Successful treatment of severe bleeding in hemophilic target joints by selective angiographic embolization

Mauser‐Bunschoten, Eveline P.; Zijl, Jacco A. C.; Mali, W. P. T. M.; Rinsum, A. C. van; Berg, H. M. Van Den; Roosendaal, G.

doi:10.1182/blood-2004-06-2063

Cited by 40 publications

(59 citation statements)

References 19 publications

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“…In these circumstances, angiographic embolization might be considered as a promising therapeutic and coagulation factor saving option in joint bleeds not responding to replacement of coagulation factor to normal levels [18,19]. It is important to bear in mind that despite its efficacy, arterial embolization is an invasive procedure with a reported rate of complications up to 25% (16% minor, 7% serious, 2% death) [18].…”

Section: Resultsmentioning

confidence: 96%

Pseudoaneurysms in haemophilia

Rodríguez-Merchán

2013

Blood Coagulation &Amp; Fibrinolysis

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The incidence of bleeding as a result of a pseudoaneurysm in haemophilia is very low. The diagnosis should be suspected if the patient has a history of arterial trauma. Pseudoaneurysms can appear anywhere where trauma occurs. This can include arterial access for catheterization, blunt trauma or penetrating trauma. The diagnosis should be confirmed using Duplex ultrasonography, computed tomography (CT) angiogram or conventional angiogram. Many options exist for the treatment of pseudoaneurysms. Although surgery was the gold standard treatment in the past (surgical ligation with or without distal bypass), several less invasive treatment options are popular today. They include covered stent, ultrasound probe compression and ultrasound-guided thrombin injection. So far, only 14 pseudoaneurysms have been reported in patients with haemophilia: nine were located in the musculoskeletal system (four in the hand, four in the knee, one in the ankle), whereas five were non-musculoskeletal. Early diagnosis and treatment of this complication is vital. Endovascular treatment offers a minimally invasive treatment option. If arterial embolization fails to solve the pseudoaneurysm, open vascular surgery with surgical ligation with or without distal bypass should be performed. Whatever the procedure, a correct surgical haemostasis must be achieved by the infusion of factor concentrate (recombinant or plasma-derived) at the right dose and tranexamic acid. The advent of activated prothrombin complex concentrates and recombinant factor VIII (rFVIIa) has made invasive procedures possible in haemophilia patients with high-titre inhibitors.

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Section: Resultsmentioning

confidence: 96%

Pseudoaneurysms in haemophilia

Rodríguez-Merchán

2013

Blood Coagulation &Amp; Fibrinolysis

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“…These are more likely to be arterial instead of synovial bleedings, which may require angiographic embolization for adequate control. 44 …”

Section: Bleeding Patternmentioning

confidence: 99%

How I treat age-related morbidities in elderly persons with hemophilia

Mannucci

Schutgens

Santagostino

et al. 2009

Blood

165

191

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In persons with hemophilia, life expectancy is now approaching that of the general male population, at least in countries that can afford regular replacement therapy with coagulation factor concentrates. The new challenges for comprehensive treatment centers are thus to provide optimal health care for this aging population of patients, who often present not only with the comorbidities typically associated with hemophilia (arthropathy, chronic pain, blood-borne infections), but also with common age-related illnesses such as cardiovascular disease and cancer. There are no evidence-based guidelines for the management of these conditions, which often require drugs that interfere with hemostasis, enhance the bleeding tendency, and warrant more intensive replacement therapy. At the moment, elderly patients with hemophilia affected by other diseases should be managed like their age-group peers without hemophilia, provided replacement therapy is tailored to the heightened risk of bleeding associated with the need for invasive procedures and drugs that further compromise the deranged hemostasis. More detailed advice is provided on the schedules of replacement therapy needed to tackle cardiovascular diseases, such as acute coronary syndromes and nonvalvular atrial fibrillation, because these conditions will become more and more frequent challenges for the comprehensive treatment centers. (Blood. 2009;114: 5256-5263)

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“…A group from Amsterdam has treated 23 cases of massive knee or elbow bleeding in 18 patients by selective arterial catheterization using a micro catheter when an excessive blush, suggesting hyperaemic tissue or ruptured microaneurism, was found on angiography [62]. Embolization was effective in 20 of 23 patients, but rebleeding occurred in seven patients.…”

Section: Angiographic Embolizationmentioning

confidence: 99%

Management of acute haemarthrosis in haemophilia A without inhibitors: literature review, European survey and recommendations

Hermans

Moerloose

Fischer³

et al. 2011

Haemophilia

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Summary. Acute haemarthrosis is a frequent type of bleeding in individuals with haemophilia. Delayed and/or inadequate treatment can trigger a series of pathological changes within the joint, leading to a painful and disabling arthropathy. The early management of intra‐articular bleeding has the potential to prevent chronic joint disease and may include a combination of factor replacement, rest, ice, rehabilitation and, in certain cases, joint aspiration. Little data are, however, available regarding the optimal management of acute haemarthrosis, especially with respect to replacement therapy and the use of adjunctive therapies (aspiration, avoidance of weight bearing and immobilization, as well as the use of anti‐inflammatory medication and embolization). To provide more insight into the management of acute haemarthrosis in patients with haemophilia, a literature review was conducted. Concomitantly, current management was surveyed in 26 European haemophilia comprehensive care centres representing 15 different countries. The review highlights the need for future robust studies to better define the appropriate replacement therapy and the role of adjunctive therapies such as aspiration. The survey reveals much heterogeneity in the management of acute haemarthrosis across the EU. Within the constraints discussed, treatment recommendations are presented that reflect the literature, current practice and the clinical experience of the European Haemophilia Therapy Standardisation Board (EHTSB).

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Successful treatment of severe bleeding in hemophilic target joints by selective angiographic embolization

Cited by 40 publications

References 19 publications

Pseudoaneurysms in haemophilia

Pseudoaneurysms in haemophilia

How I treat age-related morbidities in elderly persons with hemophilia

Management of acute haemarthrosis in haemophilia A without inhibitors: literature review, European survey and recommendations

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