Endovascular Embolization in Acquired Hemophilia A: A Case Study Highlighting Diagnostic and Therapeutic Strategies

BACKGROUND Acquired hemophilia A (AHA) is a rare and potentially life-threatening bleeding disorder characterized by the formation of autoantibodies targeting coagulation factor VIII (FVIII). This condition poses considerable diagnostic and therapeutic challenges, requiring a multidisciplinary approach. Despite advancements in treatment, literature on the management of bleeding episodes in patients with hemophilia undergoing endovascular procedures remains limited. It is essential to acknowledge the significance of timely diagnosis and customized intervention for enhancing outcomes. CASE REPORT We report the case of an 82-year-old woman presenting with a large hematoma on the anterior surface of the left thigh due to AHA. The patient was initially treated with immunosuppression combined with administration of recombinant activated FVII, but there was no observed response. The patient's condition worsened, leading to hemodynamic instability. Consequently, CT angiography was performed, which identified extravasation from a branch of the left superficial femoral artery. Following this, the patient underwent successful endovascular embolization of the bleeding vessel, leading to effective hemorrhage control without complications. The whole procedure was performed under hemostasis expert supervision and administration of recombinant activated human FVII. CONCLUSIONS This case highlights that endovascular embolization can be a safe and effective option for controlling bleeding in selected patients, particularly when traditional strategies are insufficient. Its success depends on a multidisciplinary approach and collaboration among various medical specialists under the supervision of hemostasis experts, due to the high periprocedural risks.