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A 21-year-old man presented with severe abdominal pain four days after undergoing upper endoscopy with duodenal biopsies and was found to have an intramural duodenal hematoma. Symptoms progressed after attempts at diet advancement, and repeat imaging showed an enlarging hematoma with duodenal obstruction. The patient was managed with arterial embolization followed by laparoscopic surgical evacuation of the hematoma. This is the first report of an enlarging duodenal hematoma managed by this combination approach. While surgical interventions have previously been reserved for the most severe cases, we review the literature on minimally invasive approaches to manage this rare endoscopic complication. [ABSTRACT FROM AUTHOR]

This study aimed to determine which comorbidities were associated with intractable epistaxis requiring electrocauterization or embolization, and to identify the location where intractable epistaxis frequently occurred. The patients were divided into two groups: patients with epistaxis successfully controlled in outpatient department (OPD) and those with intractable epistaxis in OPD which was controlled by surgical exploration or arterial embolization (OP/EM). Evaluations of the bleeding locations, related vessels, and patient's comorbidities were conducted. A total of 41 patients from the OP/EM group and 725 patients from the OPD group were enrolled. The following comorbidities showed elevated risks of the intractable epistaxis (p < 0.05) in multivariate analysis; hypertension (OR 1.089, 95% CI 1.049 - 1.132), dyslipidemia (1.132, 1.041 - 1.232), liver cirrhosis (1.272, 1.152 - 1.406), chronic obstructive pulmonary disease (1.234, 1.078 - 1.412) and asthma (1.205, 1.053 - 1.379). Inferior and middle turbinate were equally the most common location of the intractable bleeding. In patients with epistaxis requiring hemostatic treatments, comorbidities such as hypertension, dyslipidemia, liver diseases, COPD, and asthma were associated with intractable epistaxis. The main bleeding sites of intractable epistaxis were the middle and inferior turbinate. [ABSTRACT FROM AUTHOR]

Background Diverticular bleeding is the leading cause of lower gastrointestinal bleeding, affecting 3-5% of patients with diverticulosis. Current management protocols include resuscitation, diagnosis via direct visualization, computed tomography imaging, endoscopic interventions, angioembolization, and surgery when needed. However, predictive factors for outcomes and optimal interventions remain ambiguous. Methods This retrospective cohort study analyzed data from the National Inpatient Sample (NIS) database (2016-2020) to determine predictors of adverse in-hospital outcomes in diverticular bleeding patients without perforation or abscess. Demographic and clinical data were extracted, and multivariate regression models were applied. Analysis was conducted using R statistical software (version 4.1.3), with significance set at P<0.05. Results A total of 28,269 patients hospitalized for diverticular bleeding were identified. Age >85 years, moderate to severe Charlson Comorbidity Index, hypovolemic shock, blood transfusion requirement, and requirement for colectomy were significantly associated with greater in-hospital mortality. Factors such as late colonoscopy timing and colon resection led to longer hospital stays, while arterial embolization was predicted by older age, Black race, hypovolemic shock, and blood transfusion. Predictors of colon resection included advanced age, presence of colon cancer, and hypovolemic shock. Conclusions Our retrospective study identified significant predictors of in-hospital outcomes among patients with diverticular bleeding, informing risk stratification and management strategies. Further research is warranted to validate these findings and refine management algorithms for improved patient care. Integrating these insights into clinical practice may enhance outcomes and guide personalized interventions in diverticular bleeding management. [ABSTRACT FROM AUTHOR]

Priapism is defined as a form of erectile dysfunction characterized by a prolonged and involuntary penile erection, either partial or complete, occurring without sexual stimulation and lasting for more than 4 hours. Its incidence is estimated to be 0.5-0.9 cases per 100,000 people per year.The most frequent form is ischemic priapism, results from paralysis of the cavernous smooth muscles, which are unable to contract, leading to the stagnation of hypoxic blood within the sinusoidal spaces. Characterized by a painful rigid and sustainable erection.Non-ischemic priapism constitutes a rare entity, unlike the former, this type is typically painless. It is caused by an excessive influx of blood into the penis without a concomitant increase in outgoing blood flow. Blunt trauma is the most commonly reported etiology.And finally, recurrent priapism is characterized by recurrent episodes of prolonged erection and can be challenging to treat, often requiring long-term management to prevent recurrences.We report a case of high-flow priapism in a 10-year old child, secondary to a cavernous arterial fistula following a straddle injury during sports activity. It was suspected clinically and confirmed by ultrasound-Doppler, then successfully treated radiologically with highly selective embolization, with very satisfactory postoperative outcomes.

Advances in breast cancer treatment have markedly reduced the incidence of massive bleeding, yet severe hemorrhage remains a critical issue in locally advanced or metastatic cases. Traditional management strategies often prove inadequate for significant bleeding, highlighting the need for alternative interventions. We detail the management of a 64-year-old patient with a neglected locally advanced breast tumor, leading to life-threatening hemorrhage. Conventional bleeding control measures failed, necessitating microsphere embolization. Effective hemostasis was achieved without adverse events or recurrence of bleeding, allowing for the initiation of chemotherapy. This case underscores the rarity yet potential severity of hemorrhage in breast cancer, challenging conventional management. Embolization, typically reserved for other hemorrhagic conditions, is appearing as a viable alternative for breast cancer-related hemorrhage, particularly in large tumors where surgery is impractical. Further research is necessary to establish its role in managing minor bleeding.

Objectives: To describe the clinical presentation of carotico-cavernous fistula (CCF) and outcomes of endovascular balloon embolization in a tertiary care center in a developing country. Materials and Methods: This retrospective interventional case series included 18 patients who underwent endovascular balloon embolization from 2019 to 2022 at Lahore General Hospital in Lahore, Pakistan. The analyzed data consisted of age, gender, cause and type of CCF, clinical presentation, diagnostic technique used, intervention, and the results of two-month follow-up. Patients with incomplete records and coil embolization were excluded. Digital subtraction angiography was done in all cases followed by endo-arterial balloon embolization. Procedures were carried out under general anesthesia via femoral artery approach. A single balloon was sufficient to close the fistula in all cases. Results: There were 18 patients who met the inclusion criteria. Sixteen patients had direct CCF, and the mean age of the patients was 27.2±12.6 years. The commonest cause of CCF was trauma, and the mean time of presentation after trauma was 7.89±7.19 months. The male-to-female ratio was 8:1. Preoperative visual acuity was worse than 6/60 in 8 patients, between 6/60 and 6/18 in 7 patients, and better than 6/18 in 3 patients. The mean intraocular pressure was 16.06±3.37 mmHg preoperatively and 14.83±3.49 mmHg postoperatively (p=0.005). Endovascular embolization was successful in 15 patients (83.3%). One patient developed epidural hematoma as a complication of the procedure, which was drained later. There was no mortality related with the procedure. Conclusion: Balloon embolization via the femoral artery is an efficient technique in direct as well as indirect CCF. It is safe and simple with very good results if performed in a timely manner.

