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Published on: December 22, 2023
Evaluating the Impact of Embolization on Outcomes in Iliopsoas Hematomas: A Multicenter Retrospective
Romain Moinet1, Thibaut Moyne2, Gabriel Simon1
1Department of Radiology, University Marie and Louis Pasteur, University Hospital Besançon, CHU Besançon, Besançon, France (R.M., G.S.).
Rationale And Objectives:
The role of embolization in iliopsoas hematoma (IPH) remains unclear, and there are no specific guidelines regarding the optimal timing of this procedure. This study aimed to assess the effect of embolization on 30-day mortality in patients with IPH.
Materials And Methods:
This retrospective multicenter study included patients with Computed Tomography (CT)-confirmed IPH and active arterial bleeding between January 2017 and December 2023 in the first center and between January 2015 and July 2020 in the second center. Clinical, biological, imaging and procedural data were retrospectively collected. Embolization was performed by interventional radiologists, and procedural details were recorded. The effect of embolization on 30-day mortality was assessed using propensity score matching and Cox regression analyses.
Results:
A total of 146 patients with CT-confirmed IPH and active bleeding were included. The 30-day mortality rate was 40/146 (27%). Mortality rates were 15/51 (29%), 14/52 (27%), and 11/43 (26%) for conservative management, embolization, and surgery, respectively (P = 0.84). No significant difference in 30-day mortality was observed before or after propensity score matching. In multivariable analysis, a delay ≥ 3 h between CT and embolization and anticoagulation reversal therapy administration were independently associated with higher 30-day mortality (hazard ratio [HR], 8.69; 95% CI, 1.02-72.24; P = 0.046 and HR, 4.69; 95% CI, 1.03-21.39; P = 0.047, respectively).
Conclusion:
In this multicenter cohort, embolization did not improve 30-day survival. However, among embolized patients, shorter CT-to-embolization delays were associated with better outcomes, suggesting that when embolization is chosen, it should be performed promptly.
