Skip to main content
SpringerLink
Log in

Endovascular Management of Hemarthrosis in Patients with Bleeding Diatheses: Systematic Review

  • Review
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

In this systematic review, we report the safety and efficacy of embolization for treating hemarthrosis in patients with bleeding diatheses with or without a history of prior arthroplasty.

Materials and Methods

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, MEDLINE, and SCOPUS databases of patients undergoing embolization for hemarthrosis. Demographic data, clinical history, angiographic findings, interventions, and outcomes were extracted and tabulated.

Results

The search identified 97 unique titles of which 15 were deemed relevant comprising 78 patients with coagulopathies undergoing 93 embolization procedures. Mean follow-up time was 29 months (range 3–116.5). In the 29 patients who underwent arthroplasty prior to embolization for hemarthrosis, there were 11 bleeding recurrences (37.9%). Of these patients who experienced recurrences, 10 underwent repeat embolization as coagulation factor replacement was not sufficient to address the re-bleeding. In the 49 patients with bleeding diatheses who underwent embolization for hemarthrosis with no history of prior arthroplasty, there were 11 recurrences (22.4%) and 4 of these patients underwent repeat embolization with favorable results. There were four major procedure-related complications.

Conclusion

Transarterial embolization is safe and effective in addressing recurrent hemarthrosis in patients with bleeding diatheses with or without a history of arthroplasty of the affected joint.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Pulles AE, Mastbergen SC, Schutgens RE, Lafeber FP, van Vulpen LF. Pathophysiology of hemophilic arthropathy and potential targets for therapy. Pharmacol Res. 2017;115:192–9.

    Article  CAS  Google Scholar 

  2. Soucie JM, Evatt B, Jackson D. Occurrence of hemophilia in the United States. The Hemophilia Surveillance System Project Investigators. Am J Hematol. 1998;59(4):288–94.

    Article  CAS  Google Scholar 

  3. Luck JV Jr, Silva M, Rodriguez-Merchan EC, Ghalambor N, Zahiri CA, Finn RS. Hemophilic arthropathy. J Am Acad Orthop Surg. 2004;12(4):234–45.

    Article  Google Scholar 

  4. Soucie JM, Cianfrini C, Janco RL, et al. Joint range-of-motion limitations among young males with hemophilia: prevalence and risk factors. Blood. 2004;103(7):2467.

    Article  CAS  Google Scholar 

  5. Berntorp E, Shapiro AD. Modern haemophilia care. Lancet. 2012;379(9824):1447–56.

    Article  Google Scholar 

  6. Moore MF, Tobase P, Allen DD. Meta-analysis: outcomes of total knee arthroplasty in the haemophilia population. Haemophilia. 2016;22(4):e275–85.

    Article  CAS  Google Scholar 

  7. Saksena J, Platts AD, Dowd GSE. Recurrent haemarthrosis following total knee replacement. Knee. 2010;17(1):7–14.

    Article  CAS  Google Scholar 

  8. Yamagami T, Yoshimatsu R, Miura H, et al. Selective arterial embolization with gelatin particles for refractory knee hemarthrosis. Diagn Interv Radiol. 2013;19(5):423–6.

    PubMed  Google Scholar 

  9. Kolber MK, Shukla PA, Kumar A, Zybulewski A, Markowitz T, Silberzweig JE. Endovascular management of recurrent spontaneous hemarthrosis after arthroplasty. Cardiovasc Interv Radiol. 2017;40(2):216–22.

    Article  Google Scholar 

  10. Galli E, Baques A, Moretti N, Candela M, Caviglia H. Hemophilic chronic synovitis: therapy of hemarthrosis using endovascular embolization of knee and elbow arteries. Cardiovasc Interv Radiol. 2013;36(4):964–9.

    Article  CAS  Google Scholar 

  11. Guevara CJ, Lee KA, Barrack R, Darcy MD. Technically successful geniculate artery embolization does not equate clinical success for treatment of recurrent knee hemarthrosis after knee surgery. J Vasc Interv Radiol. 2016;27(3):383–7.

    Article  Google Scholar 

  12. Kalmar PI, Leithner A, Ehall R, Portugaller RH. Is embolization an effective treatment for recurrent hemorrhage after hip or knee arthroplasty? Clin Orthop Relat Res. 2016;474(1):267–71.

    Article  Google Scholar 

  13. Kickuth R, Anderson S, Peter-Salonen K, Lammle B, Eggli S, Triller J. Hemophilia A pseudoaneurysm in a patient with high responding inhibitors complicating total knee arthroplasty: embolization: a cost-reducing alternative to medical therapy. Cardiovasc Interv Radiol. 2006;29(6):1132–5.

