Angiographic embolization in the treatment of intrahepatic arterial bleeding in patients with blunt abdominal trauma

BACKGROUND: Angiographic embolization (AE) as an adjunct non-operative treatment of intrahepatic arterial bleeding has been widely used. The present study aimed to evaluate the efficacy of selective AE in patients with hepatic trauma.METHODS: Seventy patients with intrahepatic arterial bleeding after blunt abdominal trauma who had undergone selective AE in 10 years at this institution were retrospectively reviewed.The criteria for selective AE included active extravasation on contrast-enhanced CT, an episode of hypotension or a decrease in hemoglobin level during the non-operative treatment. The data of the patients included demographics,grade of liver injuries, mechanism of blunt abdominal trauma,associated intra-abdominal injuries, indications for AE,angiographic findings, type of AE, and AE-related hepatobiliary complications. RESULTS: In the 70 patients, 32 (45.71%) had high-grade liver injuries. Extravazation during the early arterial phase mainly involved the right hepatic segments. Thirteen (18.57%) patients underwent embolization of intrahepatic branches and the extrahepatic trunk and these patients all developed AE-related hepatobiliary complications. In 19 patients with AE-related complications, 14 received minimally invasive treatment and recovered without severe sequelae. CONCLUSIONS: AE is an adjunct treatment for liver injuries.Selective and/or super-selective AE should be advocated to decrease the incidence and severity of AE-related hepatobiliary complications.

Subclavian Arterial Bleeding during Permanent Pacemaker Implantation: Clinical Case Report and Literature Review

Research objective: To study a clinical case that had a complication of subclavian artery bleeding during permanent pacemaker implantation process. Subject and Method: Clinical case report and literature review. Study of a patient had an indication for permanent pacemaker implantation who had complication of subclavian artery bleeding during the procedure. Result: An 84-year-old female patient was admitted to the hospital because of fainting spells with chest pain, on the background of dangerous complex arrhythmias and ischemic heart disease, and was prescribed a pacemaker for this patient. The patient had complication occurred during the procedure, which left subclavian artery bleeding was detected and treated promptly, a cardiac pacemaker was implanted on the right side of the chest, and the patient had a successful endovascular stent cover in the left subclavian artery. Conclude: Subclavian artery bleeding is a rare complication in the procedure of permanent pacemaker implantation, but it can still occur and requires quick detection and timely treatment, needs to be successful in cardiac pacemaker placement and subclavian artery drug-eluting stent cover placement intervention. Individualized patient risk assessment is needed;appropriate and standardized intervention techniques and experience can reduce the occurrence of this variable.

Transcatheter Arterial Embolization as a Treatment for Life-Threatening Retroperitoneal Hemorrhage in COVID-19 Patients on Anticoagulant Therapy

Retroperitoneal hemorrhage is a possible complication that has been noticed in COVID-19 patients on anticoagulant therapy. The data related to treatment and outcomes in this condition are scarce. We present a case series of four COVID-19 patients with lumbar artery bleeding, who were treated with transcatheter arterial embolization using embolization particles. The procedure was executed without any complications, and hemostasis was achieved in all four patients. Despite the patients survived the procedure, one patient died due to respiratory failure three weeks after the procedure, and one died due to hypovolemic shock two days later. Considering the ongoing state of COVID-19 pandemic, it is essential to be aware of transcatheter arterial embolization as a safe and effective procedure for treating retroperitoneal hemorrhage in COVID-19 patients.

A mussel-inspired supramolecular hydrogel with robust tissue anchor for rapid hemostasis of arterial and visceral bleedings

In recent years,the developed hemostatic technologies are still difficult to be applied to the hemostasis of massive arterial and visceral hemorrhage,owing to their weak hemostatic function,inferior wet tissue adhesion,and low mechanical properties.Herein,a mussel-inspired supramolecular interaction-cross-linked hydrogel with robust mechanical property(308.47±29.20 kPa)and excellent hemostatic efficiency(96.5%±2.1%)was constructed as a hemostatic sealant.Typically,we combined chitosan(CS)with silk fibroin(SF)by cross-linking them through tannic acid(TA)to maintain the structural stability of the hydrogel,especially for wet tissue adhesion ability(shear adhesive strength=29.66±0.36 kPa).Compared with other materials reported previously,the obtained CS/TA/SF hydrogel yielded a lower amount of blood loss and shorter time to hemostasis in various arterial and visceral bleeding models,which could be ascribed to the synergistic effect of wound closure under wet state as well as intrinsic hemostatic activity of CS.As a superior hemostatic sealant,the unique hydrogel proposed in this work can be exploited to offer significant advantages in the acute wound and massive hemorrhage with the restrictive access of therapeutic moieties.

A case of agnogenic intrahepatic arterioportal fistula complicated by gastric ulcer bleeding and progressive portal thrombosis

Arterioportal fistulas(APFs)are defined as vascular communications between the systemic arteries and portal circulation.APFs are classified as congenital or acquired,large or small,intrahepatic or extrahepatic,and traumatic or spontaneous.The consistent abnormal connection may result in severe presinusoidal portal hypertension,leading to gastrointestinal bleeding(GIB),ascites,elevated liver function enzymes,heart failure,diarrhea,and even pancreatitis or hematobilia in some unusual cases.Indeed,less than half reported cases have GIB,predominately caused by variceal rupture.Peptic ulcer bleeding has rarely been reported in the setting of APFs.Herein,we describe a case in which intrahepatic APF manifested as gastric ulcer bleeding,progressive portal thrombosis,and massive ascites,with these symptoms successfully relieved by endovascular treatment.

Bleeding from thermistor connector indicates entrapment of pulmonary artery catheter

Several complications of insertion and use of pulmonary artery catheter （PAC）, including catheter entrapment, are recognized during or after cardiac surgery. Early detection is very important. We report a case of PAC entrapment because the the catheter was accidentally su- tured to the superior vena cava. Bleeding from the thermistor connector was initially detected after surgery because the needle punctured the lumen of thermistor connector. The PAC was removed through re-exploration. Therefore, bleeding from the thermistor connector could early indicate the PAC entrapment. We suggest that abnormal bleeding from the non-injectate lumen ports of PAC should be checked before sternal closure.