To evaluate the outcome of transcatheter arterial embolization with gelatin sponge
particles, microcoils, and N-butyl cyanoacrylate (NBCA) for acute arterial hemorrhage
in the setting of coagulopathy.
Coagulopathy is defined by a platelet count less than 5 x 10(4)/microL and/or International
Normalized Ratio (INR) greater than 1.5. Forty-six patients (31 male patients; mean
age, 62 years) with acute arterial hemorrhage in a coagulopathic condition were treated
by transcatheter arterial embolization with gelatin sponge particle, microcoils, and
NBCA.
Because of failure of hemostasis or recurrent hemorrhage, 10 patients who underwent
gelatin sponge particle embolization also received transcatheter arterial embolization
with microcoils or NBCA embolization and two patients who underwent microcoil embolization
also received transcatheter arterial embolization with NBCA. The gelatin sponge particle
group consisted of 27 hemorrhagic arteries in 25 patients, the microcoil group had
20 in 20 patients, and the NBCA group had 16 in 13 patients. The mean platelet count
and mean INR value were 5.8 x 10(4)/microL +/- 3.5 and 1.81 +/- 0.50, respectively.
The primary hemostatic rate, recurrent hemorrhage rate, and mean treatment time for
the gelatin sponge particle, microcoil, and NBCA groups were 67%, 23%, and 25 minutes
+/- 10; 80%, 0%, and 37 min +/- 19; and 100%, 0%, and 9 min +/- 4, respectively. Primary
and secondary hemostasis were achieved in 50 (80%) and 60 (95%) of the 63 hemorrhagic
arteries, respectively. Three hemorrhagic arteries in which transcatheter arterial
embolization failed were treated with surgical repair.
Although transcatheter arterial embolization with microcoils took a greater amount
of time, transcatheter arterial embolization with NBCA or microcoils was more effective
and feasible than that with gelatin sponge particle in terms of hemostasis and prevention
of recurrent hemorrhage in a coagulopathic condition.