Background: critically ill patients with SARS-CoV-2 infection present a hypercoagulable condition. Anticoagulant therapy is currently recommended to reduce thrombotic risk, leading to potentially severe complications like spontaneous bleeding (SB). Percutaneous transcatheter arterial embolization (PTAE) can be life-saving in critical patients, in addition to medical therapy. We report a major COVID-19 Italian Research Hospital experience during the pandemic, with particular focus on indications and technique of embolization. Methods: We retrospectively included all subjects with SB and with a microbiologically confirmed SARS-CoV-2 infection, over one year of pandemic, selecting two different groups: (a) patients treated with PTAE and medical therapy; (b) patients treated only with medical therapy. Computed tomography (CT) scan findings, clinical conditions, and biological findings were collected. Results: 21/1075 patients presented soft tissue SB with an incidence of 1.95%. 10/21 patients were treated with PTAE and medical therapy with a 30-days survival of 70%. Arterial blush, contrast late enhancement, and dimensions at CT scan were found discriminating for the embolization (p < 0.05). Conclusions: PTAE is an important tool in severely ill, bleeding COVID-19 patients. The decision for PTAE of COVID-19 patients must be carefully weighted with particular attention paid to the clinical and biological condition, hematoma location and volume.
HighlightsRuptured pancreaticoduodenal artery aneursym is a very rare but potentially catastrophic occurence in an emergency department and its treatment is challenging.Very few cases of emergency endovascular treatment of ruptured visceral aneursyms are reported in the literature.This case report has the intention to elucidate in pancreaticodudoenal artery aneursym the importance of collateral vessels that could feed the aneurysm sac even after embolization of the inflow and outflow of the aneurysm.
DESCRIPTIONSuccessful embolisation of an abnormal ovarian artery (OAE) feeding a fundal uterine fibroid is rarely reported.A 50-year-old woman presented with vaginal bleeding and anaemia. Ultrasound and MRI showed a single large fundal subserosal fibroid. CA 19.9, CEA, CA 125 and LDH were normal. Aortic angiography showed an exclusive supply to a leiomyoma from a hypertrophic right ovarian artery. No feeding from the uterine artery was observed. A microcatheter was inserted to the mid-third of the ovarian artery. Tris-acryl gelatin microspheres, 700-900 mm (embosphere microsphere) were injected until near-stasis was achieved. A bilateral uterine angiogram confirmed no additional vascular supply to the leiomyoma (figure 1). The fibroid volume decreased by 30%, according to MRI over 3 months. Fibroids usually derive their blood supply from the uterine artery, but vascularisation from the ovarian artery is possible.1 Blood supply to uterine fibroids can also originate from an aortoiliac haemorrhoidal artery or from distal branches of the inferior mesenteric. Uterine artery embolisation (UAE) is a widely accepted treatment for uterine fibroids and ovarian function seems to be unaffected by the procedure.2 Compared with UAE alone, the addition of OAE to UAE neither appear to precipitate the onset of menopause nor increase menopausal symptom severity. 3 The predominant flow to the peri-fibroid plexus can possibly lead to a targeted embolisation, avoiding damage to the ovary using larger particles (700-900 embospheres).
Learning points▸ Large fundal uterine fibroids can have an exclusive ovarian artery supply. ▸ An isolated ovarian artery embolisation (OAE) can be successful with no need to repeat procedures or necessity of an associated uterine artery embolisation. ▸ In our case, ovarian function was preserved after exclusive OAE.
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