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Radiology. 2019 Jan 8:181187. doi: 10.1148/radiol.2018181187. [Epub ahead of print]

Predictors of Mortality from Spontaneous Soft-Tissue Hematomas in a Large Multicenter Cohort Who Underwent Percutaneous Transarterial Embolization.

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1
From the Department of Abdominal and Interventional Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, APHP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France (M.B., P.S., A.D.); Université Paris Descartes, Sorbonne Paris-Cité-Paris V, Paris, France (M.B., P.S., A.D.); Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hopitaux de Paris, APHP, Paris, France (O.P., M.S.); and Department of Interventional Radiology, McGill University Health Centre, Montréal, Canada (V.T.T., B.G., L.M.B., D.V.).

Abstract

Purpose To evaluate the safety and efficacy of percutaneous transarterial embolization (PTAE) for the treatment of spontaneous soft-tissue hematomas (SSTHs) and identify variables predictive of short-term outcome. Materials and Methods Between 2011 and 2017, the outcome was retrospectively analyzed for 112 patients (mean age ± standard deviation, 72 years ± 14; range, 28-92 years), including 65 women (mean age, 73 years ± 12.7; range, 39-92 years) and 47 men (mean age, 70 years ± 14.9; range, 28-91 years), with SSTH treated with PTAE. Thirty-day mortality, technical and clinical success, simplified acute physiology score (SAPS) II, anticoagulation, embolic agent, hematoma volume and location, serum hemoglobin level, hemodynamic instability, and presence of active bleeding at CT and/or angiography were recorded. Clinical success was defined as cessation of bleeding as determined by hemodynamic stability and/or serum hemoglobin level stabilization after PTAE. Univariable and multivariable analyses were performed by using a Cox model to identify variables associated with time to death. Results Mortality rate was 26.8% (30 of 112 patients), angiographic success rate was 95.5% (107 of 112 patients), and clinical success rate was 83% (93 of 112 patients). For surviving patients, mean SAPS II was 19.6 ± 7.1 (range, 13-31) and mean hematoma volume was 862 cm3 ± 618 (range, 238-1887 cm3). For deceased patients, mean SAPS II was 42 ± 13.2 (range, 18-63) and mean hematoma volume was 1419 cm3 ± 788 (range, 251-3492 cm3). SAPS II (P < .001), hematoma volume (P = .01), and retroperitoneal location (P = .01) were independently associated with fatal outcome. Conclusion Percutaneous transarterial embolization is effective for the emergency treatment of spontaneous soft-tissue hematomas. Simplified acute physiology score II, hematoma volume, and retroperitoneal location are predictors of short-term outcome.

PMID:
30620252
DOI:
10.1148/radiol.2018181187

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