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Zhang KD, Jost E, Panse J, Herwartz R, Lindemann-Docter K, Jonigk D, Kricheldorf K, Köchel A, Sauerbrunn N, Brümmendorf TH, Koschmieder S, Isfort S. Bone marrow biopsy in geriatric patients above the age of 85 years: invaluable or unnecessary? A retrospective analysis. Ann Hematol 2024; 103:1149-1158. [PMID: 38336973 PMCID: PMC10940467 DOI: 10.1007/s00277-024-05650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/31/2024] [Indexed: 02/12/2024]
Abstract
Bone marrow biopsy (BMB) is a well-established diagnostic tool for various hematological, oncological, and other medical conditions. However, treatment options for geriatric patients (pts) facing these diseases are often constrained. In this single-center, retrospective analysis we assessed the diagnostic value of BMB in geriatric pts aged ≥ 85 years and examined its impact on therapeutic decisions. We examined 156 BMB procedures in 129 pts, extracting data from the electronic patient records and applying descriptive statistical methods. Nearly half of the primary diagnostic procedures (26; 44.1%) resulted in a modification of the initially suspected diagnosis. Notably, 15 (25.4%) of these procedures, led to changes in both the diagnosis and planned interventional treatment. Among the 15 follow-up procedures (36.6%), disease progression was initially suspected based on symptoms, but BMB results excluded such progression. In lymphoma staging biopsies, only 2 (3.6%) prompted a change in therapeutic intervention. Importantly, no BMB-related complications, such as bleeding, infection or nerve damage, were reported. Median survival after BMB was 16.1 months across all pts, yet it varied based on the diagnosis and comorbidity score. The survival of pts with a change in therapy based on BMB results did not significantly differ from those who did not undergo a therapy change. In conclusion, BMB proved to be generally safe and beneficial in this geriatric cancer patient cohort beyond the age of 85 years. However, the advantages of lymphoma staging in this patient population warrant further consideration.
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Affiliation(s)
- Kailun David Zhang
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
- Department of Neurology, Kliniken Maria Hilf Mönchengladbach, Mönchengladbach, Germany
| | - Edgar Jost
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Jens Panse
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Reinhild Herwartz
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Katharina Lindemann-Docter
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
- German Center for Lung Research (DZL), BREATH, Hannover, Germany
| | - Danny Jonigk
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
- German Center for Lung Research (DZL), BREATH, Hannover, Germany
| | - Kim Kricheldorf
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Anja Köchel
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Nicolas Sauerbrunn
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Tim H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Steffen Koschmieder
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Susanne Isfort
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany.
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany.
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Swartz S, Puetz JR, Madenberg D, Voigt L, Cuzovic N, Bielecki M, Umpierrez De Reguero A. Bone marrow biopsies: A hospitalist bedside procedure service 5-year experience. J Hosp Med 2023; 18:15-20. [PMID: 36238982 DOI: 10.1002/jhm.12983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/31/2022] [Accepted: 09/14/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Bone marrow aspiration and biopsies (BMAB) are a relatively frequent procedure needed in the inpatient setting, especially in a tertiary care center. OBJECTIVE Procedure-focused hospitalists can provide an excellent option for doing inpatient BMAB. Here we present five years of experience with a hospitalist bedside procedure service (BPS) performing BMAB. DESIGN In 2016, the BPS partnered with the oncology service to begin performing inpatient BMAB. SETTINGS AND PARTICIPANTS We evaluated internally collected data from the procedures performed by the BPS from 2016-2020. INTERVENTION From 2015-2016, faculty members on the BPS team were trained by the oncology department to do a BMAB, which was then offered as an inpatient procedure by the BPS from 2016-2021. MAIN OUTCOME AND MEASURES Total number of BMAB performed, success rates, bleeding risk profiles of patients, rate of trainee participation, and complication rates. RESULTS The BPS performed a total of 432 BMAB from 2016-2021. Forty-six (10.6%) were unsuccessful and required referral for CT guidance. Elevated bleeding risk was present in 88 (20.4%) of patients. Trainees assisted in 62 (14.4%) of the procedures.There was one complication (0.2%).
