Predictors of Active Extravasation and Complications after Conventional Angiography for Acute Intraabdominal Bleeding

Area of Science:

• Radiology
• Interventional Radiology
• Gastroenterology

Background:

• Conventional angiography is a standard diagnostic and therapeutic tool for intraabdominal bleeding.
• Potential complications include contrast-induced nephropathy (CIN).

Purpose of the Study:

• To identify predictors of active extravasation during angiography for acute intraabdominal bleeding.
• To determine factors associated with complications, specifically CIN, following angiography.

Main Methods:

• Retrospective review of 75 conventional angiograms for acute intraabdominal bleeding (January 2013-June 2015).
• Data collected included demographics, comorbidities, vital signs, complications, hematocrit change (ΔHct), and fluid/blood product administration.
• Statistical analysis to identify independent predictors of extravasation and CIN.

Main Results:

• Twenty-seven percent of angiograms (20/75) showed active extravasation.
• A greater decrease in hematocrit (ΔHct) over 24 hours was the sole independent predictor of extravasation (p=0.017).
• Contrast-induced nephropathy (CIN) occurred in 15% of cases (10/66).
• Pre-existing reduced glomerular filtration rate (GFR) was the only independent predictor of CIN (p=0.03).

Conclusions:

• A significant hematocrit decline preceding angiography is a strong predictor of active intraabdominal bleeding.
• Patients with impaired renal function (low GFR) are at higher risk for developing CIN post-angiography.
• While rapid angiography is recommended for patients with substantial hematocrit drops, the risk of renal complications should be considered.