience and outcomes in the management of RSHs treated with percutaneous arterial embolization of the epigastric vessels. We retrospectively analyzed 43 patients with RSH type III, submitted to percutaneous epigastric artery embolization from 2007 to 2015. Percutaneous arterial embolization was feasible and successful in patients with a high burden of comorbidities and receiving anticoagulation therapy. There was no acute mortality and a late mortality at 3 months of 9.1% (4/43) was not directly related to RSHs or arterial embolization. Patients with late mortality had lower ejection fraction, prolonged PTT, greater RDW and warfarin in overlapping with low-molecular-weight heparins. Transcatheter arterial embolization of the epigastric vessels was safe, feasible and effective in stopping the bleeding. Despite anti-platelets/anti-coagulation therapy and a high burden of comorbidities, there was no acute mortality related to RSH.

Cereda, A., Aseni, P., De Capitani, L., Cereda, M., Vercelli, R., Giannattasio, C., & Rampoldi, A. G. (2017). Percutaneous artery embolization of bleeding rectus sheath hematomas in hemodynamically unstable patients: Outcomes of 43 patients in a tertiary referral hospital. Emergency Care Journal, 13(2). https://doi.org/10.4081/ecj.2017.6753

Downloads

Download data is not yet available.

Citations