Collateral-pathway-oriented clinico-angiographic framework for inferior epigastric artery-related hemorrhage: embolization planning and clinical outcomes.

Tokue H, Ebara M, Tokue A, Tsushima Y.

research-articleOpen access

AI summary — for doctors, generated from the abstract only

A collateral-pathway-based classification of inferior epigastric artery hemorrhage showed 100% technical success of embolization but much lower clinical success in pelvic fracture-related (corona mortis) cases.

What was studied

Retrospective review of 62 consecutive patients with IEA-related hemorrhage treated with TAE, categorized into four collateral-pathway types (A abdominal wall, B round ligament/postpartum, C corona mortis/pelvic fracture, D iatrogenic).

Key findings

Technical success 100%; overall clinical success 82.3%
Clinical success by type: A 96.4%, B 80.0%, C 56.3%, D 100%
Rebleeding in 4.8%, all Type C
In-hospital mortality 12.9%, concentrated in Type C
Type C (aOR 4.6) and DIC (aOR 3.7) associated with clinical failure in exploratory analysis; specific statistic not fully captured in the abstract

Clinical relevance

This suggests anatomic categorization may aid embolization planning for IEA bleeding, while poor Type C outcomes likely reflect trauma severity and coagulopathy rather than embolization failure alone.

Who should care

Interventional Radiology

Limitations

Retrospective single-series design, small subgroups, exploratory regression and descriptive score without validation.

IEA bleeding embolization almost always works technically, but pelvic fracture-related cases do poorly due to overall injury burden.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

Background/objectives

Although inferior epigastric artery (IEA)-related hemorrhage can occur in diverse settings, outcomes following transcatheter arterial embolization (TAE) vary according to collateral anatomy and physiologic severity. We aimed to describe a collateral-pathway-oriented clinico-angiographic framework for IEA-related hemorrhage and evaluate technical and clinical outcomes of TAE across these categories. Predictors of the composite clinical failure endpoint and a simple exploratory descriptive score were assessed as exploratory secondary analyses.

Methods

We retrospectively reviewed 62 consecutive patients with IEA-related hemorrhagic events treated with TAE; cases were categorized into four collateral-pathway-oriented clinico-angiographic categories (Types A-D) based on CT/DSA findings together with the clinical context, to reflect the dominant collateral circuit relevant to embolization planning. The categories were Type A (isolated abdominal wall, n = 28), Type B (round ligament/postpartum, n = 15), Type C (corona mortis/pelvic fracture, n = 16), and Type D (iatrogenic puncture-related, n = 3). Technical success was defined as angiographic disappearance of the extravasation/pseudoaneurysm. Clinical success was defined as hemodynamic stabilization within 24 h without repeat TAE or surgery. Clinical failure comprised lack of clinical success and/or in-hospital death. Rebleeding from the treated IEA territory was also assessed separately. Logistic regression was performed after excluding Type D patients (n = 59) owing to complete separation as an exploratory analysis of factors associated with the composite clinical failure endpoint. A point-based score was derived descriptively from these factors.

Results

Technical success was achieved in all cases (62/62, 100%). The overall clinical success rate was 82.3% (51/62). Clinical success rates varied across categories: Type A 96.4%; Type B, 80.0%; Type C, 56.3%; and Type D, 100%. Rebleeding from the treated IEA territory occurred in 3 patients (4.8%), all of whom had Type C. In-hospital mortality was 12.9% (8/62), concentrated in Type C. In exploratory multivariable analysis (n = 59), Type C category (aOR, 4.6), DIC (aOR, 3.7), and SBP < 80 mmHg (aOR, 3.1) were associated with the composite clinical failure endpoint. A descriptive three-factor score (Type C = 2, DIC = 2, and SBP < 80 mmHg = 1) showed a stepwise increase in this composite endpoint from 7.1 to 71.4%.

Conclusions

A collateral-pathway-oriented clinico-angiographic framework may support systematic evaluation of the external iliac/IEA system during embolization planning. Poorer outcomes in pelvic fracture-related Type C cases should be interpreted cautiously because they may reflect trauma burden, coagulopathy, and systemic derangement rather than IEA embolization failure alone.

DOI

10.1186/s42155-026-00742-3

PMID

42521881

PMCID

PMC13415429

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

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