Endovascular management of the rectus XXXX .

@entity1 @entity548 @entity1003 @entity1410 @entity1344 @entity121
PURPOSE: Non-traumatic spontaneous @entity1410 of the rectus abdominal muscle is not considered a critical condition. Nevertheless, it can be a serious complication in some @entity1 due to continuous and/or consistent @entity548 . The most frequent cause of spontaneous rectus @entity121 is the anticoagulation therapy. The natural history of rectus @entity121 usually leads to a positive outcome and can be spontaneously self-limited only by conservative therapy. Nevertheless, in some @entity1 , despite a correct and early medical therapy, the continuous @entity548 requests a more radical handling. Up to now, the surgical @entity1410 evacuation and the bonding of blood vessels were considered the most appropriate treatment, while at present, the percutaneous management by means of selective catheters and embolization of the @entity548 vessel is considered to be the most used option. Our purpose is to report our experience in the @entity121 treatment in the elderly @entity1 . MATERIALS AND METHODS: From the data base and medical reports of the hospital, we selected 144 medical reports. We focused on those cases that showed the following criteria: @entity1 with rectus @entity121 undergoing anticoagulation therapy and/or non-traumatic spontaneous @entity1410 and with persistent @entity548 revealed on CT examination despite a pharmacological treatment aimed to timely reverse @entity1003 . These criteria were found in 18 @entity1 : 15 females and 3 males, with a median age of 73 (range 64-81). In all @entity1 , the diagnosis had been confirmed by an abdominal CT in emergency setting, performed before and after contrast medium intravenous administration. Because of clinical conditions, all @entity1 had been moved on the angiographic room for diagnostic arteriography and embolization. The criteria for this treatment were @entity1344 and the continuous @entity548 despite the correct medical therapy. RESULTS: CT imaging detected rectus @entity121 in 18/18 @entity1 and active @entity548 in 7/18 @entity1 . Selective catheterization was applied to all 18 @entity1 ; arteriographic study confirmed the information of the CT study in all of the seven @entity1 . The inferior epigastric artery was the main cause of the @entity548 in all 18 @entity1 . In 14 @entity1 , one single vessel was responsible for the @entity548 , while in the other four @entity1 , more than one vessel were involved: In two @entity1 , we also found the involvement of the superior epigastric artery; while the other two @entity1 showed also the involvement of the deep iliac circumflex artery. The material for embolization was compatible coils with micro-catheters in 17/18 @entity1 , and glue for 1/18 @entity1 . CONCLUSIONS: @entity1 with large rectus @entity121 , which have not yet recovered with conservative therapy, should then consider undergoing endovascular treatment. This procedure is highly recommended in @entity1 with other coexisting pathologies that could eventually lead to a fatal outcome. It is difficult to determine when surgery is necessary when there is very poor data provided by scientific literature review, so the decision to use surgery can be suggested when embolization is unsuccessful or when it is necessary to evacuate a complex huge fluid mass in peritoneal cavity.