Abstract Background Hamartoma is a common benign tumor that usually occurs in the kidney, liver, lung, and pancreas. Large renal hamartomas may spontaneously rupture and hemorrhage, which is potentially life-threatening. Case presentation This report describes a 46-year-old Han Chinese female patient with multiple renal and hepatic hamartomas with rupture and hemorrhage of giant hamartoma in the left kidney. She underwent arterial embolization three times successively, and her condition was stable during the 2-year follow-up. This report includes a review of the relevant literature Conclusions the findings in this report and previous literature suggest that arterial embolization can not only rapidly treat hamartoma hemorrhage in the acute phase but can also effectively control multiple lesions in the long term after repeated multisite arterial embolization.

Objectives: To describe the clinical presentation of carotico-cavernous fistula (CCF) and outcomes of endovascular balloon embolization in a tertiary care center in a developing country. Materials and Methods: This retrospective interventional case series included 18 patients who underwent endovascular balloon embolization from 2019 to 2022 at Lahore General Hospital in Lahore, Pakistan. The analyzed data consisted of age, gender, cause and type of CCF, clinical presentation, diagnostic technique used, intervention, and the results of two-month follow-up. Patients with incomplete records and coil embolization were excluded. Digital subtraction angiography was done in all cases followed by endo-arterial balloon embolization. Procedures were carried out under general anesthesia via femoral artery approach. A single balloon was sufficient to close the fistula in all cases. Results: There were 18 patients who met the inclusion criteria. Sixteen patients had direct CCF, and the mean age of the patients was 27.2±12.6 years. The commonest cause of CCF was trauma, and the mean time of presentation after trauma was 7.89±7.19 months. The male-to-female ratio was 8:1. Preoperative visual acuity was worse than 6/60 in 8 patients, between 6/60 and 6/18 in 7 patients, and better than 6/18 in 3 patients. The mean intraocular pressure was 16.06±3.37 mmHg preoperatively and 14.83±3.49 mmHg postoperatively (p=0.005). Endovascular embolization was successful in 15 patients (83.3%). One patient developed epidural hematoma as a complication of the procedure, which was drained later. There was no mortality related with the procedure. Conclusion: Balloon embolization via the femoral artery is an efficient technique in direct as well as indirect CCF. It is safe and simple with very good results if performed in a timely manner. [ABSTRACT FROM AUTHOR]

A 21-year-old man presented with severe abdominal pain four days after undergoing upper endoscopy with duodenal biopsies and was found to have an intramural duodenal hematoma. Symptoms progressed after attempts at diet advancement, and repeat imaging showed an enlarging hematoma with duodenal obstruction. The patient was managed with arterial embolization followed by laparoscopic surgical evacuation of the hematoma. This is the first report of an enlarging duodenal hematoma managed by this combination approach. While surgical interventions have previously been reserved for the most severe cases, we review the literature on minimally invasive approaches to manage this rare endoscopic complication.

Purpose: To investigate the incidence and patterns of chest compression-associated internal thoracic artery injury (CAI) during cardiopulmonary resuscitation and identify the embolization techniques used to treat hemorrhage. Materials and Methods: A retrospective study was conducted in the patients who underwent transcatheter arterial embolization (TAE) for life-threatening hemorrhage caused by CAI at two tertiary care centers between May 2013 and December 2019. Data on background characteristics, imaging findings, embolization and outcomes were collected from the medical records. Results: Among 385 patients in whom circulation returned after resuscitation, there were 9 patients (2.3%) who required TAE for CAI. Eight of 9 patients had acute myocardial infarction, and all had been started on extracorporeal membrane oxygenation before TAE. Seven patients had unilateral, and two had bilateral internal thoracic artery injuries. Main trunk injury of internal thoracic artery was seen in 27%, while branch injury in 73%. Six patients (67%) had multiple injuries in the internal thoracic artery territory, and five (56%) had injuries to other vessels. In all cases, we embolized the main trunk of the internal thoracic artery using n-butyl 2-cyanoacrylate and coils (n = 8), a gelatin sponge only (n = 2), or coils and a gelatin sponge (n = 1). TAE was technically successful in all, without any complication. The 30-day mortality rate was 44%. Conclusions: CAI needing hemostatic intervention occurred in 2.3% of patients after successful cardiopulmonary resuscitation. Branch injury was more common than main trunk injury, and multiple vessel injuries were common. TAE appears to be safe and effective for controlling life-threatening hemorrhage. [ABSTRACT FROM AUTHOR]

Robotic partial nephrectomy (RPN) offers faster recovery time, shorter hospital stays, and decreased intraoperative blood loss. Thus, it has become a frequently preferred technique. Different major and minor complications may occur in RPN. However, there are insufficient data regarding the management of robotic surgery-related complications. A 62-year-old man presented with an incidental left renal mass. Magnetic resonance imaging demonstrated a 3.3x3.1x3.8 cm solid and contrast-enhanced renal mass localized at the lower pole of the left kidney. The PADUA score was 7. We performed robotic left partial nephrectomy (PN). Perioperative bleeding, warm ischemia time, and operation time were 100 cc, 26 min, and 180 min, respectively. There were no unexpected events during the operation. During the postoperative 2nd hour in the recovery room, the patient had syncope, hypotension, and tachycardia. Urgent ultrasonography demonstrated a 7x6 cm retroperitoneal hematoma. The selective renal angiography and embolization (SRAE) technique was preferred to manage the complication. Intra-arterial access was provided by femoral artery cannulation in the supine position under local anesthesia. Pseudoaneurysm was observed as a sign of bleeding in the lower pole segmental artery. An endovascular coiling procedure was performed on the pseudoaneurysm originating from the lower pole renal artery. The patient’s post-angioembolization course was uneventful, with no other complications after the intervention. The patient was discharged after five days of follow-up. Complications following RPN performed by experienced surgeons can be acceptably low. However, postoperative arterial malformation leading to hemorrhage can be life-threatening. It has been reported that minimally invasive PN increases the risk of arterial malformation compared with open PN, and the reported incidence varies by approximately 3-10%. In our case, we preferred SRAE because surgical exploration had a potential risk of nephrectomy. SRAE is a technically feasible and safe option for managing arterial hemorrhage after RPN.

