Transcatheter Arterial Embolization (TAE) of Cancer-Related Bleeding
Roberto Minici,
Giuseppe Guzzardi,
Massimo Venturini,
Federico Fontana,
Andrea Coppola,
Marco Spinetta,
Filippo Piacentino,
Armando Pingitore,
Raffaele Serra,
Davide Costa,
Nicola Ielapi,
Pasquale Guerriero,
Biagio Apollonio,
Rita Santoro,
MGJR Research Team,
Luca Brunese,
Domenico Laganà
Affiliations
Roberto Minici
Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
Giuseppe Guzzardi
Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
Massimo Venturini
Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
Federico Fontana
Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
Andrea Coppola
Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
Marco Spinetta
Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
Filippo Piacentino
Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
Armando Pingitore
Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
Raffaele Serra
Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy
Davide Costa
Department of Law, Economics and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
Nicola Ielapi
Department of Public Health and Infectious Disease, Sapienza University of Rome, 00185 Rome, Italy
Pasquale Guerriero
Radiology Unit, Santobono-Pausilipon Hospital, 80129 Naples, Italy
Biagio Apollonio
Radiology Unit, San Timoteo Hospital, 86039 Termoli, Italy
Rita Santoro
Haemophilia and Thrombosis Center, Dulbecco University Hospital, 88100 Catanzaro, Italy
MGJR Research Team
Magna Graecia Junior Radiologists Research Team, 88100 Catanzaro, Italy
Luca Brunese
Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
Domenico Laganà
Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
Background and Objectives: Roughly 10% of cancer patients experience an episode of bleeding. The bleeding severity can range from occasional trivial bleeds to major bleeding. The treatment for the bleeding may vary, depending on the clinical condition and anatomical site, and may include various strategies, among which TAE is a cornerstone of major bleeding management. However, the existing literature on tumor hemorrhages is inconsistent. The objective of this multicenter retrospective cohort study was to evaluate the effectiveness and safety of arterial embolization in the treatment of tumor hemorrhages in patients with solid cancers. Materials and Methods: The data for patients with solid cancers undergoing TAE for the management of tumor hemorrhages from January 2020 to May 2023 were gathered. Results: A total of 92 patients with cancer-related bleeding were treated between January 2020 and May 2023. No bleeding was detected by X-ray angiography (XA) in 12 (13%) cases; therefore, a blind embolization was performed. The most common bleeding site was the liver (21.7%). A total of 66 tumor hemorrhages were spontaneous. The most commonly used embolic agent was polyvinyl alcohol (PVA) particles (30.4%). Technical success was achieved in 82 (89.1%) cases, with an 84.8% clinical success rate related to 14 cases of rebleeding. Proximal embolization was performed for 19 (20.7%) patients. Complications were recorded for 10 (10.9%) patients. The 30-day bleeding-related mortality was 15.2%. The technical success, clinical success, proximal embolization rate, and 30-day rebleeding were worse in the subset of patients undergoing TAE with coils. Conclusions: Transcatheter arterial embolization (TAE) represents a viable and potentially life-saving therapeutic approach in the management of tumor hemorrhages, demonstrating a notable effectiveness and safety. The TAE of bleeding tumors using coils resulted in a higher rate of non-superselective proximal embolization, with a trend toward lower clinical success rates and higher rebleeding episodes.
