Transcatheter arterial embolization is efficient and safe for paediatric blunt torso trauma: a case-control study

Abstract Background: It remains unclear whether transcatheter arterial embolization (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE in paediatric patients (age ≤ 15 years) with blunt torso trauma to those of TAE in adult patients. Methods: This was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a “paediatric patient group” and an “adult patient group”.The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR).Results: A total of 504 patients with blunt torso trauma were transported to the trauma centre. Among them, 23% (N=114) of patients with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs. 22%, P=.221). The median age was 11 (IQR 7–14) years for paediatric patients. The predicted mortality (PMR) rate and SMR for paediatric patients were lower than that for adult patients (18.3% vs. 25.9%, P =.026, and 0.37 vs. 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in the paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients that underwent surgery before TAE or urgent blood transfusion (33% vs. 26%, P =.566, or 67% vs. 85%, P =.084).Conclusions: It is possible to provide an equal level of care related to TAE for both paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. We should prepare alternative haemorrhage control procedures as soon as possible whenever the patients reach a hemodynamic unstable state.

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Transcatheter Arterial Embolization is an Efficient and Safe for Paediatric Blunt Torso Trauma: A Case Control Study

10.21203/rs.3.rs-50560/v1 ◽

2020 ◽

Author(s):

Masayasu Gakumazawa ◽

Chiaki Toida ◽

Takashi Muguruma ◽

Naoki Yogo ◽

Mafumi Shinohara ◽

...

Keyword(s):

Patient Group ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Trauma Centre ◽

Adult Patients ◽

Unstable State ◽

Paediatric Patients ◽

Significant Difference ◽

Haemorrhage Control ◽

Torso Trauma

Abstract Background: It remains unclear whether transcatheter arterial embolization (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE in paediatric patients (age ≤ 15 years) with blunt torso trauma to those of TAE in adult patients. Methods: This was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a “paediatric patient group” and an “adult patient group”.The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR). Results: A total of 504 patients with blunt torso trauma were transported to the trauma centre. Among them, 23% (N=114) of patients with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs. 22%, P=.221). The median age was 11 (IQR 7–14) years for paediatric patients. The predicted mortality (PMR) rate and SMR for paediatric patients were lower than that for adult patients (18.3% vs. 25.9%, P =.026, and 0.37 vs. 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in the paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients that underwent surgery before TAE or urgent blood transfusion (33% vs. 26%, P =.566, or 67% vs. 85%, P =.084). Conclusions: It is possible to provide an equal level of care related to TAE for both paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. We should prepare alternative haemorrhage control procedures as soon as possible whenever the patients reach a hemodynamic unstable state.

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Transcatheter Arterial Embolization is an Efficient and Safe for Paediatric Blunt Torso Trauma: A Case Control Study

10.21203/rs.3.rs-51268/v1 ◽

2020 ◽

Author(s):

Masayasu Gakumazawa ◽

Chiaki Toida ◽

Takashi Muguruma ◽

Naoki Yogo ◽

Mafumi Shinohara ◽

...

Keyword(s):

Patient Group ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Trauma Centre ◽

Adult Patients ◽

Unstable State ◽

Paediatric Patients ◽

Significant Difference ◽

Haemorrhage Control ◽

Torso Trauma

Abstract Background: It remains unclear whether transcatheter arterial embolization (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE in paediatric patients (age ≤ 15 years) with blunt torso trauma to those of TAE in adult patients. Methods: This was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a “paediatric patient group” and an “adult patient group”.The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR). Results: A total of 504 patients with blunt torso trauma were transported to the trauma centre. Among them, 23% (N=114) of patients with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs. 22%, P=.221). The median age was 11 (IQR 7–14) years for paediatric patients. The predicted mortality (PMR) rate and SMR for paediatric patients were lower than that for adult patients (18.3% vs. 25.9%, P =.026, and 0.37 vs. 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in the paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients that underwent surgery before TAE or urgent blood transfusion (33% vs. 26%, P =.566, or 67% vs. 85%, P =.084). Conclusions: It is possible to provide an equal level of care related to TAE for both paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. We should prepare alternative haemorrhage control procedures as soon as possible whenever the patients reach a hemodynamic unstable state.

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Transcatheter arterial embolsation is efficient and safe for paediatric blunt torso trauma: a case-control study

10.21203/rs.3.rs-51268/v3 ◽

2020 ◽

Author(s):

Masayasu Gakumazawa ◽

Chiaki Toida ◽

Takashi Muguruma ◽

Naoki Yogo ◽

Mafumi Shinohara ◽

...

