Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Traumatic Hemothorax Caused by Thoracic Wall and Intrathoracic Injuries: Clinical Outcomes of Transcatheter Systemic Artery Embolization

흉벽 및 흉곽 내 장기 손상으로 인한 외상성 혈흉: 전신 동맥 색전술의 임상 결과

  • Chang Mu Lee (Department of Radiology, Pusan National University Hospital) ;
  • Chang Ho Jeon (Department of Radiology, Pusan National University Hospital) ;
  • Rang Lee (Department of Radiology, Pusan National University Hospital) ;
  • Hoon Kwon (Department of Radiology, Pusan National University Hospital) ;
  • Chang Won Kim (Department of Radiology, Pusan National University Hospital) ;
  • Jin Hyeok Kim (Department of Radiology, Pusan National University Yangsan Hospital) ;
  • Jae Hun Kim (Department of Trauma and Surgical Critical Care, Pusan National University Hospital) ;
  • Hohyun Kim (Department of Trauma and Surgical Critical Care, Pusan National University Hospital) ;
  • Seon Hee Kim (Department of Trauma and Surgical Critical Care, Pusan National University Hospital) ;
  • Chan Kyu Lee (Department of Trauma and Surgical Critical Care, Pusan National University Hospital) ;
  • Chan Yong Park (Department of Trauma Surgery, Wonkwang University Hospital) ;
  • Miju Bae (Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital)
  • 이창무 (부산대학교병 영상의학과) ;
  • 전창호 (부산대학교병 영상의학과) ;
  • 이랑 (부산대학교병 영상의학과) ;
  • 권훈 (부산대학교병 영상의학과) ;
  • 김창원 (부산대학교병 영상의학과) ;
  • 김진혁 (양산부산대학교병원 영상의학과) ;
  • 김재훈 (부산대학교병원 외상외과) ;
  • 김호현 (부산대학교병원 외상외과) ;
  • 김선희 (부산대학교병원 외상외과) ;
  • 이찬규 (부산대학교병원 외상외과) ;
  • 박찬용 (원광대학교병원 외상외과) ;
  • 배미주 (부산대학교병원 흉부외과)
  • Received : 2020.06.09
  • Accepted : 2020.08.11
  • Published : 2021.07.01
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Abstract

Purpose We aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma. Materials and Methods Between 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications. Results Bleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia. Conclusion TAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency surgery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.

목적 흉부 외상에 의해 발생한 혈흉에 대해 동맥 색전술의 임상적 효용성을 보고하고자 한다. 대상과 방법 2015년부터 2019년까지 68명의(남자 56명; 평균 나이 58.2세) 흉부 출혈에 대한 동맥색전술을 시행 받은 환자가 포함되었다. 후향적으로 환자군의 특징, 혈관조영술 소견, 색전술에 사용한 기법, 기술적 및 임상적 성공률과 합병증을 조사하였다. 결과 출혈 부위는 늑간동맥(50%)이 가장 많았고, 그다음은 내흉동맥(29.5%)이었다. 한 명을 제외한 나머지 환자에서는 즉각적인 출혈 정지로 정의된 기술적 성공을 획득할 수 있었다. 첫 동맥 색전술 이후 네 명의 환자에서 지연 출혈 또는 혈흉의 증가 소견이 있었고, 이에 대해 반복적 동맥 색전술을 시행하여 성공적인 결과를 얻었다. 동맥 색전술 후 지혈 목적의 개흉술이 필요하지 않은 것으로 정의된 임상적 성공은 92.6%로 보고되었다. 다섯 명의 환자는 지혈을 위해 색전술 후 개흉술을 시행하였다. 뇌경색이나 사지 마비와 같은 동맥 색전술과 관련한 주요 합병증은 발생하지 않았다. 결론 외상성 흉벽 및 흉곽 내 장기 손상에 의한 동맥 출혈에 대해 시행하는 동맥 색전술은 안전하고 효과적인 최소 침습적 시술이다. 외상성 혈흉 환자에서 응급 수술을 필요로 하지 않는 혈흉만 있거나, 또는 동반된 복부나 골반 손상의 지혈을 위해 응급 동맥 색전술을 시행하는 경우, 흉부 영역의 동맥 색전술을 고려할 수 있다.

Keywords

Acknowledgement

This work was supported by clinical research grant from Pusan National University Hospital in 2020.

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