title: Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms.
abstract: OBJECTIVE
  To assess the role and effectiveness of percutaneous arterial embolization (TAE) in patients with hemodynamic instability due to hypovolemic shock secondary to ruptured splanchnic artery pseudoaneurysms (SAPA).
  
  
  METHODS
  Seventeen patients (11 men, 6 women; mean age, 53 years) with hemodynamic instability (systolic blood pressure <90 mmHg) due to hypovolemic shock secondary to ruptured SAPA were treated by TAE. Clinical files, multidetector row computed tomography angiography, and angiographic examinations along with procedure details were reviewed.
  
  
  RESULTS
  Seventeen SAPAs were present, predominantly located on gastroduodenal or pancreatic arteries (9/17; 53%). Angiography showed extravasation of contrast medium from SAPA in 15/17 patients (88%). Technical success rate of TAE was 100%. TAE was performed using metallic coils in all patients (100%), in association with gelatin sponge in 5/17 patients (29%). TAE allowed controlling the bleeding and returning to normal hemodynamic status in 16/17 patients (94%). In 1/17 patient (6%), surgery was needed to definitively control the bleeding. The mortality and morbidity rate of TAE at 30 days were 0 and 12%, respectively. Morbidity consisted in coil migration in 1/17 patient (6%) and transient serum liver enzyme elevation in 1/17 patient (6%).
  
  
  CONCLUSIONS
  TAE is an effective and safe treatment option for ruptured SAPA in hemodynamically unstable patients, with a success rate of 94%. Our results suggest that TAE should be the favored option in patients with hemodynamic instability due to ruptured SAPA.
authors.affiliation: Department of Abdominal and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France, anthony.dohan@lrb.aphp.fr.
authors.forename: Anthony
authors.initials: A
authors.lastname: Dohan
authors.forename: Clarisse
authors.initials: C
authors.lastname: Eveno
authors.forename: Raphael
authors.initials: R
authors.lastname: Dautry
authors.forename: Youcef
authors.initials: Y
authors.lastname: Guerrache
authors.forename: Marine
authors.initials: M
authors.lastname: Camus
authors.forename: Mourad
authors.initials: M
authors.lastname: Boudiaf
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.forename: Olivier
authors.initials: O
authors.lastname: Le Dref
authors.forename: Marc
authors.initials: M
authors.lastname: Sirol
authors.forename: Philippe
authors.initials: P
authors.lastname: Soyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D015331:Cohort Studies; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging*; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology / Q000503:physiopathology; D013152:Splanchnic Circulation; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media