Keyword(s):

Patient Group ◽

Case Reports ◽

Trauma Centre ◽

Adult Patients ◽

Unstable State ◽

Trauma Patients ◽

Paediatric Patients ◽

Significant Difference ◽

Haemorrhage Control ◽

Torso Trauma

Abstract Background: It remains unclear whether transcatheter arterial embolisation (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE performed in paediatric (age ≤ 15 years) and adult patients with blunt torso trauma. Methods: This was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a ‘paediatric patient group’ and an ‘adult patient group’. The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR).Results: A total of 504 patients with blunt torso trauma were transported to the trauma centre, out of which 23% (N=114) with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs 22%, P=.221). The paediatric patients’ median age was 11 years (IQR 7–14). The predicted mortality rate (PMR) and SMR for paediatric patients were lower than those for adult patients (18.3% vs 25.9%, P=.026, and 0.37 vs 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients who underwent surgery before TAE or urgent blood transfusion (33% vs 26%, P=.566, or 67% vs 85%, P=.084).Conclusions: It is possible to provide an equal level of care related to TAE for paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. Alternative haemorrhage control procedures should be established as soon as possible whenever the patients reach a haemodynamically unstable state.

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Transcatheter arterial embolisation is efficient and safe for paediatric blunt torso trauma: a case-control study

BMC Emergency Medicine ◽

10.1186/s12873-020-00381-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Masayasu Gakumazawa ◽

Chiaki Toida ◽

Takashi Muguruma ◽

Naoki Yogo ◽

Mafumi Shinohara ◽

...

Keyword(s):

Patient Group ◽

Trauma Centre ◽

Adult Patients ◽

Unstable State ◽

Transcatheter Arterial Embolisation ◽

Paediatric Patients ◽

Arterial Embolisation ◽

Significant Difference ◽

Haemorrhage Control ◽

Torso Trauma

Abstract Background It remains unclear whether transcatheter arterial embolisation (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE performed in paediatric (age ≤ 15 years) and adult patients with blunt torso trauma. Methods This was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a ‘paediatric patient group’ and an ‘adult patient group’. The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR). Results A total of 504 patients with blunt torso trauma were transported to the trauma centre, out of which 23% (N = 114) with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs 22%, P = .221). The paediatric patients’ median age was 11 years (interquartile ranges 7–14). The predicted mortality rate and SMR for paediatric patients were lower than those for adult patients (18.3% vs 25.9%, P = .026, and 0.37 vs 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients who underwent surgery before TAE or urgent blood transfusion (33% vs 26%, P = .566, or 67% vs 85%, P = .084). Conclusions It is possible to provide an equal level of care related to TAE for paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. Alternative haemorrhage control procedures should be established as soon as possible whenever the patients reach a haemodynamically unstable state.

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Transcatheter Arterial Embolization with N-butyl-2 Cyanoacrylate Glubrans 2 for the Treatment of Acute Renal Hemorrhage Under Coagulopathic Condition

10.21203/rs.3.rs-26879/v1 ◽

2020 ◽

Author(s):

Maofeng Gong ◽

Xu He ◽

Boxiang Zhao ◽

Jie Kong ◽

Tao Wang ◽

...

Keyword(s):

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Arterial Embolization ◽

Hemodynamic Instability ◽

Attractive Alternative ◽

Safe Alternative ◽

Renal Hemorrhage ◽

Active Hemorrhage ◽

Significant Difference

Abstract Background:The efficacy and safety of transcatheter arterial embolization (TAE) using the N-butyl-2 cyanoacrylate (NBCA) Glubran2 in the treatment of acute renal hemorrhage (RH) under coagulopathic conditionsarestill no consensus.Methods: Between February 2014 and June 2019, 8 patients underwent TAE with the NBCA Glubran2 for acute RH under coagulopathic conditions. Coagulopathy was defined as abnormal values of prothrombin time and activated partial thromboplastin time and/or a reduced platelet count.Angiograms and medical records were retrospectively reviewed to determine technical/clinical success, complications and recurrent hemorrhage after TAE, and follow-up outcomes were assessed.Results: Of note, one patient presented with severe coagulopathy, and three presented with severe RH and hemodynamic instability. The NBCA Glubran2 was employed as a sole embolic material in sixpatients. In the remaining two patients, it was employed for secondary embolization.Under coagulopathic conditions, due to the use of the NBCA Glubran2, both technical success and clinical success for acute RH were achieved in all patients. Duringa mean follow-up time of 30.1 months (range, 3-84 months), neither persistent nor recurrent active hemorrhage required repeat endovascular or surgical treatment for hemostasis. No Glubran2related complications occurred mid-TAE pro-cedure. In addition, renal function information was available for all patients, and there was no significant difference between the serum creatinine levels [(83.8 ± 15.5) vs (85.8 ± 32.2) μmol/L] before and one week after Glubran2 embolization (p=0.89; CI, -34.5 to 30.5).Conclusions: The present findings suggest that TAE with the NBCA Glubran2 may be a safe alternative treatment for the management of RH under coagulopathic conditions. In particular, this method appears to be a potentially attractive alternative when con-ventional embolic materials fail in patients with ongoing hemodynamic instability or even under severe coagulopathic conditions.

