A Retrospective Review on Feasibility and Safety of a New Pneumatic Compression Device for Femoral Arteriotomy Hemostasis

강민호,신성욱 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.1

Objective: To report our initial experience on the technical feasibility and safety for hemostasis of a new pneumatic compression device in patients undergoing femoral arteriotomy. Materials and Methods: This study included 40 consecutive patients in whom hemostasis after transfemoral catheterization was readered by using a pneumatic compression device consisting of an inflatable bulb-containing main body and four pieces of supplementary tape. Medical records were retrospectively reviewed for outcomes and complications of hemostasis. Technical success was defined as achieving immediate hemostasis 10 minutes after applying the device over the arteriotomy sites, and clinical success was defined as the ability to ambulate after 4 hours of bed rest without any complications. Results: Technical and clinical success was achieved in 38 (95%) and 37 (93%) patients, respectively. In two patients, hemostasis was achieved after conversion to manual compression. One patient required sand bag placement after removal of the device to control minimal oozing of blood. No patients had late complications. Conclusion: The new pneumatic compression device provides effective and safe hemostasis after transfemoral catheterization in selected patient populations. Objective: To report our initial experience on the technical feasibility and safety for hemostasis of a new pneumatic compression device in patients undergoing femoral arteriotomy. Materials and Methods: This study included 40 consecutive patients in whom hemostasis after transfemoral catheterization was readered by using a pneumatic compression device consisting of an inflatable bulb-containing main body and four pieces of supplementary tape. Medical records were retrospectively reviewed for outcomes and complications of hemostasis. Technical success was defined as achieving immediate hemostasis 10 minutes after applying the device over the arteriotomy sites, and clinical success was defined as the ability to ambulate after 4 hours of bed rest without any complications. Results: Technical and clinical success was achieved in 38 (95%) and 37 (93%) patients, respectively. In two patients, hemostasis was achieved after conversion to manual compression. One patient required sand bag placement after removal of the device to control minimal oozing of blood. No patients had late complications. Conclusion: The new pneumatic compression device provides effective and safe hemostasis after transfemoral catheterization in selected patient populations.

Rebleeding after Initial Endoscopic Hemostasis in Peptic Ulcer Disease

홍미진,이선영,김정환,성인경,박형석,심찬섭,진춘조 대한의학회 2014 Journal of Korean medical science Vol.29 No.10

Endoscopic hemostasis is the first-line treatment for upper gastrointestinal bleeding (UGIB). Although several factors are known to be risk factors for rebleeding, little is known aboutthe use of antithrombotics. We tried to verify whether the use of antithrombotics affectsrebleeding rate after a successful endoscopic hemostasis for peptic ulcer disease (PUD). UGIB patients who underwent successful endoscopic hemostasis were included. Rebleedingwas diagnosed when the previously treated lesion bled again within 30 days of the initialepisode. Of 522 UGIB patients with PUD, rebleeding occurred in 93 patients (17.8%). Therate of rebleeding was higher with aspirin medication (P = 0.006) and after a longendoscopic hemostasis (P < 0.001). Of all significant variables, procedure time longer than13.5 min was related to the rate of rebleeding (OR, 2.899; 95% CI, 1.768-4.754;P < 0.001) on the logistic regression analysis. The rate of rebleeding after endoscopichemostasis for PUD is higher in the patients after a long endoscopic hemostasis. Endoscopic hemostasis longer than 13.5 min is related to rebleeding after a successfulendoscopic hemostasis for PUD.

Clinical Outcomes of Endoscopic Hemostasis for Bleeding in Patients with Unresectable Advanced Gastric Cancer

송인지,김현주,이지애,박준철,신성관,이상길,이용찬,정현수 대한위암학회 2017 Journal of gastric cancer Vol.17 No.4

Purpose: Bleeding is one of the most serious complications of advanced gastric cancer (AGC) and is associated with a poor prognosis. This study aimed to evaluate the clinical outcomes of endoscopic hemostasis for bleeding in patients with unresectable AGC. Materials and Methods: This study included 106 patients with bleeding associated with gastric cancer who had undergone endoscopic hemostasis between January 2010 and December 2013. Clinical characteristics, treatment outcomes, including rates of successful endoscopic hemostasis and rebleeding, risk factors for rebleeding, and overall survival (OS) were investigated. Results: Successful initial hemostasis was achieved in 83% of patients. Rebleeding occurred in 28.3% of patients within 30 days. The median OS after initial hemostasis was lower in patients with rebleeding than in those without rebleeding (2.7 and 3.9 months, respectively, P=0.02). There were no significant differences in disease status and rebleeding rates among patients with partial response or stable disease (n=4), progressive disease (n=64), and first diagnosis of disease (n=38). Univariate and multivariate analyses (P=0.038 and 0.034, respectively) revealed that transfusion of ≥5 units of RBCs was a significant risk factor for rebleeding. Conclusions: Despite favorable success rates of endoscopic hemostasis for bleeding associated with gastric cancer, the 30-day rebleeding rate was 28.3% and the median OS was significantly lower in patients with rebleeding than in those without rebleeding. Massive transfusion (≥5 units of RBCs) was the only significant risk factor for rebleeding. Patients with bleeding associated with AGC who have undergone massive transfusion should be observed closely following endoscopic hemostasis. Further research on approaches to reduce rebleeding rate and prevent death is needed.

