Hemostatic Embolization: Hemostasis Embolization: Experience of the Radiology Department of Marrakech

Background: Hemostatic embolization, a rapidly developing interventional radiology technique, is an integral part of the therapeutic arsenal, contributing to the multidisciplinary management of various pathologies. Its use is specifically dedicated to the treatment of hemorrhagic syndromes. The objective of this work is to share the experience of our radiology department on the hemostasis embolization technique, highlighting its varied indications, describing the necessary equipment and exposing the technical steps, while evaluating its effectiveness at from the results obtained.

Educational Points: This is a retrospective and prospective study involving 60 patients who underwent 65 hemostasis embolization sessions between March 1, 2019 and October 16, 2023, performed in the Radiology Department of Mohamed VI University Hospital of Marrakech. The average age of the patients was 36.7 years, with a M/F sex ratio of 1.14.. The indications for hemostasis embolization were diverse, with a predominance of hemoptysis (23.3%), epistaxis (11.7%), metrorrhagia (10%), hematuria (6.7% each), as well as digestive bleeding and pelvic trauma (5% each). Radiologically, all patients benefited from prior morphological exploration by CT angiography, depending on each indication, allowing precise radiological characterization of the lesions to be treated. All hemostasis embolization procedures were decided after multidisciplinary discussion, verification of morphological assessment, and preanesthetic consultation. All interventions were performed in the presence of the anesthesia-resuscitation team. During the embolization sessions, the equipment used included an 18G gauge needle with or without Teflon, a 0.035” hydrophilic guide, and different types of catheters, mainly the Cobra catheter (GLIDECATH). Various embolization agents were administered, such as resorbable agents (33.3% of cases), nonresorbable microparticles (63.3%), coils and microcoils (18.3%), and biological glue (Glubran 2, 11.7%). Complications were known in 4 of our patients (death of a child immediately post-embolization following sudden hemoptysis, death of a woman 2 days after embolization of a splenic AVM probably due to rupture of the latter, death of a patient following peritonitis on postoperative day 3, rebleeding on third hour of uterine embolization for placenta percreta). The evaluation of response to treatment was based on clinical criteria such as cessation of bleeding, biological parameters including control of hemoglobin level after embolization, and intraoperative observations for patients scheduled for surgery. Among the patients undergoing emergency procedures, bleeding stopped in all cases, and of the 20 patients operated on, 18 (i.e., 90%) had minimal preoperative bleeding, while 2 patients (i.e., 10%) experienced moderate bleeding intraoperatively. For patients scheduled for surgery, complete devascularization of hemorrhagic foci was observed. Recent advances in the field of interventional radiology seek to expand the applications of this type of treatment, thus transforming hemostasis embolization into much more than a first-line palliative alternative. The objective is to position it as an effective curative treatment for a varied range of pathologies.

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Artikel online veröffentlicht:
02. April 2024