Does this Need Embolisation? Arterial Bleeding at Anatomically Compressible Sites

To assess the efficacy of conservative management for haematomas that demonstrate arterial bleeding, in anatomical regions of the body that are compressible against a firm bony landmark.

Single-centre retrospective cohort study of patients presenting with arterial bleeding managed conservatively or with either endovascular embolisation or surgical intervention. Patients who were identified to have a CT confirmed haematoma with arterial bleeding, in an anatomical location deemed compressible were included. Conservative management included compression, ice, anticoagulation reversal, and fluid resuscitation. Conservative management was deemed successful if no further intervention was required. Clinical outcomes measured included success of conservative management, length of hospital stay, and 30-day all-cause mortality.

256 patients were included with a mean age of 60 years (SD 21.2). The most common location of bleeding was gluteal (37%) and the most common cause for bleeding was motor vehicle accidents (42%). 67% of cases were managed conservatively as the primary management. Overall, 92.2% of patients were successfully treated with the primary management of choice, with no significant difference between patients managed conservatively or with intervention (92.4% vs. 91.8%, p = 0.43). Subgroup analysis of patients presenting in acute shock also demonstrated no significant difference between the conservatively managed group and the group managed with intervention (88% vs. 95% success, p = 0.26). The intervention group were more clinically unwell at presentation and had a higher 30-day all-cause mortality (p =  < 0.001). There was no significant difference in hospital length of stay.

Conservative management for arterial bleeding in anatomically compressible sites has a high success rate.