Clinical Outcomes of Endoscopic Hemostasis for Bleeding in Patients with Unresectable Advanced Gastric Cancer

Song, In Ji,Kim, Hyun Ju,Lee, Ji Ae,Park, Jun Chul,Shin, Sung Kwan,Lee, Sang Kil,Lee, Yong Chan,Chung, Hyunsoo The Korean Gastric Cancer Association 2017 Journal of gastric cancer Vol.17 No.4

Purpose: Bleeding is one of the most serious complications of advanced gastric cancer (AGC) and is associated with a poor prognosis. This study aimed to evaluate the clinical outcomes of endoscopic hemostasis for bleeding in patients with unresectable AGC. Materials and Methods: This study included 106 patients with bleeding associated with gastric cancer who had undergone endoscopic hemostasis between January 2010 and December 2013. Clinical characteristics, treatment outcomes, including rates of successful endoscopic hemostasis and rebleeding, risk factors for rebleeding, and overall survival (OS) were investigated. Results: Successful initial hemostasis was achieved in 83% of patients. Rebleeding occurred in 28.3% of patients within 30 days. The median OS after initial hemostasis was lower in patients with rebleeding than in those without rebleeding (2.7 and 3.9 months, respectively, P=0.02). There were no significant differences in disease status and rebleeding rates among patients with partial response or stable disease (n=4), progressive disease (n=64), and first diagnosis of disease (n=38). Univariate and multivariate analyses (P=0.038 and 0.034, respectively) revealed that transfusion of ${\geq}5$ units of RBCs was a significant risk factor for rebleeding. Conclusions: Despite favorable success rates of endoscopic hemostasis for bleeding associated with gastric cancer, the 30-day rebleeding rate was 28.3% and the median OS was significantly lower in patients with rebleeding than in those without rebleeding. Massive transfusion (${\geq}5$ units of RBCs) was the only significant risk factor for rebleeding. Patients with bleeding associated with AGC who have undergone massive transfusion should be observed closely following endoscopic hemostasis. Further research on approaches to reduce rebleeding rate and prevent death is needed.

Predictors for the need for endoscopic therapy in patients with presumed acute upper gastrointestinal bleeding

( Su Sun Kim ),( Kyung Up Kim ),( Sung Jun Kim ),( Seung In Seo ),( Hyoung Su Kim ),( Myoung Kuk Jang ),( Hak Yang Kim ),( Woon Geon Shin ) 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.2

Background/Aims: Selecting patients with an urgent need for endoscopic hemostasis is difficult based only on simple parameters of presumed acute upper gastrointestinal bleeding. This study assessed easily applicable factors to predict cases in need of urgent endoscopic hemostasis due to acute upper gastrointestinal bleeding. Methods: The consecutively included patients were divided into the endoscopic hemostasis and nonendoscopic hemostasis groups. We reviewed the enrolled patients’ medical records and analyzed various variables and parameters for acute upper gastrointestinal bleeding outcomes such as demographic factors, comorbidities, symptoms, signs, laboratory findings, rebleeding rate, and mortality to evaluate simple predictive factors for endoscopic treatment. Results: A total of 613 patients were analyzed, including 329 patients in the endoscopic hemostasis and 284 patients in the non-endoscopic hemostasis groups. In the multivariate analysis, a bloody nasogastric lavage (adjusted odds ratio [AOR], 6.786; 95% confidence interval [CI], 3.990 to 11.543; p < 0.0001) and a hemoglobin level less than 8.6 g/dL (AOR, 1.768; 95% CI, 1.028 to 3.039; p = 0.039) were independent predictors for endoscopic hemostasis. Significant differences in the morbidity rates of endoscopic hemostasis were detected between the group with no predictive factors and the group with one or more predictive factors (OR, 2.677; 95% CI, 1.920 to 3.733; p < 0.0001). Conclusions: A bloody nasogastric lavage and hemoglobin < 8.6 g/dL were independent predictors of endoscopic hemostasis in patients with acute upper gastrointestinal bleeding.