    Article  Google Scholar 

  14. Kidder W, Chang EY, Moran CM, Rose SC, von Drygalski A. Persistent vascular remodeling and leakiness are important components of the pathobiology of re-bleeding in hemophilic joints: two informative cases. Microcirculation. 2016;23(5):373–8.

    Article  Google Scholar 

  15. Kim MJ, Oh JY, Park YS. Availability of angiography and therapeutic embolization for the treatment of acute bleeding in patients with hemophilia. Int J Hematol. 2017;106(6):787–93.

    Article  Google Scholar 

  16. Klamroth R, Gottstein S, Essers E, Landgraf H, Wilaschek M, Oldenburg J. Successful angiographic embolization of recurrent elbow and knee joint bleeds in seven patients with severe haemophilia. Haemophilia. 2009;15(1):247–52. https://doi.org/10.1111/j.1365-2516.2008.01842.x.

    Article  CAS  PubMed  Google Scholar 

  17. Mann HA, Goddard NJ, Lee CA, Brown SA. Periarticular aneurysm following total knee replacement in hemophilic arthropathy. A case report. J Bone Joint Surg Am. 2003;85-a(12):2437–40.

    Article  Google Scholar 

  18. Mauser-Bunschoten EP, Zijl JAC, Mali W, van Rinsum AC, van den Berg HM, Roosendaal G. Successful treatment of severe bleeding in hemophilic target joints by selective angiographic embolization. Blood. 2005;105(7):2654–7.

    Article  CAS  Google Scholar 

  19. Obaji S, Jones C, Yates A, et al. Selective angiographic embolization for recurrent elbow and knee haemarthroses in haemophilia: a retrospective case series. Haemophilia. 2015;21(3):e226–8.

    Article  CAS  Google Scholar 

  20. Park JJ, Slover JD, Stuchin SA. Recurrent hemarthrosis in a hemophilic patient after revision total knee arthroplasty. Orthopedics. 2010;33(10):771.

    Article  Google Scholar 

  21. Rodriguez-Merchan EC, Jimenez-Yuste V, Gomez-Cardero P, Rodriguez T. Severe postoperative haemarthrosis following a total knee replacement in a haemophiliac patient caused by a pseudoaneurysm: early treatment with arterial embolization. Haemophilia. 2014;20(1):e86–9.

    Article  CAS  Google Scholar 

  22. Sadat U, Naik J, Hayes PD. Surgical complications in a hemophilia patient with factor VIII inhibitor and their endovascular management. Vasc Endovasc Surg. 2008;42(2):168–72.

    Article  Google Scholar 

  23. Saris DBF, vanRinsum AC, Dhert WJA, Roosendaal G, Mali W. Periarticular aneurysm formation in haemophilia. Lancet. 1997;349(9054):766–8.

    Article  CAS  Google Scholar 

  24. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the Cirse Classification System. Cardiovasc Interv Radiol. 2017;40(8):1141–6.

    Article  CAS  Google Scholar 

  25. Rodriguez-Merchan EC. Hemophilic synovitis of the knee: radiosynovectomy or arthroscopic synovectomy? Expert Rev Hematol. 2014;7(4):507–11.

    Article  CAS  Google Scholar 

  26. De la Corte-Rodriguez H, Rodriguez-Merchan EC. The role of physical medicine and rehabilitation in haemophiliac patients. Blood Coagul Fibrinolysis. 2013;24(1):1–9.

    Article  Google Scholar 

Download references

Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

  1. Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers – New Jersey Medical School, 185 South Orange Ave. MSB F-560, Newark, NJ, 07103, USA

    Srinidhi Shanmugasundaram, Vishnu Chandra, Abhishek Kumar, Sohail Contractor & Pratik A. Shukla

  2. Division of Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA

    Marcin Kolber

Authors
  1. Srinidhi Shanmugasundaram
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vishnu Chandra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcin Kolber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abhishek Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sohail Contractor
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pratik A. Shukla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pratik A. Shukla.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human Participants or Animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Ethical Approval

This study was exempt from institutional review board review.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shanmugasundaram, S., Chandra, V., Kolber, M. et al. Endovascular Management of Hemarthrosis in Patients with Bleeding Diatheses: Systematic Review. Cardiovasc Intervent Radiol 43, 362–368 (2020). https://doi.org/10.1007/s00270-019-02367-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-019-02367-7

Keywords

Search

Navigation