Robotic partial nephrectomy (RPN) offers faster recovery time, shorter hospital stays, and decreased intraoperative blood loss. Thus, it has become a frequently preferred technique. Different major and minor complications may occur in RPN. However, there are insufficient data regarding the management of robotic surgery-related complications. A 62-year-old man presented with an incidental left renal mass. Magnetic resonance imaging demonstrated a 3.3x3.1x3.8 cm solid and contrast-enhanced renal mass localized at the lower pole of the left kidney. The PADUA score was 7. We performed robotic left partial nephrectomy (PN). Perioperative bleeding, warm ischemia time, and operation time were 100 cc, 26 min, and 180 min, respectively. There were no unexpected events during the operation. During the postoperative 2nd hour in the recovery room, the patient had syncope, hypotension, and tachycardia. Urgent ultrasonography demonstrated a 7x6 cm retroperitoneal hematoma. The selective renal angiography and embolization (SRAE) technique was preferred to manage the complication. Intra-arterial access was provided by femoral artery cannulation in the supine position under local anesthesia. Pseudoaneurysm was observed as a sign of bleeding in the lower pole segmental artery. An endovascular coiling procedure was performed on the pseudoaneurysm originating from the lower pole renal artery. The patient's post-angioembolization course was uneventful, with no other complications after the intervention. The patient was discharged after five days of follow-up. Complications following RPN performed by experienced surgeons can be acceptably low. However, postoperative arterial malformation leading to hemorrhage can be life-threatening. It has been reported that minimally invasive PN increases the risk of arterial malformation compared with open PN, and the reported incidence varies by approximately 3-10%. In our case, we preferred SRAE because surgical exploration had a potential risk of nephrectomy. SRAE is a technically feasible and safe option for managing arterial hemorrhage after RPN. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the safety, efficacy, and clinical outcomes of transarterial embolization (TAE) in patients with intraabdominal hemorrhage. Materials and Methods: Eighty-one patients who underwent intraabdominal TAE between January 1, 2020, and March 1, 2023 were evaluated retrospectively. Patients who underwent transarterial chemoembolization (n=15), mass embolization (n=12), and venous embolization (n=4) were excluded. Patient characteristics, hemorrhage etiology, embolized arteries, embolizing agents used, clinical and technical success, and rebleeding and in-hospital mortality rates were recorded. Results: A total of 50 patients (37 males, 74%) were included in the study. The mean age of patients was 53.4±21.1 years. The most common pathology causing hemorrhage was upper gastrointestinal bleeding due to peptic ulcers (n=21, 42%), followed by tumors (n=8, 16%), iatrogenic causes (n=8, 16%), and trauma (n=6, 12%). The most commonly used embolizing agents were isolated coil (n=26, 52%) and a combination of coil and polyvinyl alcohol (n=12, 24%). The rate of technical success was 98% (n=49/50), and catheterization could not be performed in only one of the patients due to advanced vasospasm in the first procedure. After the first angiography, rebleeding occurred in 8% (n=4) cases, of which three were due to peptic ulcers and one was related to gastric cancer. One of these patients died in hospital, while the remaining three were discharged. The rate of in-hospital mortality was 16% (n=8) in all patients, and the clinical success rate was 84% (n=42). Conclusion: TAE provides high rates of immediate and complete hemostasis with low complication rates. It is an effective method, especially for solid organ injuries and in the management of bleeding complications after surgery or intervention. [ABSTRACT FROM AUTHOR]

Our purpose was to devise a radiomics model using preoperative computed tomography angiography (CTA) images to differentiate new from old emboli of acute lower limb arterial embolism. 57 patients (95 regions of interest; training set: n = 57; internal validation set: n = 38) with femoral popliteal acute lower limb arterial embolism confirmed by pathology and with preoperative CTA images were retrospectively analyzed. We selected the best prediction model according to the model performance tested by area under the curve (AUC) analysis across 1,000 iterations of prediction from three most common machine learning methods: support vector machine, feed-forward neural network (FNN), and random forest, through several steps of feature selection. Then, the selected best model was also validated in an external validation dataset (n = 24). The established radiomics signature had good predictive efficacy. FNN exhibited the best model performance on the training and validation groups: its AUC value was 0.960 (95% CI, 0.899–1). The accuracy of this model was 89.5%, and its sensitivity and specificity were 0.938 and 0.864, respectively. The AUC of external validation dataset was 0.793. Our radiomics model based on preoperative CTA images is valuable. The radiomics approach of preoperative CTA to differentiate new emboli from old is feasible.

Abstract Background Primary angiosarcoma of the breast is very rare, accounting for 0.05% of all malignant breast tumors. It has very high malignant potential and poor prognosis, though due to the rarity of the disease, there is no established treatment. We report this case along with a literature review. Case presentation We report the case of a 30-year-old Asian woman who was diagnosed with bilateral primary angiosarcoma of the breast while breastfeeding. After surgery, she underwent radiation therapy, chemotherapy, and hepatic arterial infusion chemotherapy for local recurrence of liver metastases, but these were ineffective, and she required several arterial embolization procedures for intratumoral bleeding and rupture of liver metastases. Conclusions Angiosarcoma has a poor prognosis due to a high rate of local recurrence and distant metastasis. Although there is no established evidence for radiotherapy or chemotherapy, multimodality treatment may be necessary because of the high malignancy and rapid progression of the disease.

Biodegradable hydrogel-based matrices are becoming more widely utilized for a variety of medical applications, including SpaceOAR which is a hydrogel injected into the recto-prostatic space under ultrasound guidance to protect the rectum during prostate radiation therapy. Although a greater number of these procedures are being performed, there are no case reports on the potential complications which may result. In this report, we present the first case of retrograde embolization of SpaceOAR hydrogel into the right common iliac artery during routine office administration, as well as subsequent interventional angiography, inpatient and outpatient management, and clinical and imaging results at 1.5-month patient follow-up.

