title: Intra-arterial treatment for massive subcutaneous hemorrhage in hemodialysis patients.
abstract: The incidence of acute massive hemorrhage in hemodialysis (HD) patients is thought to be higher than in healthy individuals, and a large, expanding subcutaneous hematoma can result in necrosis of the overlying skin. We evaluated the efficacy of intra-arterial treatment for acute massive subcutaneous hemorrhage in HD patients. Seven HD patients with subcutaneous hemorrhage following minor blunt trauma were treated using superselective transarterial embolization, between July 2005 and October 2012. After examining the site of the hemorrhage using contrast-enhanced computed tomography (CT), embolizations were performed using microcoils, gelatin sponges, or N-butyl cyanoacrylate. Hematoma evacuation or skin grafting was performed as needed. Four men and three women with a mean age of 70 years (range, 63-82 years) comprised the study population. Sites of bleeding were as follows: lower leg (N = 3), upper leg (N = 1), buttock (N = 1), precordia (N = 1), and forearm (N = 1). Blood transfusions were administered to five cases. All patients were successfully salvaged using transarterial embolization. Six patients underwent hematoma evacuation after transarterial embolization, and two patients underwent split-thickness skin grafting for skin necrosis. We established a treatment strategy for HD patients with acute subcutaneous hemorrhage. Immediate confirmation of the site and the degree of bleeding with contrast-enhanced CT and early treatment using the transarterial embolization and as needed, hematoma evacuation are effective for preventing skin necrosis in HD patients with acute subcutaneous hemorrhage.
authors.affiliation: Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Banshodani
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawanishi
authors.forename: Misaki
authors.initials: M
authors.lastname: Moriishi
authors.forename: Sadanori
authors.initials: S
authors.lastname: Shintaku
authors.forename: Tomoyasu
authors.initials: T
authors.lastname: Sato
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Tsuchiya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D016038:Skin Transplantation / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications
keywords: Hematoma evacuation; Hemodialysis; Interventional radiology; Intra-arterial treatment; Subcutaneous hemorrhage; Transarterial embolization