020 - Outcomes of Patients with Posttraumatic Bleeding Treated with Selective Transcatheter Arterial nBCA Liquid Embolization
Raghuram Posham, MD – Chief resident-IR, Mount Sinai Hospital; Vivian Bishay, MD – MD, Mount Sinai Hospital; Robert Lookstein, MD – MD, Mount Sinai Hospital; Scott Nowakowski, MD – MD, Mount Sinai Hospital; Rajesh Patel, MD – MD, Mount Sinai Hospital; Aaron Fischman, MD – MD, Mount Sinai Hospital
Purpose: Transcatheter arterial embolization (TAE) is a useful endovascular technique for controlling hemorrhage in posttraumatic bleeding. However, there is limited data showing that N-butyl-2-cyanoacrylate (NBCA) alone is safe and effective for controlling hemorrhage in the setting of trauma. The purpose of this study is to assess 30-day clinical outcomes of selective transcatheter arterial embolization (TAE) with nBCA glue for patients with posttraumatic bleeding.
Material and Methods: Retrospective review was performed of patients who underwent selective TAE with nBCA for posttraumatic bleeding from 2010-2021 at a single center. Procedural and clinical details including location of bleed, etiology of bleed, nBCA concentration used, and presence of coagulopathy, were recorded. Technical success (defined as disappearance of angiographic findings of hemorrhage on completion angiography), rebleeding (requiring additional treatment within 30 days of initial embolization), and adverse events (AEs)were recorded.
Results: Nine patients (mean age 58.6 y) with posttraumatic bleeding underwent embolization with nBCA. 7 (78%) patients were men. Lipiodol:nBCA dilution ratio used ranged from 3:1 to 5:1. The bleeding vessels embolized were in the splenic artery (n=2), hepatic artery (n=1), renal artery (n=1),obturator artery (n=1), pancreatic artery (n=1) ,femoral artery (n=1),phrenic artery (n=1) and epigastric artery (n=1). Coagulopathy was present in 2 patients. On an intention to treat basis, technical success (TS) was 100%. There were no embolization related ischemic complications such as end organ infarction, nontarget embolization, or bowel infarction. There was no episodes of rebleeding. One patient had a small post-operative access site hematoma. One patient presented with an evolving liver lesion and had CTA done which showed stable hematoma. He had complete resolution with medical management.
Conclusions: Selective TAE with NBCA liquid embolic in patients with post traumatic bleeding is safe, durable, and effective and warrants further close study.