Transcatheter arterial embolization for traumatic adrenal hemorrhage with contrast extravasation: case series and literature review

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PURPOSE: To evaluate the feasibility, short-term clinical outcomes, and technical considerations of transcatheter arterial embolization (TAE) for traumatic adrenal hemorrhage with contrast extravasation on CT. MATERIALS AND METHODS: This single-center retrospective study included consecutive patients with traumatic adrenal hemorrhage showing contrast extravasation on CT who underwent TAE. Technical success was defined as complete embolization of the bleeding artery with no contrast extravasation on post-embolization angiography. Clinical success was defined as effective control of adrenal hemorrhage during the index hospitalization, as evidenced by the absence of repeat embolization or surgery and no clinical or imaging evidence of persistent or recurrent bleeding. RESULTS: Eight patients (4 men; median age, 78 years) underwent TAE. Adrenal hemorrhage was unilateral in all patients, involving the right side in 6 (75%) and the left side in 2 (25%). Contrast extravasation was observed in all patients during angiography. Gelatin sponge particles were used in all procedures. Technical and clinical success were both 100% (8/8). Single-artery embolization was performed in 6 patients (75%). Embolization of the middle adrenal artery was performed in 6 patients, the superior adrenal artery in 2, and the inferior adrenal artery in 3. One intraprocedural injury to the right inferior phrenic artery occurred. No procedure-related mortality or overt clinical evidence of adrenal insufficiency was observed during hospitalization. One patient died on hospital Day 8 of complications unrelated to adrenal hemorrhage. CONCLUSION: TAE appears to be a technically feasible hemostatic option in selected patients with traumatic adrenal hemorrhage and CT-detected contrast extravasation, with favorable short-term in-hospital hemostatic outcomes in this small case series. However, the necessity of embolization and its comparative benefit over conservative management remain unclear.

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