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Affiliation(s)
- Sheila Swartz
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph R Puetz
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Devin Madenberg
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lara Voigt
- Department of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Nikola Cuzovic
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew Bielecki
- Department of Medicine, Apogee Physicians Medical Group, Milwaukee, Wisconsin, USA
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Khdhir M, Jabbour Y, Azzi C, El-Alam R, Muallem N, Moukaddam H. Complications associated with improper palpation-guided iliac bone marrow biopsy tracts identified on follow-up imaging. Skeletal Radiol 2022; 51:2155-2166. [PMID: 35612650 DOI: 10.1007/s00256-022-04078-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Bone marrow biopsy complications are rare. Our aim is to study the association of improper palpation-guided iliac biopsy tract with complications. MATERIALS AND METHODS This is a retrospective study of adult patients who underwent iliac bone marrow biopsy without image guidance at our hospital from January 2019 to January 2021, and have cross-sectional radiologic imaging of the pelvis within 30 days following the procedure. Electronic health records were reviewed for clinical data. Two radiologists reviewed images of the pelvis for assessment of biopsy tract and complications. RESULTS A total of 443 procedures were included in 309 patients, mean age 53.4 ± 18.1 years, 112 females (36.2%). In addition, 332 tracts were proper (75%), 97 improper (22%), and 14 unidentified (3%). All 11 complications occurred in procedures with improper tracts; nine bleeding, one fracture, and one facet joint injury. Improper tract was significantly associated with complications (p < .001). There was no statistically significant association between platelet count, international normalized ratio, antiplatelet use and anticoagulant use, and presence of complications (p > .05). Body mass index and subcutaneous fat thickness overlying posterior superior iliac spine were not associated with improper tract (p > .05). Procedures performed by providers with ≤ 12 months' experience were significantly associated with improper tract (p < .001) and hence associated with complications (p = .007). CONCLUSION Improper tracts were common in palpation-guided iliac bone marrow biopsy and significantly associated with complications. No complications were encountered in proper tract procedures. Procedures performed by providers with ≤ 12 months' experience were significantly associated with improper tract and complications.
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Affiliation(s)
- Mihran Khdhir
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon.
| | - Yara Jabbour
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon
| | - Caline Azzi
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon
| | - Raquelle El-Alam
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon
| | - Nadim Muallem
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon
| | - Hicham Moukaddam
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon
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Maruhashi T, Kurihara Y, Oi M, Kashimi F, Tamura S, Kim M, Asari Y. Efficacy of median sacral artery embolization for treating severe pelvic fractures: a retrospective study. J Int Med Res 2021; 49:3000605211063315. [PMID: 34878941 PMCID: PMC8664313 DOI: 10.1177/03000605211063315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Transcatheter arterial embolization (TAE) of bilateral internal iliac arteries (IIAs) in patients with a hemodynamically unstable pelvic fracture is associated with a low mortality rate. The persistence of unstable hemodynamics after IIA embolization indicates the involvement of other arteries, such as the median sacral artery (MSA). This study aimed to evaluate the efficacy of MSA embolization. Methods In this single-center, retrospective, observational study, medical records of patients who underwent MSA angiography or embolization for pelvic fractures (n = 21) between January 2007 and August 2019 were reviewed. The percentage of patients achieving hemodynamic stabilization by MSA embolization was calculated. Results Fifteen patients underwent MSA embolization, and the remaining six underwent MSA angiography. The shock index value was significantly higher after MSA embolization than that before MSA embolization in hemodynamically unstable patients who underwent this procedure. The success rate of MSA selection was 100%. One patient presented with urinary retention because of bladder and rectal disorders after MSA embolization. The 30-day survival rate was 85.7%. Conclusions Severe pelvic fractures, such as a Dennis Zone III fracture and suicidal jumper’s fracture due to trauma from a fall, may require MSA embolization.
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Affiliation(s)
- Takaaki Maruhashi
- Department of Emergency and Critical Care Medicine, 38088Kitasato University School of Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Yutaro Kurihara
- Department of Emergency and Critical Care Medicine, 38088Kitasato University School of Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Marina Oi
- Department of Emergency and Critical Care Medicine, 38088Kitasato University School of Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Fumie Kashimi
- Department of Emergency and Critical Care Medicine, 38088Kitasato University School of Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Satoshi Tamura
- Department of Emergency and Critical Care Medicine, 38088Kitasato University School of Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Muneyoshi Kim
- Department of Emergency and Critical Care Medicine, 38088Kitasato University School of Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Yasushi Asari
- Department of Emergency and Critical Care Medicine, 38088Kitasato University School of Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
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Smith TA, Gage D, Quencer KB. Narrative review of vascular iatrogenic trauma and endovascular treatment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1199. [PMID: 34430640 PMCID: PMC8350708 DOI: 10.21037/atm-20-4332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
Iatrogenic injury is unfortunately a leading cause of morbidity and mortality for patients worldwide. The etiology of iatrogenic injury is broad, and can be seen with both diagnostic and therapeutic interventions. While steps can be taken to reduce the occurrence of iatrogenic injury, it is often not completely avoidable. Once iatrogenic injury has occurred, prompt recognition and appropriate management can help reduce further harm. The objective of this narrative review it to help reader better understand the risk factors associated with, and treatment options for a broad range of potential iatrogenic injuries by presenting a series of iatrogenic injury cases. This review also discusses rates, risk factors, as well as imaging and clinical signs of iatrogenic injury with an emphasis on endovascular and minimally invasive treatments. While iatrogenic vascular injury once required surgical intervention, now minimally invasive endovascular treatment is a potential option for certain patients. Further research is needed to help identify patients that are at the highest risk for iatrogenic injury, allowing patients and providers to reconsider or avoid interventions where the risk of iatrogenic injury may outweigh the benefit. Further research is also needed to better define outcomes for patients with iatrogenic vascular injury treated with minimally invasive endovascular techniques verses conservative management or surgical intervention.
