Transcatheter arterial embolization for the treatment of spontaneous bleeding into soft tissues in COVID-19 patients

• Polyaev A.Yu.
• Tyagunov A.E.
• Stradymov E.A.
• Polonsky A.A.
• Trudkov D.Yu.
• Mosin S.V.
• Sazhin A.V.

Abstract

Objective. The aim of our investigation was to evaluate the efficacy and safety of transcatheter arterial embolization for spontaneous soft tissue bleeding in patients with COVID-19.

Material and methods. We retrospectively analyzed the outcomes of treating 60 patients with confirmed COVID-19 and spontaneous hematomas of the abdominal, thoracic wall and retroperitoneal space. All patients underwent multispiral computed tomography (MSCT) and contrast-enhanced angiography for possible embolization. 41 (68.3%) patients were subjected to transcatheter arterial embolization (TAE) and 19 (31.7%) only to diagnostic angiography. The severity of the underlying disease (COVID-19), as well as clinical and laboratory data were evaluated. The immediate results of the manipulations were assessed based on the findings of ultrasound examination (n=57) and multispiral computed tomography (n=13). Complications of the endovascular procedures and 30-day mortality were also studied.

Results. More than half of the patients (51.3%) had severe COVID-19. In 86.6% of patients, therapeutic doses of low-molecular-weight heparins were used. Extravasation on MSCT was detected in 57 (95%) patients. At the subsequent transcatheter angiography, extravasation was revealed only in 27 (45%) patients. Extravasation on angiography was more often detected if extravasation was determined in the arterial phase on MSCT.

Transcatheter arterial embolization was performed in 41 patients, in 27 (65.8%) of them due to established extravasation of the contrast agent revealed on angiography (“therapeutic” TAE). In 14 (34.2%) patients, TAE was performed in the absence of extravasation (“preventive” TAE). Technical success was achieved in 100% of patients. Dissection of the common femoral artery occurred in two patients (4.9%), when attempting catheterization of the inferior epigastric artery, which required balloon angioplasty in one of them, and stenting of the common femoral artery in the other.

In the postoperative period, 26 (43.3%) patients died, all diagnosed as having extremely severe COVID-19 (p<0.001), with 15 of these subjected to transcatheter arterial embolization and 11 to diagnostic angiography.

Conclusion. Transcatheter arterial embolization for spontaneous bleeding into soft tissues in patients with COVID-19 is accompanied by a high frequency of technical success and a low risk of perioperative complications. High mortality in such patients is associated primarily with the severity of COVID-19.

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Polyaev A.Yu., Tyagunov A.E.; data collection and handling – Polyaev A.Yu., Trudkov D.Yu., Mosin S.V.; statistical processing – Stradymov E.A., Polonsky A.A.; draft manuscript preparation – Polyaev A.Yu., Tyagunov A.E.; manuscript revision – Sazhin A.V.

For citation: Polyaev A.Yu., Tyagunov A.E., Stradymov E.A., Polonsky A.A., Trudkov D.Yu., Mosin S.V., Sazhin A.V. Transcatheter arterial embolization for the treatment of spontaneous bleeding into soft tissues in COVID-19 patients. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 21–9. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-21-29

Keywords:transcatheter arterial embolization; spontaneous bleeding; spontaneous hematoma; COVID-19