Paracentesis is a validated procedure for diagnosing and managing ascites. Although paracentesis is a safe procedure with a 1–2% risk of complications such as bleeding, it is necessary to inform the patient about the possible adverse events. We would like to share our experience with two cases of bleeding after paracentesis. In our unit, two major hemorrhagic complications occurred in 162 procedures performed over the year 2020 (frequency of bleeding complications: 1.2%). We report two clinical cases of post-paracentesis abdominal wall hematomas. Despite a similar clinical presentation, the management approach was different: in the first case, embolization of the epigastric artery supplying the hematoma was performed. In the second case, conservative treatment was adopted. Our report aims to provide food for thought about a potentially challenging hemorrhagic complication, even with the risk of adverse outcomes.

Abstract Background Transcatheter arterial embolization (TAE) has long been used for hemostasis of traumatic or postoperative hemorrhage and embolization of tumors. Previous retrospective studies of TAE for painful bone metastases showed 60%–80% pain reduction with a median time to response of 1–2 days. Compared with radiotherapy and bisphosphonates, time to response appeared earlier than that of radiotherapy or bone-modifying agents. However, few prospective studies have examined TAE for this indication. Here, we describe the protocol for a confirmatory study designed to clarify the efficacy and safety profile of TAE. Methods This study will be a multicenter, single-arm confirmatory study (phase 2–3 design). Patients with painful bone metastases from any primary tumor are eligible for enrollment. TAE will be the main intervention. Following puncture of the femoral artery under local anesthesia and insertion of an angiographic sheath, angiography will confirm that the injected region includes tumor vasculature. Catheter position will be adjusted so that the embolization range does not include non-target tissues. Spherical embolic material will then be slowly injected into the artery to embolize it. The primary endpoint (efficacy) is the proportion of subjects with pain relief at 72 h after TAE and the secondary endpoint (safety) is the incidence of all NCI Common Terminology Criteria for Adverse Events version 5.0 Grade 4 adverse events and Grade ≥ 3 necrosis of the central nervous system. Discussion If the primary and secondary endpoints are met, TAE can be a treatment choice for painful bone metastases. Trial registry number is UMIN-CTR ID: UMIN000040794. Trial registration The study is ongoing, and patients are currently being enrolled. Enrollment started in March 2021. A total of 36 patients have participated as of Aug 2022. Protocol Version: Ver1.4, 13/07/2022.

Dieulafoy's disease is a rare and important cause of recurrent upper gastrointestinal bleeding, which can cause fatal gastrointestinal bleeding. We reported a patient with Dieulafoy's disease in both of the stomach and duodenum for the first time. The patient achieved no effective hemostasis after two endoscopic treatments and two arterial angiography embolizations. Finally, successful hemostasis was achieved through surgery. There are many endoscopic treatment methods, but there is no consensus on the best treatment for hemorrhagic Dieulafoy's disease. Surgery is only a last resort after the failure of endoscopic treatment and angiography embolization. [ABSTRACT FROM AUTHOR]

A nontraumatic and idiopathic spontaneous subcapsular hepatic hematoma is a rare but often fatal condition. Herein, we report a case of nontraumatic progressive massive subcapsular hepatic hematoma that straddled both liver lobes and was successfully treated by repeated arterial embolization. Following treatment, the hematoma did not progress. [ABSTRACT FROM AUTHOR]

Background: There are many ways to treat prostatic hyperplasia; these are currently more inclined to minimally invasive treatment. We mainly compared the differences between two treatment methods， ultrasound-guided transperineal laser ablation (US-TPLA) and prostatic artery embolization (PAE). Purpose: To evaluate the efficacy and safety of US-TPLA and PAE in the treatment of benign prostatic hyperplasia (BPH). Material and Methods: The clinical information for 40 patients with BPH admitted to our hospital between June 2018 and January 2021 were retrospectively analyzed. The changes in International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate volume (PV), and the incidence of complications were compared between groups. Results: The IPSS (P < 0.001; P < 0.001), QoL (P < 0.001; P < 0.001), Qmax (P < 0.001; P < 0.001), PVR (P < 0.001; P < 0.001), and PV (P < 0.001; P < 0.001) at three and six months after US-TPLA and PAE improved with respect to those before surgery. There was no significant difference in IPSS (P = 0.235; P = 0.151), QoL (P = 0.527; P = 0.294), Qmax (P = 0.776; P = 0.420), PVR (P = 0.745; P = 0.607), and PV (P = 0.527; P = 0.573) between the groups at three and six months after surgery. No serious complications occurred in either group. Conclusion: US-TPLA and PAE seem to have a similar short-term efficacy. The efficacy of the two procedures is comparable, and neither is associated with serious complications. US-TPLA and PAE are both effective complementary measures for the treatment of BPH. [ABSTRACT FROM AUTHOR]

The aim of the study is to prepare embolic hydroxyl ethyl cellulose (HEC)– polyvinyl prolidone (PVP)–magnetic particles suitable for transcatheter arterial chemoembolization (TACE) procedures, drug delivery, and magnetic hyperthermia. Two different sizes (microsized and nanosized) of iron oxide particles were used to prepare the embolic particles to investigate the embolization and drug delivery properties. Iron oxides were linked with PVP via bridging flocculation process, then outermost layer of the linked particles was coated with HEC in order to load drugs to particles and reach size requirements for a successful TACE procedure. Size of each particle was calibrated to the range that allows easy injections through microcatheters (40–500 μm). The results showed that the size of the final embolic particles reached around 70 μm with 82 W/g specific absorption rate (SAR) values for nano-iron oxide particles and 45 μm with 77 W/g SAR values for micro-iron oxide particles, which are quite suitable for TACE applications. Furthermore, an anticancer drug doxorubicin (DOX) was successfully loaded onto these particles in order to achieve localized chemotherapy at the tumor site. Particles produced in this study, loaded DOX successfully and prolonged drug release time, performed similarly to pure DOX at higher concentration treatments against human breast cancer cell lines, were heatable under applied alternating magnetic fields.In addition, in vivo embolization studies performed using a rabbit renal embolization model, indicated that these particles were easily delivered through microcatheters and were able to embolize the target. [ABSTRACT FROM AUTHOR]