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Novel transcatheter arterial embolization method for hemodynamically unstable pelvic fractures to prevent complications of gluteal necrosis

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-018-01066-1 ◽

2019 ◽

Vol 46 (5) ◽

pp. 1129-1136 ◽

Cited By ~ 1

Author(s):

Takaaki Maruhashi ◽

Fumie Kashimi ◽

Rika Kotoh ◽

Shun Kasahara ◽

Hiroaki Minehara ◽

...

Keyword(s):

Overall Survival ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Pelvic Fractures ◽

Embolic Agent ◽

Gelatin Sponge ◽

Procedure Time ◽

Iliac Arteries ◽

Significant Difference ◽

Embolization Procedure

Abstract Purpose To validate our previously designed transcatheter arterial embolization (TAE) technique for bilateral iliac arteries in unstable pelvic fractures, which is designed to also prevent gluteal necrosis and avoid vasopressors. Methods We retrospectively analyzed the data of patients with pelvic fractures who underwent our new TAE procedure to determine the incidence of subsequent gluteal necrosis. We also compared certain variables between patients who underwent TAE before 2005 using a different technique and developed gluteal necrosis and patients who underwent TAE in 2005 and onward using our technique. Gluteal necrosis was confirmed by a radiologist based on imaging findings. Results Seventy patients with pelvic fractures who underwent our TAE technique met the inclusion criteria (bilateral iliac arterial embolization and no embolic agent other than a gelatin sponge). Patients’ median age was 47.5 years, 33 were male, and 92.9% (65/70) had unstable fractures. Sixty-eight patients had severe multiple trauma. No patients developed gluteal necrosis following our TAE procedure and the overall survival rate was 82.9% (58/70). We found no statistically significant difference in procedure time between the previous and new technique, although the new procedure tended to be shorter. Furthermore, overall survival did not significantly differ between the groups. Multiple regression analysis revealed that TAE procedure time and external pelvic fracture fixation were independently related to gluteal necrosis. Conclusions Our non-selective bilateral iliac arterial embolization procedure involves arresting shock quickly, resulting in no post-procedure gluteal necrosis. The procedure involves cutting the gelatin sponge rather than “pumping” and avoids the use of vasopressors.

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Association of Low Concentrations of Serum Mannose-Binding Protein with Recurrent Infections in Adults

Clinical and Diagnostic Laboratory Immunology ◽

10.1128/cdli.5.3.319-321.1998 ◽

1998 ◽

Vol 5 (3) ◽

pp. 319-321 ◽

Cited By ~ 26

Author(s):

Vellalore N. Kakkanaiah ◽

Guo Qiu Shen ◽

Emmanuel A. Ojo-Amaize ◽

James B. Peter

Keyword(s):

Patient Group ◽

Binding Protein ◽

Adult Patients ◽

Control Group ◽

Recurrent Infections ◽

Group I ◽

Low Concentrations ◽

Significant Difference ◽

Mannose Binding Protein ◽

Mannose Binding

ABSTRACT Low concentrations of mannose-binding protein (MBP; also known as mannose-binding lectin) are associated with common opsonic defect in immunodeficient children. We compared the concentrations of MBP in the sera of 47 adults with non-human immunodeficiency virus-related recurrent infections (group I) and 50 healthy adult controls. Mean serum MBP concentrations in the patient group did not differ significantly from those in the control group (P < 0.4). Nevertheless, the proportion of individuals with less than 5 ng of serum MBP per ml was significantly larger in the patient group (21%, P = 0.01) than in the control group (4%). Group II consisted of 73 pediatric and 56 adult patients with recurrent infections. Pediatric patients had significantly lower mean concentrations of serum MBP than their controls (P < 0.005), and there was no significant difference between the concentrations in sera of adult patients and adult controls (P < 0.4). Again, the proportion of individuals with less than 5 ng of serum MBP per ml was significantly larger in both pediatric (22%, P = 0.045) and adult (38%,P = 0.000016) patients than in their respective controls (4%). Our results demonstrate that, as in children, low concentrations of serum MBP can be associated with recurrent infections in adults.

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