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International Journal of Hematology

, Volume 106, Issue 6, pp 787–793 | Cite as

Availability of angiography and therapeutic embolization for the treatment of acute bleeding in patients with hemophilia

Original Article
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Abstract

Clotting factor replacement therapy alone is often inadequate for acute bleeding in hemophilia patients, and surgery for such patients poses significant clinical challenges. Arterial angiographic intervention is used to control bleeding in local blood vessels. In the present study, we examined the clinical course and prognosis of hemophilia patients with bleeding who had undergone angiography, and evaluated the validity of diagnostic angiography and therapeutic embolization in these patients. Angiography was performed in five hemophilia patients, who experienced bleeding that was difficult to control even after treatment with clotting factor replacement or bypassing agent therapy. Of these patients, four were confirmed to have continued bleeding, and angiographic embolization was performed using clotting factor concentrates or bypassing agents. However, one patient developed uncontrollable bleeding at the puncture site, which eventually led to the patient’s death. Thus, angiography and therapeutic embolization may be the preferred procedures for the treatment of hemorrhagic complications, refractory to treatment with clotting factor concentrates or bypassing agents. Further comprehensive, multidisciplinary team studies are needed to develop effective strategies to reduce hemorrhagic complications.

Keywords

Hemophilia Embolization Angiography 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.

References

  1. 1.
    Klamroth R, Gottstein S, Essers E, Landgraf H, Wilaschek M, Oldenburg J. Successful angiographic embolization of recurrent elbow and knee joint bleeds in seven patients with severe haemophilia. Haemophilia. 2009;15:247–52.CrossRefPubMedGoogle Scholar
  2. 2.
    van den Berg HM, Fischer K, Mauser-Bunschoten EP, Beek FJ, Rosendal G, van der Bom JG, et al. Long-term outcome of individualized prophylactic treatment of children with severe haemophilia. Br J Haematol. 2001;112:561–5.CrossRefPubMedGoogle Scholar
  3. 3.
    Defreyne L, Vanlangenhove P, De Vos M, Pattyn P, Van Maele G, Decruyenaere J, et al. Embolization as a first approach with endoscopically unmanageable acute nonvariceal gastrointestinal hemorrhage. Radiology. 2001;218:739–48.CrossRefPubMedGoogle Scholar
  4. 4.
    Pollak JS, White RI. The use of cyanoacrylate adhesives in peripheral embolization. J Vasc Interv Radiol. 2001;12:907–13.CrossRefPubMedGoogle Scholar
  5. 5.
    Aina R, Oliva VL, Therasse E, Perreault P, Bui BT, Dufresne MP, et al. Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol. 2001;12:195–200.CrossRefPubMedGoogle Scholar
  6. 6.
    Mauser-Bunschoten EP, Zijl JA, Mali W, van Rinsum AC, van den Berg HM, Roosendaal G. Successful treatment of severe bleeding in hemophilic target joints by selective angiographic embolization. Blood. 2005;105:2654–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Keller A, Terrier F, Schneider PA, Bianchi S, Howarth N, De Moerloose P. Pelvic haemophilic pseudotumour: management of a patient with high level of inhibitors. Skelet Radiol. 2002;31:550–3.CrossRefGoogle Scholar
  8. 8.
    Mann HA, Goddard NJ, Lee CA, Brown SA. Periarticular aneurysm following total knee replacement in hemophilic arthropathy. A case report. J Bone Jt Surg Am. 2003;85-A:2437–40.CrossRefGoogle Scholar
  9. 9.
    Thomas CD, Asumu T, Chalmers N, Hirst P. Therapeutic embolization for sustained hemorrhage following total hip replacement in a patient with hemophilia A. Orthopedics. 2000;23:849–50.PubMedGoogle Scholar
  10. 10.
    Kish JW, Katz MD, Marx MV, Harrell DS, Hanks SE. N-butyl cyanoacrylate embolization for control of acute arterial hemorrhage. J Vasc Interv Radiol. 2004;15:689–95.CrossRefPubMedGoogle Scholar
  11. 11.
    Garge S, Keshava SN, Moses V, Mammen S, Ahmed M, Chiramel GK, et al. Role of endovascular embolization in treatment of acute bleeding complications in haemophilia patients. Br J Radiol 2016;89:20151064.CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Hemingway AP, Allison DJ. Complications of embolization: analysis of 410 procedures. Radiology. 1988;166:669–72.CrossRefPubMedGoogle Scholar
  13. 13.
    Kickuth R, Anderson S, Peter-Salonen K, Lammle B, Eggli S, Triller J. Hemophilia A pseudoaneurysm in a patient with high responding inhibitors complicating total knee arthroplasty: embolization: a cost-reducing alternative to medical therapy. Cardiovasc Interv Radiol. 2006;29:1132–5.CrossRefGoogle Scholar
  14. 14.
    Espandar R, Heidari P, Rodriguez-Merchan EC. Management of haemophilic pseudotumours with special emphasis on radiotherapy and arterial embolization. Haemophilia. 2009;15:448–57.CrossRefPubMedGoogle Scholar
  15. 15.
    Rodriguez-Merchan EC. The haemophilic pseudotumour. Haemophilia. 2002;8:12–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Hagiwara A, Yukioka T, Ohta S, Nitatori T, Matsuda H, Shimazaki S. Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolization. Am J Roentgenol. 1996;167:159–66.CrossRefGoogle Scholar
  17. 17.
    Schenker MP, Duszak R Jr, Soulen MC, Smith KP, Baum RA, Cope C, et al. Upper gastrointestinal hemorrhage and transcatheter embolotherapy: clinical and technical factors impacting success and survival. J Vasc Interv Radiol. 2001;12:1263–71.CrossRefPubMedGoogle Scholar
  18. 18.
    Encarnacion CE, Kadir S, Beam CA, Payne CS. Gastrointestinal-bleeding—treatment with gastrointestinal arterial embolization. Radiology. 1992;183:505–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Beeton K. Evaluation of outcome of care in patients with haemophilia. Haemophilia. 2002;8:428–34.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2017

Authors and Affiliations

  1. 1.Department of PediatricsKyung Hee University Hospital at GangdongSeoulKorea
  2. 2.Department of RadiologyKyung Hee University Hospital at GangdongSeoulKorea

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