Abstract Background Maxillofacial fractures can lead to massive oronasal bleeding; however, surgical hemostasis and packing procedures can be challenging owing to complex facial anatomy. Only a few studies investigated maxillofacial fractures with massive oronasal hemorrhage. However, thus far, no studies have reported a protocolized management approach for maxillofacial trauma from a single center. This study aimed to evaluate the effectiveness of protocolized management for maxillofacial fractures with oronasal bleeding. Methods Patients were identified from the National Cheng University Hospital trauma registry from 2010 to 2020. We included patients with a face Abbreviated Injury Scale (AIS) score of > 3 and active oronasal bleeding. Patients’ characteristics were compared between the angiography and non-angiography groups and between survivors and nonsurvivors. Results Forty-nine patients were included. Among them, 34 (69%) underwent angiography, of whom 21 received arterial embolization. Forty-seven patients (96%) successfully achieved hemostasis by adhering to the treatment protocol at our institution. Compared with the non-angiography group, the angiography group had significantly more patients requiring oral intubation (97% vs. 53%, P 3 (65% vs. 13%, P = 0.001), higher Injury Severity Score (ISS; 43 [33–50] vs. 22 [18–27], P 3 (92% vs. 33%; P

Abstract Background Trans-hepatic arterial chemoembolization (TACE) is a treatment option for liver cancer patients. It can prolong patients’ survival but can also cause symptom distress. Symptom distress (SDs) can directly impact quality of life (QOL) and may indirectly influence QOL by lessening hope. In this study, we wanted to explore the mediating effect of hope on the relationship between SDs and QOL among patients with liver cancer receiving TACE. Methods A cross-sectional study was conducted from December 20, 2017, to August 6, 2018, at a gastroenterology ward of a medical center. The participants were 92 liver cancer patients (69.6% male, mean age 67.8) who were admitted for TACE treatment. Information on SDs, hope, and QOL was collected by questionnaire on discharge day. Hayes’ PROCESS model was used to test the mediating effect of hope on the relationship between SDs and QOL. Results The mean score and standard deviation (SD) of SDs, hope, and QOL were 32.08 (SD = 6.22), 27.09 (SD = 3.51), and 55.16 (SD = 17.33), respectively. SDs negatively impacts quality of life. The total effect of SDs on QOL was − 1.41 (95% confidence interval [CI]: − 1.96, − 0.86). The indirect effect via the mediation of hope was − 0.95 (95% CI: − 1.7, − 0.45). Hope partially mediated the effect of SDs on QOL. Conclusion SDs after TACE is vital; it directly reduces a patient’s overall QOL and can indirectly hinder it by reducing the patient’s hope. In addition to symptom management, interventions that help patients maintain their hope are key to improving QOL among patients receiving TACE.

To our knowledge, there have been no previous reports of biliary injury or bilomas due to microvalve infusion catheters (Trinav Infusion System; Westminster, CO). Here, we describe an interesting case of large hepatic biloma following bland hepatic arterial embolization with an antireflux catheter.

Paracentesis is a validated procedure for diagnosing and managing ascites. Although paracentesis is a safe procedure with a 1–2% risk of complications such as bleeding, it is necessary to inform the patient about the possible adverse events. We would like to share our experience with two cases of bleeding after paracentesis. In our unit, two major hemorrhagic complications occurred in 162 procedures performed over the year 2020 (frequency of bleeding complications: 1.2%). We report two clinical cases of post-paracentesis abdominal wall hematomas. Despite a similar clinical presentation, the management approach was different: in the first case, embolization of the epigastric artery supplying the hematoma was performed. In the second case, conservative treatment was adopted. Our report aims to provide food for thought about a potentially challenging hemorrhagic complication, even with the risk of adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: Primary angiosarcoma of the breast is very rare, accounting for 0.05% of all malignant breast tumors. It has very high malignant potential and poor prognosis, though due to the rarity of the disease, there is no established treatment. We report this case along with a literature review. Case presentation: We report the case of a 30-year-old Asian woman who was diagnosed with bilateral primary angiosarcoma of the breast while breastfeeding. After surgery, she underwent radiation therapy, chemotherapy, and hepatic arterial infusion chemotherapy for local recurrence of liver metastases, but these were ineffective, and she required several arterial embolization procedures for intratumoral bleeding and rupture of liver metastases. Conclusions: Angiosarcoma has a poor prognosis due to a high rate of local recurrence and distant metastasis. Although there is no established evidence for radiotherapy or chemotherapy, multimodality treatment may be necessary because of the high malignancy and rapid progression of the disease. [ABSTRACT FROM AUTHOR]

Background: Transcatheter arterial embolization (TAE) has long been used for hemostasis of traumatic or postoperative hemorrhage and embolization of tumors. Previous retrospective studies of TAE for painful bone metastases showed 60%–80% pain reduction with a median time to response of 1–2 days. Compared with radiotherapy and bisphosphonates, time to response appeared earlier than that of radiotherapy or bone-modifying agents. However, few prospective studies have examined TAE for this indication. Here, we describe the protocol for a confirmatory study designed to clarify the efficacy and safety profile of TAE. Methods: This study will be a multicenter, single-arm confirmatory study (phase 2–3 design). Patients with painful bone metastases from any primary tumor are eligible for enrollment. TAE will be the main intervention. Following puncture of the femoral artery under local anesthesia and insertion of an angiographic sheath, angiography will confirm that the injected region includes tumor vasculature. Catheter position will be adjusted so that the embolization range does not include non-target tissues. Spherical embolic material will then be slowly injected into the artery to embolize it. The primary endpoint (efficacy) is the proportion of subjects with pain relief at 72 h after TAE and the secondary endpoint (safety) is the incidence of all NCI Common Terminology Criteria for Adverse Events version 5.0 Grade 4 adverse events and Grade ≥ 3 necrosis of the central nervous system. Discussion: If the primary and secondary endpoints are met, TAE can be a treatment choice for painful bone metastases. Trial registry number is UMIN-CTR ID: UMIN000040794. Trial registration: The study is ongoing, and patients are currently being enrolled. Enrollment started in March 2021. A total of 36 patients have participated as of Aug 2022. Protocol Version: Ver1.4, 13/07/2022. [ABSTRACT FROM AUTHOR]

Our purpose was to devise a radiomics model using preoperative computed tomography angiography (CTA) images to differentiate new from old emboli of acute lower limb arterial embolism. 57 patients (95 regions of interest; training set: n = 57; internal validation set: n = 38) with femoral popliteal acute lower limb arterial embolism confirmed by pathology and with preoperative CTA images were retrospectively analyzed. We selected the best prediction model according to the model performance tested by area under the curve (AUC) analysis across 1,000 iterations of prediction from three most common machine learning methods: support vector machine, feedforward neural network (FNN), and random forest, through several steps of feature selection. Then, the selected best model was also validated in an external validation dataset (n = 24). The established radiomics signature had good predictive efficacy. FNN exhibited the best model performance on the training and validation groups: its AUC value was 0.960 (95% CI, 0.899–1). The accuracy of this model was 89.5%, and its sensitivity and specificity were 0.938 and 0.864, respectively. The AUC of external validation dataset was 0.793. Our radiomics model based on preoperative CTA images is valuable. The radiomics approach of preoperative CTA to differentiate new emboli from old is feasible. [ABSTRACT FROM AUTHOR]

Abstract 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.