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Affiliation(s)
- Tyler Andrew Smith
- Department of Interventional Radiology, University of Utah, Salt Lake City, UT, USA
| | - David Gage
- Department of Medicine, Intermountain Healthcare, Murray, UT, USA
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6
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Stensby JD, Long JR, Hillen TJ, Jennings JW. Safety of bone marrow aspiration and biopsy in severely thrombocytopenic patients. Skeletal Radiol 2021; 50:915-920. [PMID: 33011873 DOI: 10.1007/s00256-020-03623-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/11/2020] [Accepted: 09/20/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the safety of fluoroscopically guided drill-assisted bone marrow aspirate and biopsy in severely thrombocytopenic patients. MATERIALS AND METHODS The study was approved by the IRB with waiver of informed consent. Retrospective review of 111 bone marrow aspirate and biopsies (BMAB) performed in 94 patients who received a CT scan which included the pelvis and biopsy site within the 7 days following the BMAB. The 94 patients were subdivided based on their platelet count: severe thrombocytopenia (< 20 platelets × 109/L), thrombocytopenia (20-50 platelets × 109/L), and control (> 50 platelets × 109/L). The procedure report was reviewed for sedation time, aspirate volume, and aggregate size of core biopsy specimens. The electronic medical record was reviewed for specimen adequacy; pathologic diagnosis; body mass index; pre- and post-procedure labs including platelet count, hemoglobin (HGB), hematocrit (HCT), prothrombin time (PT), and international normalized ratio (INR) levels; post-procedural transfusion; and complications including mortality at 30 and 90 days. CT scans were independently reviewed by 2 fellowship-trained radiologists for the presence of post-procedural hemorrhage. RESULTS There was no significant difference in CT-identified post-procedural hematoma, or change in the hemoglobin and hematocrit levels pre- and post-procedure between the three groups. There was no significant difference in complication rate or all-cause mortality. There was a significant difference in transfusion at 30 days with thrombocytopenic and severely thrombocytopenic patients more likely to receive transfusion within the 30 days post-procedure. CONCLUSION Fluoroscopically guided BMAB can be safely performed in patients with severe thrombocytopenia.
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Affiliation(s)
- J D Stensby
- Department of Radiology, University of Missouri, 1 Hospital Dr., Columbia, MO, 65203, USA.
| | - J R Long
- Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - T J Hillen
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA
| | - J W Jennings
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA
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Nagasawa H, Omori K, Yanagawa Y. A case of median sacral artery avulsion injury by L4-5 lateral dislocation fracture. Trauma Case Rep 2021; 33:100484. [PMID: 33997228 PMCID: PMC8102800 DOI: 10.1016/j.tcr.2021.100484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 11/03/2022] Open
Abstract
Introduction The median sacral artery injury is a rare entity, especially in trauma. And the injuries are always with pelvic fractures. We describe a case of the median sacral injury which was induced by blunt trauma without pelvic fractures. Case presentation A 26-year-old male who suffered L4-5 fracture dislocation and some hemorrhage in pelvic cavity following a motorcycle accident. He had a median sacral artery injury, and we tried to the trans-catheter arterial embolization, however it could not be success. The embolization was performed using of gelatin sponges in bilateral internal iliac artery and left 4th lumber artery. After his admission, a demand of transfusions lasted for 7 days. Conclusion We successfully treated a case of median sacral avulsion injury by choosing conservative treatment.
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Affiliation(s)
- Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
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Faraj J, Daneshmand A, Mwipatayi BP. Large spontaneous median sacral artery pseudoaneurysm masquerading as hip pain. J Vasc Surg Cases Innov Tech 2020; 6:224-227. [PMID: 32368705 PMCID: PMC7184062 DOI: 10.1016/j.jvscit.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/23/2020] [Indexed: 12/04/2022] Open
Abstract
We report the case of an 81-year-old man who presented with severe right hip pain and reduced physical function secondary to a large spontaneous median sacral artery pseudoaneurysm measuring 83.5 × 55.4 mm. The patient had no history of recent trauma, infective or inflammatory disease, or any recent procedures. The patient was taking apixaban for atrial fibrillation. Percutaneous coil embolization was used to occlude the pseudoaneurysm. This case describes a novel disease, spontaneous median sacral artery pseudoaneurysm, presenting with hip pain.
