title: Evaluation of transcatheter arterial embolization with gelatin sponge particles, microcoils, and n-butyl cyanoacrylate for acute arterial bleeding in a coagulopathic condition.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8510, Japan.
authors: Takafumi
authors: T
authors: Yonemitsu
authors: Nobuyuki
authors: N
authors: Kawai
authors: Morio
authors: M
authors: Sato
authors: Hirohiko
authors: H
authors: Tanihata
authors: Isao
authors: I
authors: Takasaka
authors: Motoki
authors: M
authors: Nakai
authors: Hiroki
authors: H
authors: Minamiguchi
authors: Shinya
authors: S
authors: Sahara
authors: Yasuhiro
authors: Y
authors: Iwasaki
authors: Yukihiro
authors: Y
authors: Shima
authors: Maki
authors: M
authors: Shinozaki
authors: Toshio
authors: T
authors: Naka
authors: Masahiro
authors: M
authors: Shinozaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006490:Hemostatics