Abstract Background The Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists have issued the guidelines and recommendations on postpartum hemorrhage since 2010 and have been conducted widespread educational activities from 2012. The aim of this study was to investigate the impact of these efforts by the Societies to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan. Methods A national retrospective cohort study was conducted using the national database of health insurance claims for the period 2012 and 2018. The subjects were all insured women who received a blood transfusion for postpartum hemorrhage. The primary endpoints of this study were hysterectomy and maternal mortality. The etiology of hemorrhage, treatment facility, type of procedure, and blood transfusion volume were tabulated. Results Women with postpartum hemorrhage that underwent transfusion increased from 3.5 to 5.5 per 1000 deliveries between 2012 and 2018. The most common cause of postpartum hemorrhage was atonic hemorrhage. After insurance coverage in 2013, the intrauterine balloon tamponade use increased to 20.3% of postpartum hemorrhages treated with transfusion in 2018, while the proportion of hysterectomy was decreased from 7.6% (2013–2015) to 6.4% (2016–2018) (p

Lobular capillary hemangioma (LCH), previously known as pyogenic granuloma, is a benign vascular lesion commonly found within the oral and nasal cavities. However, it is rarely encountered within the trachea, especially in pediatric patients, where it manifests as hemoptysis, cough, and wheeze, and is frequently misdiagnosed as bronchitis or asthma. There is limited literature on the presentation, behavior, and management of tracheal LCH. Herein, we describe a rare case of tracheal LCH in an 11-year-old boy with a history of hemoptysis, which was successfully managed with arterial embolization followed by electrocautery loop snaring via flexible bronchoscopy. No complications occurred during and after the procedure. A review of the relevant literature is also provided. Our case is unique, given the therapeutic strategy utilized for pediatric tracheal LCH, and reminds physicians to be aware of tracheal LCH in the differential diagnosis for hemoptysis.

Congenital uterine arteriovenous malformations (AVMs) are an uncommon cause of vaginal bleeding in women of reproductive age. In the medical literature, there are few reports of congenital uterine AVMs. This report describes a 23-year-old woman who presented with intermittent vaginal bleeding following a vaginal delivery two years prior. Initially, a molar pregnancy was suspected, but further assessment with magnetic resonance imaging revealed a diagnosis of right uterine AVM. The patient underwent uterine artery embolization, which was repeated three months later. At two-year follow-up, the patient remained free of symptoms. This case highlights the importance of considering congenital uterine AVM as a potential cause of vaginal bleeding and emphasizes the need for clinical examination and radiologic investigations to establish an accurate diagnosis. Treatment depends on disease severity, comorbidities, patient age, and fertility desires.

Background Superselective adrenal arterial embolization (SAAE) is an alternative treatment for patients with primary aldosteronism (PA). This single-center prospective cohort study aimed to compare the efficacy of SAAE with mineralocorticoid receptor antagonists (MRA) in treating patients with PA who refused unilateral adrenalectomy. Methods Of the 140 PA patients who were enrolled in the study and completed 12-month follow-up, 74 patients underwent SAAE and 66 received MRA treatment. The clinical and biochemical outcome was compared at 1, 6, and 12 months after the procedure. Results Baseline clinical and biochemical characteristics of the patients were similar between groups. Office, home, and ambulatory blood pressure reduction at 1 month after discharge was more pronounced in the SAAE group than MRA group (all P < 0.05) while the blood pressure reduction was comparable between the 2 groups at 6 and 12 months. Patients who underwent SAAE took less antihypertensive medications than the MRA group during 12-month follow-up (P < 0.01). Both SAAE and MRA treatment improved renin suppression, aldosterone-to-renin ratio elevation, and hypokalemia at 6 and 12 months, whereas only SAAE but not MRA reduced plasma aldosterone levels. Moreover, SAAE achieved higher rates of complete clinical and biochemical success than MRA (both P < 0.01). Logistic regression found that complete clinical and biochemical success was only directly associated with diagnosis of unilateral PA in contrast to bilateral PA (P < 0.01). Conclusions The present study provides evidence that SAAE is a reasonable choice of treatment in patients with either unilateral or bilateral PA in terms of clinical and biochemical outcomes. This study was registered at Chictr.org.cn (ChiCTR2100045896). [ABSTRACT FROM AUTHOR]

Background: Maxillofacial fractures can lead to massive oronasal bleeding; however, surgical hemostasis and packing procedures can be challenging owing to complex facial anatomy. Only a few studies investigated maxillofacial fractures with massive oronasal hemorrhage. However, thus far, no studies have reported a protocolized management approach for maxillofacial trauma from a single center. This study aimed to evaluate the effectiveness of protocolized management for maxillofacial fractures with oronasal bleeding. Methods: Patients were identified from the National Cheng University Hospital trauma registry from 2010 to 2020. We included patients with a face Abbreviated Injury Scale (AIS) score of > 3 and active oronasal bleeding. Patients' characteristics were compared between the angiography and non-angiography groups and between survivors and nonsurvivors. Results: Forty-nine patients were included. Among them, 34 (69%) underwent angiography, of whom 21 received arterial embolization. Forty-seven patients (96%) successfully achieved hemostasis by adhering to the treatment protocol at our institution. Compared with the non-angiography group, the angiography group had significantly more patients requiring oral intubation (97% vs. 53%, P < 0.001), Glasgow Coma Scale < 9 (GCS; 79% vs. 27%, P < 0.001), head AIS > 3 (65% vs. 13%, P = 0.001), higher Injury Severity Score (ISS; 43 [33–50] vs. 22 [18–27], P < 0.001), higher incidence of cardiopulmonary resuscitation (CPR; 41% vs. 0%, P = 0.002), higher mortality rate (35% vs. 7%, P = 0.043), and more units of packed red blood cells (PRBC) transfused within 24 h (12 [6–20] vs. 2 [0–4], P < 0.001). The nonsurvivor group had significantly more patients with hypotension (62% vs. 8%; P < 0.001), higher need for CPR (85% vs. 8%; P < 0.001), head AIS > 3 (92% vs. 33%; P < 0.001), skull base fracture (100% vs. 64%; P = 0.011), GCS score < 9 (100% vs. 50%; P = 0.003), higher ISS (50 [43–57] vs. 29 [19–48]; P < 0.001), and more units of PRBC transfused within 24 h (18 [13–22] vs. 6 [2–12]; P = 0.001) than the survivor group. More patients underwent angiography in the nonsurvivor group than in the survivor group (92% vs. 61%; P = 0.043). Among embolized vessels, the internal maxillary artery (65%) was the most common bleeding site. Hypoxic encephalopathy accounted for 92% of deaths. Conclusions: Protocol-guided management effectively optimizes outcomes in patients with maxillofacial bleeding. [ABSTRACT FROM AUTHOR]