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Affiliation(s)
- Joseph Faraj
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ali Daneshmand
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Bibombe Patrice Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia
- Medical Research Facility, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Vascular Surgery, Joondalup Health Campus, Perth, Western Australia, Australia
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Abstract
The bone marrow biopsy is usually a safe procedure; however, it can occasionally present important complications. These complications are not always immediately evident or quickly diagnosed and may include pain at the biopsy site, trauma to neighboring structures, vascular injuries, infection, transient pressure neuropathies, pneumoretroperitoneum, and hemorrhage. Several risk factors are recognized, including thrombocytopenia, concurrent use of anticoagulants, and the presence of an underlying myeloproliferative disorder. While several reports of adverse events have been published, only 2 deaths attributable to this procedure have been reported. We present 2 cases of fatal hemorrhage after bone marrow biopsy.
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Wojciechowski A, Duckert M, Hartmann J, Bullinger L, Matzdorff A. Retroperitoneal Hematoma after Bone Marrow Biopsy: The First Cut Should Not Be the Deepest. Oncol Res Treat 2019; 42:283-288. [DOI: 10.1159/000499743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/19/2019] [Indexed: 11/19/2022]
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Liu SY, Zeng B, Deng JB. Massive retroperitoneal hemorrhage secondary to femoral artery puncture: A case report and review of literature. Medicine (Baltimore) 2017; 96:e8724. [PMID: 29390265 PMCID: PMC5815677 DOI: 10.1097/md.0000000000008724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE A rare case of massive bleeding with rupture of the branch artery deriving from uterine artery was reported in the present study. PATIENT CONCERNS A 29-year old female patient received embolism of malformed cerebral vessels. Ten hours after the operation, a sudden drop in blood pressure occurred. The patient developed coma and shock, and again underwent interventional angiography, which revealed bleeding at the right femoral artery puncture site of the first interventional procedure. The bleeding sign disappeared by pressure dressing. At 19 hours after stable condition, blood pressure fell again, and it was considered that recurrent bleeding occurred at the femoral artery puncture point. Therefore surgical suture of punctured blood vessel was performed. Then the condition was stabilized again. After another 20 hours, the third times blood pressure dropped. The third interventional angiography displayed a rupture of the branch artery deriving from the right uterine artery. Blood pressure of the patient elevated after embolism of right uterine artery, and the condition gradually stabilized. DIAGNOSES The massive bleeding with rupture of the branch artery deriving from uterine artery seconded huge retroperitoneal hematoma after femoral artery puncture. INTERVENTIONS The patient underwent three times interventional treatment including an embolism of malformed cerebral vessels, a right femoral artery interventional treatment, an embolism of the branch artery deriving from the right uterine artery and one time of surgical suture of punctured blood vessel. OUTCOMES Half a month of comprehensive treatment later, the patient was discharged from the hospital. LESSONS Massive bleeding with rupture of branch of artery deriving from the uterine artery following grain retroperitoneal hemorrhage is extremely rare, to the best of our knowledge, it has not been previously reported. The rupture of branch of artery deriving from the uterine artery should be considered as one the differential diagnosis in the retroperitoneal hemorrhage when the bleeding cause was not found. Endovascular trans-arterial embolism was a safe, effective, and minimally invasive therapeutic option.
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De Gregorio C, Spalla F, Padricelli A, Narese D, Bracale U, Ferrara D, Del Guercio L, Bracale UM. The Endovascular Management of an Iatrogenic Superior Gluteal Artery Rupture Following Bone Marrow Biopsy. Intern Med 2017; 56:2639-2643. [PMID: 28883230 PMCID: PMC5658532 DOI: 10.2169/internalmedicine.8195-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report an uncommon case of a life-threatening retroperitoneal hematoma after a bone marrow biopsy. Two hours after iliac crest bone harvesting, the patient experienced syncope and severe hypotension. Urgent contrast-enhanced computed tomography demonstrated extravasation from the superior gluteal artery. Transcatheter coil embolization was performed successfully, without complications. Life-threatening complications caused by retroperitoneal bleeding after bone marrow biopsy are very rare. There are few reports on the use of endovascular treatment in the management of life-threatening hemorrhagic complications after bone marrow biopsy.
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Affiliation(s)
- Claudia De Gregorio
- Department of Vascular and Endovascular Surgery, University Federico II of Naples, Italy
| | - Flavia Spalla
- Department of Vascular and Endovascular Surgery, University Federico II of Naples, Italy
| | - Andrea Padricelli
- Department of Vascular and Endovascular Surgery, University Federico II of Naples, Italy
| | | | - Umberto Bracale
- Department of General Surgery, University Federico II of Naples, Italy
| | - Doriana Ferrara
- Department of Vascular and Endovascular Surgery, University Federico II of Naples, Italy
| | - Luca Del Guercio
- Department of Vascular and Endovascular Surgery, University Federico II of Naples, Italy
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