Endovascular Embolisation for Rectus Sheath Haematoma
JHM Cheng, FKY Cho, WKW Leung, WK Kan
Hong Kong J Radiol 2017;20:324-9
DOI: 10.12809/hkjr1716846
Objective: To review outcomes of patients who underwent endovascular embolisation for rectus sheath haematoma (RSH).
Methods: We retrospectively reviewed patients who underwent endovascular embolisation for RSH from January 2013 to March 2016 in a regional hospital in Hong Kong.
Results: Six women aged 55 to 93 (mean, 76) years underwent endovascular embolisation after conservative management for RSH had failed. All were prescribed anticoagulants. Clinical presentations included the presence of an abdominal mass, acute abdominal pain, and hypotension, as well as haemoglobin drop of ≥3 g/dl, haemodynamic instability, and persistent active bleeding. Computed tomographic angiography confirmed a large RSH with contrast extravasation in all patients. Digital subtraction angiography (DSA) demonstrated contrast extravasation from the inferior epigastric artery (n = 4) and superior epigastric artery (n = 1) in four patients. The affected arteries were accessed by retrograde placement of a 5-Fr arterial sheath, and cannulated by a Cobra-I catheter (5 Fr or 4 Fr) over a hydrophilic guidewire. The inferior epigastric artery (n = 6) and superior epigastric artery (n = 1) were superselectively cannulated using a microcatheter to enable more precise
dispersion of embolic agents. DSA was performed at the external iliac artery and inferior epigastric artery ipsilateral to the side of RSH. The embolic agents used were platinum microcoils (n = 1) and polyvinyl alcohol particles (n = 5). All patients achieved haemostasis with stabilisation of haemodynamic status and haemoglobin level, and absence of contrast extravasation. Two patients had endovascular-related complications: one sustained injury to the left inferior epigastric artery and was treated with coil embolisation; another developed haematoma around the puncture site 9 days later and was treated with surgical ligation of the feeding artery. Both patients were eventually discharged. One patient died from severe pneumonia complicated with myocardial infarction.
Conclusion: Endovascular embolisation is a safe and effective option for severe RSH in which conservative treatment has failed.
Authors' affiliation:
JHM Cheng, FKY Cho, WKW Leung, WK Kan
Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
中文摘要
血管內栓塞治療腹直肌鞘膜血腫
鄭希敏、曹君彥、梁錦榮、簡偉權
目的：回顧經血管內栓塞治療腹直肌鞘膜血腫（RSH）的患者。
方法：我們回顧分析2013年1月至2016年3月期間接受血管內栓塞治療RSH患者的治療結果。
結果：6名年齡在55至93歲（平均76歲）的女性在保守治療RSH失敗後接受血管內栓塞治療。他們全服用抗凝血藥。臨床表現包括腹部腫塊、急腹痛、低血壓、血紅蛋白下降≥3g / dl、血流不穩定和持續活躍出血。CT血管造影證實有大量RSH，併有造影劑外滲。數字減影血管造影（DSA）顯示下腹壁動脈（n = 4）和上腹壁動脈（n = 1）有造影劑外滲。通過逆行放置5-Fr動脈鞘進入受累的動脈，並通過親水性導絲在Cobra-I導管（5 Fr 或 4 Fr）上插管。將下腹壁動脈（n = 6）和上腹壁動脈（n = 1）用微導管超選擇性插管，以使栓塞劑更精確地注入。DSA在髂外動脈和下腹壁動脈的同側進行。所使用的栓塞劑是鉑微線圈（n = 1）和聚乙烯醇顆粒（n = 5）。所有患者成功止血，血流狀態和血紅蛋白水平穩定，沒有造影劑外滲。兩名患者有血管內相關併發症：一位患者左下腹壁動脈損傷並接受線圈栓塞治療；另一位患者9天後在穿刺部位出現血腫並接受手術結紮供血動脈。兩名病人最終出院。另一位患者因重症肺炎合併心肌梗死死亡。
結論：對於保守治療失敗的嚴重RSH，血管內栓塞是一種安全且有效的選擇。