Background: Trans-hepatic arterial chemoembolization (TACE) is a treatment option for liver cancer patients. It can prolong patients' survival but can also cause symptom distress. Symptom distress (SDs) can directly impact quality of life (QOL) and may indirectly influence QOL by lessening hope. In this study, we wanted to explore the mediating effect of hope on the relationship between SDs and QOL among patients with liver cancer receiving TACE.Methods: A cross-sectional study was conducted from December 20, 2017, to August 6, 2018, at a gastroenterology ward of a medical center. The participants were 92 liver cancer patients (69.6% male, mean age 67.8) who were admitted for TACE treatment. Information on SDs, hope, and QOL was collected by questionnaire on discharge day. Hayes' PROCESS model was used to test the mediating effect of hope on the relationship between SDs and QOL.Results: The mean score and standard deviation (SD) of SDs, hope, and QOL were 32.08 (SD = 6.22), 27.09 (SD = 3.51), and 55.16 (SD = 17.33), respectively. SDs negatively impacts quality of life. The total effect of SDs on QOL was - 1.41 (95% confidence interval [CI]: - 1.96, - 0.86). The indirect effect via the mediation of hope was - 0.95 (95% CI: - 1.7, - 0.45). Hope partially mediated the effect of SDs on QOL.Conclusion: SDs after TACE is vital; it directly reduces a patient's overall QOL and can indirectly hinder it by reducing the patient's hope. In addition to symptom management, interventions that help patients maintain their hope are key to improving QOL among patients receiving TACE. [ABSTRACT FROM AUTHOR]

The Emborrhoid is an innovative non-surgical technique for the treatment of severe hemorrhoidal bleeding. Patient selection and the impact on quality of life have not been fully investigated. This prospective observational study aims to evaluate the clinical outcomes after Emborrhoid in patients with high surgical risk. All patients with high surgical risk and anemia due to hemorrhoids were enrolled. Clinical data and previous blood transfusions were collected. The Hemorrhoidal Disease Symptom Score and Short Health Scala were completed before the procedure and during the follow-up visits at 1, 6 and 12 months. Transfusions and serum hemoglobin level variations were registered. Perioperative complications and the recurrence of bleeding were assessed. Trans-radial/femoral embolization of superior rectal artery, and/or middle rectal artery was performed with Interlock and Detachable Embolization Coils. From September 2020 to February 2022, 21 patients underwent a superselective embolization of all branches of the superior rectal artery. The transradial approach was most frequently performed compared to transfemoral access. After the procedure, no signs of ischemia were identified; three minor complications were observed. The mean follow-up was 18.5 ± 6.0 months. At the last follow-up, the mean increase of hemoglobin for patients was 1.2 ± 1.6 g/dL. Three patients needed transfusions during follow-up for recurrent hemorrhoidal bleeding. The Hemorrhoidal Disease Symptom Score and Short Health Scala decreased from 11.1 ± 4.2 to 4.7 ± 4.6 (p < 0.0001) and from 18.8 ± 4.8 to 10.2 ± 4.9 (p < 0.0001), respectively. Patients who had given up on their daily activities due to anemia have returned to their previous lifestyle. Emborrhoid seems to be a safe and effective option for the treatment of bleeding hemorrhoids in frail patients. The low complication rate and the significant reduction of post-defecation bleeding episodes are related to the improvement of the hemorrhoidal symptoms and patients' quality of life. [ABSTRACT FROM AUTHOR]

Presentation of a 62-year-old man with baseline chronic obstructive pulmonary disease admitted to the hospital with dyspnea and newly diagnosed COVID-19 infection. CT scan of the chest was obtained to rule out pulmonary embolism. This revealed a mural thrombus of the inner curvature of the aortic arch with a floating component. Therapeutic full dose anticoagulation was initiated in combination with close clinical observation and treatment for modest hypoxia. He did well for 1 month and then returned with ischemic rest pain of the right foot. Angiography revealed thrombosis of all 3 tibial arteries in the right leg. Percutaneous mechanical thrombectomy with tissue plasminogen activator injection and angioplasty was performed with success in 1 tibial artery to achieve in line flow to the foot. After continued anticoagulation, the remainder of the tibial arteries autolysed and the aortic thrombus was noted to be resolved 4 months later. A brief pathophysiology discussion is included. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the association between arterial embolisation (AE) for pelvic fractures and death. The study had a retrospective design, using data from a nationwide population based prospective registry of trauma patients in Japan. This propensity score matched study included all adult patients from the registry with pelvic fractures between January 2004 and December 2018. The primary outcome was hospital death. Secondary outcomes included 28 day survival and length of hospital stay (LOS) in days. Multivariable logistic regression analyses were performed to control confounding variables, including patient, clinical, and hospital related variables; concomitant trauma; severe trauma; and haemodynamic instability. A conditional logistic regression analysis was performed to assess the association between treatment of pelvic fracture with AE and hospital mortality rate. Among 17 670 eligible patients with pelvic fractures, 2 379 (13.5%) underwent AE (AE group) and 1 512 (8.6%) died in the hospital. After one to one propensity matching with 2 138 patients from each group (AE and non-AE), the hospital mortality rate was significantly lower in the AE group than in the non-AE group (15.0% vs. 18.1%; p =.007). The AE group had significantly lower mortality (odds ratio; 95% confidence interval [CI] 0.60; 0.43 – 0.84; p =.003) and a significantly higher 28 day mean survival rate than the non-AE group (0.89; 95% CI 0.87 – 0.90 vs. 0.86; 0.85 – 0.88; p =.003), although there was no significant difference in the LOS (48 days vs. 46 days; p =.11). This propensity score matched analysis showed an association between AE for pelvic fractures and lower hospital mortality rates. The findings in this large nationwide cohort study provide strong evidence for the benefit of embolisation for patients with pelvic fractures. [ABSTRACT FROM AUTHOR]

