Transcatheter Arterial Embolization of Concurrent Spontaneous Hematomas of the Rectus Sheath and Psoas Muscle in Patients Undergoing Anticoagulation

Abstract

We report a case of concurrent rectus sheath and psoas hematomas in a patient undergoing anticoagulant therapy, treated by transcatheter arterial embolization (TAE) of inferior epigastric and lumbar arteries. Computed tomography (CT) demonstrated signs of active bleeding in two hematomas of the anterior and posterior abdominal walls. Transfemoral arteriogram confirmed the extravasation of contrast from the right inferior epigastric artery (RIEA). Indirect signs of bleeding were also found in a right lumbar artery (RLA). We successfully performed TAE of the feeding arteries. There have been few reports in the literature of such spontaneous hemorrhages in patients undergoing anticoagulation, successfully treated by TAE.

Spontaneous soft tissue hematomas

“…It has the advantage of being less invasive and selective [12]. Technical and clinical success rates are 75 to 100% and 57 to 69%, respectively, depending on the series.…”

“…If hemodynamic instability is present in these cases it is usually due to another associated traumatic visceral or bone lesion. However, unlike traumatic hematomas, SMH occurs in patients being treated by anticoagulants and with several comorbidities [12,18,21]. Hematomas, especially when they are voluminous, can be the site of active bleeding in these fragile patients, and they may not spontaneously resolve.…”

“…It is based on a multifactorial microangiopathy [8]. The risk factors include hemostatic disorders, age, atheromatosis, vascular lesions from chronic arterial hypertension, and especially diabetes [3,11,12]. Furthermore, a genuine anticoagulant-induced immune microangiopathy has been reported to be a predisposing factor [11].…”

Emergency Endovascular Hemostatic Technique Using N-butyl Cyanoacrylate for Retroperitoneal Hematoma Caused by Inferior Epigastric Artery Injury after Undergoing Catheter Ablation for Atrial Fibrillation: A Case Report

“…[4][5][6] As far as we searched in MEDical Literature Analysis and Retrieval System Online (MEDLINE), 19 published reports of 56 iatrogenic IEA injuries treated by EVT were identified between January 1965 and July 2016 ( Table 1). [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] to avoid adherence of the catheter to the glue, and the catheter should be retrieved with aspiration after the injection.…”

A Conservative Approach to Rectus Sheath Haematomas

“…The mortality rate of the surgical intervention done in case of the failure of conservative treatment is high (1). When surgery becomes obligatory, the haematoma must be drained and the bleeding epigastric vessels must be ligated (14,15). Arterial embolization can be conducted by locating the bleeding vessel via transfemoral catheterization and embolizing it (15).…”