Abstract Number: PB0914
Meeting: ISTH 2020 Congress
Background: Rare bleeding disorders such as hemophilia A and type-3 von Willebrand Disease (VWD) are caused by a deficiency of clotting factors VIII (FVIII), and von Willebrand factor (VWF) with variable deficiency of FVIII. Recurrent bleeding (hemarthrosis) in target joints (joint with more than 4 bleeding events over 6 months) may lead to chronic arthropathy. Treatment options of acute events include replacement therapy and anti-inflammatory drugs, whereas treatment of compromised joints is mainly major orthopedic surgery. However, some patients may experience arthropathy refractory to any treatment.
Angiographic embolization of target joints is a minimally invasive technique associated with limited bleeding and infection risk. It does not require general or local anesthesia and can be applied earlier than the traditional surgical approach.
Aims: To describe the Milan centre experience on the clinical and radiological outcomes of a series of patients undergoing selective angiographic embolization of target joints.
Methods: Four patients with target joint (elbow) were evaluated for the procedure: three patients affected by severe hemophilia A on prophylaxis with factor VIII concentrate and 1 patient affected by type 3 VWF (basal FVIII:C < 1%) with inhibitor.
Clinical follow-up (hemarthrosis episodes of the target joint, therapeutic regimen) every 3 months and radiological (MRI) follow-up after 12 months was performed.
Results: All four patients underwent the embolization procedure. The procedure was successful in all patients, with an observed reduction of target joint bleeding over the 12-month follow-up. Only one procedure was complicated with transient arterial vasospasm, with fast recovery. The same patient experienced local soft tissue edema one week after the procedure, but then no recurrent bleeding.
Conclusions: Joint vascular embolization is a non-invasive procedure that may be an effective alternative treatment in recurrent hemarthrosis refractory to traditional approaches.
To cite this abstract in AMA style:Siboni SM, Gualtierotti R, Braham S, Mancuso ME, Biguzzi E, Nicolini A, Peyvandi F. Elbow Embolization for Recurrent Massive Hemarthrosis: A Case Series with Successful Outcome [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/elbow-embolization-for-recurrent-massive-hemarthrosis-a-case-series-with-successful-outcome/. Accessed September 29, 2023.
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