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Transcatheter arterial embolization as an effective treatment for spontaneous inferior epigastric artery bleeding caused by anticoagulant therapy: Case reports

Spontaneous inferior epigastric artery hemorrhage (SIEAH) is a rare, yet potentially fatal condition. In some cases, the failure of hemostasis can result in hypovolemic shock or even death. Anticoagulant therapy is strongly associated with patient mortality. The present study describes two cases of SIEAH that were successfully dealt with using transcatheter arterial embolization (TAE). The standard use of anticoagulant or antiplatelet agents may induce episodes of severe bleeding, such as SIEAH. Although the condition is rare, it can potentially be life-threatening. The diagnosis mainly depends on computed tomography (CT) findings. With hemodynamic instability, surgical intervention is the most standard treatment. However, in patients with severe comorbidities, old age, or other associated injuries, several post-operative complications may occur. To date, data supporting that TAE is more suitable than the traditional open surgery are lacking. In some selected patients, compared with open surgery, TAE can be a relatively safe and effective modality for the termination of bleeding. Introduction Spontaneous inferior epigastric artery hemorrhage (SIEAH) is a rare condition and can lead to rectus sheath hematoma (RSH), and may thus prove potentially fatal condition (1-5). Bleeding can lead to hematoma and tamponade; therefore, this episode may be self-limited (2,6-8). However, in some cases, hemorrhaging can result in hypovolemic shock or even death. Anticoagulant therapy has been reported to be a risk factor of mortality (1,3,4). Other risk factors of SIEAH include hypertension, pregnancy, atherosclerosis, obesity, the use of corticosteroids, thrombophilia and leukemia (1,5,8). Initially, conservative treatment, including blood transfusion, anticoagulation therapy and coagulation parameter correction, is the most commonly used treatment (1,2,4,9,10). However, in some patients with an unstable hemodynamic status, invasive intervention is indicated (2,4,9,10). In some selected cases, compared with open surgery, transcatheter arterial embolization (TAE) can be a relatively safe and effective modality for the termination of bleeding (2,9,10). The present study describes two cases that underwent anticoagulant therapy and developed spontaneous inferior epigastric artery (IEA) bleeding. Both cases were successfully dealt with using TAE.