Introduction: The increasing incidence of obstetric complications, such as post-partum hemorrhage in the case of placenta accreta spectrum, calls for innovative and adapted therapeutic approaches. This presentation highlights the effectiveness of arterial embolization of the hypogastric artery, properly known as the internal iliac artery, in managing obstetric bleeding, even after initial surgical ligation. An approach never described in the literature., Presenation of Cases: 1st Case: A 38-year-old patient, in her fourth pregnancy with two previous caesarean sections, was admitted for moderate metrorrhagia at 19 weeks gestation. Ultrasound showed a monofetal pregnancy at 17 WG with a 6 cm placental abruption and an anterior placenta with accretion signs. An emergency subtotal hysterectomy with triple Tsirulsikov arterial ligation was performed after transfusion. Due to persistent bleeding, bilateral hypogastric artery ligation and abdominal packing were added, but without improvement. The patient was referred for embolization after hemodynamic stabilization. The procedure was carried out successfully and no complications were reported. 2nd Case: A 35-year-old patient with vaginal bleeding from placenta accreta at 25 WG required hemostasis hysterectomy. Despite the procedure, bleeding continued, leading to bilateral hypogastric artery ligation and pelvic packing. The patient was hemodynamically stabilized and transferred for hypogastric artery ligation, which was successfully performed without complication., Discussion: The role of interventional radiology in managing postpartum hemorrhage (PPH) is well established, with substantial literature supporting the benefits of uterine artery embolization as a lifesaving and often uterine-sparing procedure in PPH. While its indication for prevention is well-known, what about post-operatively? Our experience indicates that consulting a radiologist specializing in pelvic embolization can yield satisfactory outcomes despite technical difficulties., Conclusion: Embolization of the hypogastric arteries as well as embolization followed by surgical ligation of these arteries have been well described in the literature, the originality in our case reports is the embolization performed after surgical ligation which has not been described before according to our knowledge and which despite its technical difficulty can be a satisfactory alternative for the control of post-partum hemorrhage., Competing Interests: Declaration of competing interest We declare on our honor to have respected the ethics and anonymity of women in the use of data. We declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Flexible esophagogastroduodenoscopy is the gold standard for the management of acute upper gastrointestinal bleeding. This is a case of a man who was admitted in the emergency department because of melena with hypotension because of an ulcer in the anterior face of the duodenal bulb, refractory to 3 attempts of endoscopic therapy. Then, a gastroduodenal arterial embolization was tried, being impossible because of the presence of the median arcuate ligament, compressing the celiac trunk. A balloon-expandable stent was inserted in the celiac trunk, and then, the embolization was performed. After unsuccessful endoscopic management, the arterial embolization is one of the treatment options in nonvariceal acute upper gastrointestinal bleeding., (© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Objective: This study aimed to evaluate the prevalence of severe hemorrhage as a potentially life-threatening complication in elderly patients with isolated, low-energy pelvic ring fractures, which may be more common than previously described., Patients and Methods: A retrospective cohort study was conducted at an academic level 1 trauma center, including 579 patients aged over 65 who suffered from isolated low-energy pelvic fractures between 2006 and 2020. Pelvic computer tomography (CT) scans, with or without contrast, were performed and reviewed for patients with suspected posterior ring injury or bleeding. Patients without CT scans were excluded from the study., Results: Among the 123 patients with isolated pubic rami fractures, 30 (24.4 %) had bleeding with a significant hemoglobin drop (>2 g%). 21(70 %) patients of these had posterior pelvic ring involvement as compared to 45 who did not bleed (51 %, p = 0.07). There was a significantly larger proportion of patient who received anticoagulant therapy (ACT) with posterior ring injury among the bleeding group (20 % vs 3.2 % p < 0.01). Treatment included blood transfusion (19/123, 15.5 %), and arterial angiographic embolization (5/123, 4 %). No complications related to angio-embolization were observed, and all patients survived the initial 90-day period. No other source of bleeding was identified in any of these patients., Conclusion: Severe pelvic hemorrhage in the older adults due to a minor pelvic injury after a low-energy trauma is not an uncommon complication, especially with combination of ACT and posterior pelvic ring fracture. This indicates that these injuries more challenging than previously believed. Geriatric pelvic ring injuries should be monitored carefully with serial blood counts, and low threshold for imaging including contrast enhanced CT scans and angiography., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists have issued the guidelines and recommendations on postpartum hemorrhage since 2010 and have been conducted widespread educational activities from 2012. The aim of this study was to investigate the impact of these efforts by the Societies to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan.Methods: A national retrospective cohort study was conducted using the national database of health insurance claims for the period 2012 and 2018. The subjects were all insured women who received a blood transfusion for postpartum hemorrhage. The primary endpoints of this study were hysterectomy and maternal mortality. The etiology of hemorrhage, treatment facility, type of procedure, and blood transfusion volume were tabulated.Results: Women with postpartum hemorrhage that underwent transfusion increased from 3.5 to 5.5 per 1000 deliveries between 2012 and 2018. The most common cause of postpartum hemorrhage was atonic hemorrhage. After insurance coverage in 2013, the intrauterine balloon tamponade use increased to 20.3% of postpartum hemorrhages treated with transfusion in 2018, while the proportion of hysterectomy was decreased from 7.6% (2013-2015) to 6.4% (2016-2018) (p < 0.0001). The proportion of postpartum hemorrhage in maternal deaths decreased from 21.1% (2013-2015) to 14.1% (2016-2018) per all maternal deaths cases (p = 0.14). Cases with postpartum hemorrhage managed in large referral hospitals was increased (65.9% in 2012 to 70.4% in 2018) during the study period (p < 0.0001).Conclusions: The efforts by the Societies to prevent maternal mortality due to obstetric hemorrhage resulted in a significant decrease in the frequency of hysterectomies and a downward trend in maternal mortality due to obstetric hemorrhage. [ABSTRACT FROM AUTHOR]