Embolization for multicompartmental bleeding in patients in hemodynamically unstable condition: prognostic factors and outcome.

Détails

ID Serval
serval:BIB_08CD3E6CD7BA
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Embolization for multicompartmental bleeding in patients in hemodynamically unstable condition: prognostic factors and outcome.
Périodique
Journal of Vascular and Interventional Radiology
Auteur⸱e⸱s
Bize P.E., Duran R., Madoff D.C., Golliet-Mercier N., Heim C., Pilleul F., Demartines N., Denys A.
ISSN
1535-7732 (Electronic)
ISSN-L
1051-0443
Statut éditorial
Publié
Date de publication
2012
Volume
23
Numéro
6
Pages
751-760.e4
Langue
anglais
Notes
Publication types: Journal ArticlePublication Status: ppublish
Résumé
PURPOSE: To determine prognostic factors and evaluate outcomes of transcatheter arterial embolization in severely injured patients in hemodynamically unstable condition with multicompartmental bleeding.¦MATERIALS AND METHODS: Between June 2000 and May 2008, 36 consecutive patients treated with transcatheter arterial embolization for major retroperitoneal bleeding associated with at least one additional source of bleeding were retrospectively reviewed. Mean Injury Severity Score (ISS) was 49.4 ± 15.8. Univariate and multivariate analyses were performed to identify parameters associated with failure of embolization, need for additional surgery to control bleeding, and fatal outcome at 30 d.¦RESULTS: Embolization was technically successful in 35 of 36 patients (97.2%) and resulted in immediate and sustained (> 24 h) hemodynamic improvement in 29 (80.5%). Additional hemostatic surgery was necessary after embolization in six patients (16.6%). Fifteen patients (41.6%) died within 30 d. Failure to restore hemodynamic stability was correlated with the rate of administration of packed red blood cells (P = .014), rate of administration of fresh frozen plasma (FFP; P = .031), and systolic blood pressure (SBP) immediately before embolization (P = .002). The need for additional surgery was correlated with FFP administration rate before embolization (P = .0002) and hemodynamic success (P = .003). Death was correlated with Glasgow Coma Scale score at admission (P = .001), ISS (P = .014), New Injury Severity Score (P = .016), number of injured sites (P = .012), SBP before embolization (P = .042), need for vasopressive drugs before embolization (P = .037), and hemodynamic success (P = .0004).¦CONCLUSIONS: In patients in hemodynamically unstable condition, transcatheter arterial embolization effectively controls bleeding and improves hemodynamic stability. Immediate survival is related to hemodynamic condition before embolization, and 30-d mortality is mainly related to associated brain trauma.
Pubmed
Web of science
Création de la notice
10/05/2012 14:47
Dernière modification de la notice
20/08/2019 12:31
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