Transcatheter Arterial Embolization (TAE) in the Management of Bleeding in the COVID-19 Patient
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Treatment
2.3. Outcomes and Definitions
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Variables | All Patients (n = 73) |
---|---|
Age (years) | 65.8 (±15.4) |
Sex (M/F) | 48 (65.8%)/25 (34.2%) |
BMI | 26 (±3.6) |
eGFR (mL/min) | 66.4 (±25) |
CKD Stage | 2 (1–3) |
INR | 1.3 (±0.3) |
aPTT (s) | 37.5 (±4.9) |
PT (s) | 13.9 (±2.6) |
D-Dimer (mg/L) | 1.2 (±0.7) |
Fibrinogen (g/L) | 1.9 (±0.6) |
Platelet count (No. ×103/μL) | 367.4 (±99) |
Coagulopathy (no/yes) | 29 (39.7%)/44 (60.3%) |
Hemoglobin (g/dL) | 7.7 (±0.8) |
CT-angiography execution | 69 (94.5%) |
Bleeding on CT-angiography | 69 (94.5%) |
Hematoma volume (mL) | 356.2 (±309.4) |
Antiplatelet therapy | 12 (16.4%) |
| 9 (12.3%) |
| 3 (4.1%) |
Anticoagulant therapy | 47 (64.4%) |
Antiplatelet AND Anticoagulant therapy | 1 (1.4%) |
Antiplatelet OR Anticoagulant therapy | 57 (78.1%) |
Variables | All Patients (n = 73) |
---|---|
Bleeding on XA | 72 (98.6%) |
Blind embolization | 1 (1.4%) |
Site of bleeding | |
| 9 (12.3%) |
| 1 (1.4%) |
| 2 (2.8%) |
| 49 (67.1%) |
| 8 (11%) |
| 2 (2.7%) |
| 2 (2.7%) |
Number of embolized vessels | 1.2 (±0.5) |
Cause of the bleeding | |
| 18 (24.7%) |
| 46 (63.0%) |
| 9 (12.3%) |
Embolic agent | |
| 41 (56.2%) |
| 16 (21.9%) |
| 12 (16.4%) |
| 2 (2.75%) |
| 2 (2.75%) |
Intraoperative unfractionated heparin (IU) | |
| 67 (91.8%) |
| 4 (5.5%) |
| 2 (2.7%) |
Intraoperative contrast medium (mL) | 35.3 (±9.5) |
Volume of contrast to creatinine clearance ratio | 0.7 (±0.6) |
Vascular access site | |
| 54 (74%) |
| 16 (21.9%) |
| 3 (4.1%) |
Sheath diameter, 4F/5F/6F/≥7F | 9 (12.3%)/59 (80.8%)/5 (6.8%)/0 (0%) |
Angiography injection technique (manual/powered) | 40 (54.8%)/33 (45.2%) |
CT-to-groin time (min) | 41.8 (±48.9) |
Procedure time (min) | 28.3 (±8.4) |
CT-to-embolization time (min) | 70.1 (±48.8) |
Fluoroscopy time (min) | 7.7 (±3) |
Cumulative air kerma (mGy) | 162 (±60.8) |
Dose area product (DAP) (Gy/cm2) | 25.4 (±9.5) |
Variables | All Patients (n = 73) |
---|---|
Technical success | 73 (100%) |
Clinical success | 67 (91.8%) |
Vascular access site hemostasis | |
| 68 (93.2%) |
| 5 (6.8%) |
Units of packed red blood cells transfused per patient | 1 (±0.6) |
Rebleeding | 6 (8.2%) |
Non-target embolization | 0 (0%) |
Complications | 13 (17.8%) |
Vascular access-site complications (VASCs) | 4 (5.5%) |
Complications, according to SIR classifications | |
| 60 (82.2%) |
| 10 (13.7%) |
| 3 (4.1%) |
Complications, according to CIRSE classification | |
| 60 (82.2%) |
| 11 (15.1%) |
| 2 (2.7%) |
Treatment required for complications | |
| 60 (82.2%) |
| 8 (11.0%) |
| 5 (6.8%) |
| 0 (0%) |
30-day bleeding-related mortality | 2 (2.7%) |
Variables | Group 1 (n = 44) Patients with Coagulopathy | Group 2 (n = 29) Patients without Coagulopathy | p Value |
---|---|---|---|
BMI | 25.8 (±3.2) | 26.1 (±3.9) | 0.5856 |
INR | 1.4 (±0.3) | 1.1 (±0.1) | <0.0001 |
D-Dimer (mg/L) | 1.7 (±0.2) | 0.4 (±0.2) | <0.0001 |
Platelet count (No. ×103/μL) | 344.7 (±119.9) | 401.8 (±33.2) | 0.0543 |
Anticoagulant therapy | 43 (97.7%) | 4 (13.8%) | <0.0001 |
Hematoma volume (mL) | 417.5 (±285.1) | 206.2 (NA) | 0.0001 |
Cause of the bleeding | <0.0001 | ||
| 44 (100%) | 2 (6.9%) | |
| 0 (0%) | 27 (93.1%) | |
CT-to-groin time (min) | 51.1 (±58.5) | 25.4 (NA) | 0.0316 |
Procedure time (min) | 28.2 (±9.3) | 28.4 (±7) | 0.7432 |
Fluoroscopy time (min) | 7.5 (±3) | 7.9 (±2.9) | 0.7236 |
Technical success | 44 (100%) | 29 (100%) | 1 |
Clinical success | 41 (93.2%) | 26 (97.8%) | 0.6762 |
Rebleeding | 41 (93.2%) | 26 (89.6%) | 0.6762 |
Complications | 6 (13.6%) | 7 (24.1%) | 0.3499 |
30-day bleeding-related mortality | 1 (2.3%) | 1 (3.4%) | 1 |
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Minici, R.; Fontana, F.; Venturini, M.; Guzzardi, G.; Siciliano, A.; Piacentino, F.; Serra, R.; Coppola, A.; Guerriero, P.; Apollonio, B.; et al. Transcatheter Arterial Embolization (TAE) in the Management of Bleeding in the COVID-19 Patient. Medicina 2023, 59, 1062. https://doi.org/10.3390/medicina59061062
Minici R, Fontana F, Venturini M, Guzzardi G, Siciliano A, Piacentino F, Serra R, Coppola A, Guerriero P, Apollonio B, et al. Transcatheter Arterial Embolization (TAE) in the Management of Bleeding in the COVID-19 Patient. Medicina. 2023; 59(6):1062. https://doi.org/10.3390/medicina59061062
Chicago/Turabian StyleMinici, Roberto, Federico Fontana, Massimo Venturini, Giuseppe Guzzardi, Agostino Siciliano, Filippo Piacentino, Raffaele Serra, Andrea Coppola, Pasquale Guerriero, Biagio Apollonio, and et al. 2023. "Transcatheter Arterial Embolization (TAE) in the Management of Bleeding in the COVID-19 Patient" Medicina 59, no. 6: 1062. https://doi.org/10.3390/medicina59061062
APA StyleMinici, R., Fontana, F., Venturini, M., Guzzardi, G., Siciliano, A., Piacentino, F., Serra, R., Coppola, A., Guerriero, P., Apollonio, B., Santoro, R., Team, M. R., Brunese, L., & Laganà, D. (2023). Transcatheter Arterial Embolization (TAE) in the Management of Bleeding in the COVID-19 Patient. Medicina, 59(6), 1062. https://doi.org/10.3390/medicina59061062