Outcomes of Transcatheter Arterial Embolization with a Modified N-Butyl Cyanoacrylate Glue for Spontaneous Iliopsoas and Rectus Sheath Hematomas in Anticoagulated Patients

Purpose: To assess the efficacy and safety of n-butyl cyanoacrylate methacryloxy sulfolane (NBCA-MS) transcatheter arterial embolization for anticoagulation-related soft-tissue bleeding and to evaluate predictive factors of clinical success and 30-day mortality. Materials and Methods: A retrospective review of 50 anticoagulated patients (25 male; mean age, 71.7 y +/- 14.2; range, 19-87 y) who underwent emergent Glubran 2 NBCA-MS embolization for iliopsoas hematomas (IPHs; n = 38), rectus sheath hematomas (n = 11), or both (n = 1) between 2011 and 2016 was performed. Inclusion criteria were active bleeding on computed tomography (CT) and anticoagulation. The mean number of red blood cell (RBC) units transfused was 4.8 +/- 3.2 (range, 0-14), median hemoglobin level before embolization was 9.7 g/dL (range, 6.2-18 g/dL), and median ``mean blood pressure'' (MBP) was 62.5 mm Hg (range, 58.3-75 mm Hg). Mean International Normalized Ratio before intervention was 2.5 +/- 1.5 (range, 1.0-6.9). Angiograrns revealed extravasation in 44 of 50 patients (88%). Mean hematoma volume was 1,119.2 cm(3) +/- 863.5 (range, 134.0-3,589.0 cm(3)). Results: Technical success was achieved in 100% of patients, and 30-day clinical success was achieved in 66% of patients. Recurrent bleeding and mortality rates within 30 days of embolization were 34% and 44%, respectively. No complications related to the embolization procedure occurred. Lower MBP (P=.003), greater number of RBC units transfused (P=.003), greater volume of hematoma (P=.04), and IPH location (P=.02) were associated with decreased clinical success. Clinical failure (P=.00002), lower MBP (P=.004), greater number of RBC units transfused (P=.002), and IPH location ( P=.01) were significantly associated with higher 30-day mortality rates. Conclusions: Transcatheter arterial embolization with NBCA-MS is safe and effective in treating refractory soft-tissue bleeding in anticoagulated patients despite the high mortality rates associated with this patient population.