Adrenal glands hemorrhages: embolization in acute setting

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Emergency Medicine

Background:

• Acute adrenal hemorrhages are rare abdominal injuries, often caused by trauma or ruptured neoplasms.
• The adrenal glands' location makes them less susceptible to injury compared to other abdominal organs.
• This study details a single center's experience with transarterial embolization for adrenal hemorrhages in emergency cases.

Purpose of the Study:

• To evaluate the safety and efficacy of transarterial embolization for acute adrenal hemorrhages.
• To report on the technical and clinical outcomes of endovascular embolization in a cohort of patients.
• To highlight the importance of detailed imaging for managing adrenal bleeding.

Main Methods:

• Retrospective analysis of 17 patients treated with endovascular embolization for adrenal bleeding from 2010 to present.
• Etiologies included trauma (7), ruptured neoplasms (8), and spontaneous bleeding (2) in patients on anticoagulants.
• Superselective embolization was performed using various agents after thin-slice contrast-enhanced CT and angiography.

Main Results:

• Technical success rate of 94.1% (interruption of bleeding on angiography).
• Clinical success rate of 82.3% (hemodynamic stability within 24 hours).
• No major procedure-related complications, infarctions, necrosis, abscesses, or need for long-term steroid supplementation.

Conclusions:

• Catheter-directed embolization provides a safe and effective management for acute adrenal hemorrhages.
• Thorough CT and angiography are crucial for identifying bleeding sources within the adrenal gland's complex arterial network.
• Endovascular embolization is a viable alternative to surgery for adrenal bleeding.