Should Arterial Embolization in Recurrent Spontaneous Hemoph ilic Hemarthroses Refractory to Intensive Prophylaxis be the First Invas ive Resort?

Title:Should Arterial Embolization in Recurrent Spontaneous Hemoph ilic Hemarthroses Refractory to Intensive Prophylaxis be the First Invas ive Resort?

Volume: 17 Issue: 1

Author(s): E. Carlos Rodriguez-Merchan*

Affiliation:

• Department of Orthopaedic Surgery, La Paz University Hospital, Paseo de la Castellana 261, 28046- Madrid,Spain

Keywords: Hemophilia, recurrent hemarthroses, arterial embolization, radiosynovectomy, prophylaxis, hypertrophic, synovitis.

Abstract: Background: Some reports have suggested that arterial embolization (AE) is a good indication to manage recurrent spontaneous hemartroses (RSH) that are refractory to intensive prophylaxis (RIP) in people with hemophilia (PWH).

Objective: To clarify the role of AE in RSH that are RIP in PWH.

Method: A literature review of arterial embolization in patients with hemophilia was performed using MEDLINE (PubMed) and the Cochrane Library.

Results: A total of 68 articles were found, of which 6 were selected and reviewed because they were deeply focused on the topic. The total number of AEs performed so far is 78 in 69 patients. Four second AEs were required (4/78), and a third AE in one (1/78). Two complications have been found so far: a pseudoaneurym (1/78) of the femoral artery at the puncture site (that eventually required surgical repair) and a patient (1/78) that had recurrence of bleeding for whom surgical exploration was required. AE seems to be a good procedure for RSH that are RIP.

Conclusion: AE seems to be too aggressive to be considered the first resort. Radiosynovectomy (RS) must always be the first resort. AE should only be indicated in RSH that are RIP to 3 RSs (with 6 month intervals) followed by an arthroscopic synovectomy. AE in PWH is technically challenging and should be performed by highly skilled interventional radiologists.

Cite this article as:

Rodriguez-Merchan Carlos E.*, Should Arterial Embolization in Recurrent Spontaneous Hemoph ilic Hemarthroses Refractory to Intensive Prophylaxis be the First Invas ive Resort?, Cardiovascular & Hematological Disorders-Drug Targets 2017; 17 (1) . https://dx.doi.org/10.2174/1871529X17666161216112745

DOI https://dx.doi.org/10.2174/1871529X17666161216112745	Print ISSN 1871-529X
Publisher Name Bentham Science Publisher	Online ISSN 2212-4063