급성 비정맥류 상부위장관 출혈 의심 환자에서 내시경적 지혈술 예측에 있어 혈중 요소 수치의 유용성

최낙영,조영모,왕일재,염석란,박성욱 대한응급의학회 2022 대한응급의학회지 Vol.33 No.4

Objective: Urgent upper endoscopy is performed to achieve acute hemostasis in patients with high-risk bleeding sources. Emergency physicians must identify patients who require urgent endoscopic treatments. This study assessed the performance of blood urea nitrogen (BUN) for predicting severe bleeding that necessitates urgent endoscopic hemostasis compared to the risk assessment scores in patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB). Methods: The presumed ANVUGIB patients were classified into endoscopic and non-endoscopic hemostasis groups. Data including historical features, symptoms, signs, and routine laboratory tests were collected and compared. Results: Three hundred and ninety-one patients were analyzed, including 116 patients in the endoscopic hemostasis and 275 patients in the non-endoscopic hemostasis group. In the area under curve (AUC) of the receiver operator characteristic curve, BUN (AUC 0.733; 95% confidence interval [CI], 0.681-0.785) and BUN/creatinine (AUC, 0.727; 95% CI, 0.672-0.783) were superior to total protein, Glasgow-Blatchford score (GBS), modified GBS (AUC, 0.649, 0.623 and 0.646, respectively) for predicting endoscopic hemostasis. Pre-endoscopy Rockall score and AIMS65 were statistically insignificant. The same results were obtained when the patients with liver and chronic kidney diseases were excluded. Conclusion: The current results suggest that BUN was an independent predictor of endoscopic hemostasis in patients with ANVUGIB. Further studies will be needed to determine if BUN can be used in clinical practice.

Rescue fibrin glue-infiltrating hemostasis combined with hepatorrhaphy to control intractable postoperative bleeding from the liver cut surface

Shin Hwang,Byeong-Gon Na,Minjae Kim,Dae-Hyeon Won 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.4

Various topical hemostatic agents can help induce coagulation at the liver cut surface. However, hemostasis is usually ineffective in controlling bleeding. We present a case of rescue fibrin glue-infiltrating hemostasis combined with hepatorrhaphy to manage intractable postoperative bleeding from the liver cut surface. The case was a 56-year-old male patient with hepatocellular carcinoma in hepatitis B virus-associated cirrhotic liver. The patient was administered warfarin because of graft replacement of the ascending aorta and hemi-arch one year earlier. After warfarin was discontinued, segment VII partial hepatectomy was performed according to standard procedures. However, considerable bleeding occurred during and after hepatectomy. Bleeding from the liver cut surface was controlled over one hour using surface coagulation and topical application of four kinds of hemostatic agents. However, active abdominal bleeding led to reoperation soon after the hepatectomy. During the reoperation, we identified diffuse oozing from the edge of the liver cut surface which was difficult to control. Thus, we performed direct parenchymal injection of fibrin glue at the bleeding points using 12 fibrin glue kits which induced complete hemostasis. Because the patient would undergo anticoagulation again soon after the operation, we also performed hepatorrhaphy. The patient recovered uneventfully after the reoperation. He has been doing well for six months without complications. In conclusion, fibrin glue-infiltrating hemostasis effectively controlled intractable bleeding from the hepatic cut surface in our case. Thus, it can be considered as an optional method for rescue hemostasis.

Fibrin glue-infiltrating hemostasis for intractable bleeding from the liver or spleen during liver transplantation

Shin Hwang,Dong-Hwan Jung,Gi-Won Song,Tae-Yong Ha,Eun-Kyeong Jwa,Sung-Gyu Lee 한국간담췌외과학회 2016 Annals of hepato-biliary-pancreatic surgery Vol.20 No.4

Portal hypertension induces congestion of the liver and spleen, thus any capsular or parenchymal injury to these organs can produce intractable bleeding which generally is not easily controlled. To cope with intractable bleeding such as being encountered during liver transplantation, we developed an infiltrating hemostasis technique as a conceptual shift from conventional application methods, in which fibrin glue is locally injected into the bleeding area on the liver or spleen. This technique, which uses a fibrin glue kit (2 ml kit; Greenplast, Green Cross, Seoul, Korea), consists of inserting the needle 0.5-1 cm deep at the bleeding point, forcefully injecting 1 ml of fibrin glue contained in the fibrin glue kit, and then slowly withdrawing the needle with continuous forceful injection of the remaining 1 ml of fibrin glue. We have successfully performed this procedure in 6 cases of living donor liver transplantation and in 2 cases of non-transplant resection of the cirrhotic livers with hepatocellular carcinoma. This technique was also successfully applied to one liver transplant recipient in which intractable bleeding occurred from a small laceration at the spleen. Our fibrin glue-infiltrating hemostasis would be indicated to intractable bleeding from the hepatic or splenic cut surface. In such a situation, it would be applicable as a second-line rescue method for hemostasis.

Advances in the development of hemostatic biomaterials for medical application

Yong Kiel Sung,Dae Ryeong Lee,정동준 한국생체재료학회 2021 생체재료학회지 Vol.25 No.4

Background: Medical hemostatic biological materials are necessary for the development of the process of preventing and stopping damaged intravascular bleeding. In the process, some red blood cells and white blood cells are trapped in nets. The resulting plug is called a blood clot. This is often a good step in wound healing, but separation of blood clots from blood vessel walls can cause serious health problems. Main body: The advance in the development of hemostatic biomaterials is necessary for biomedical application. Firstly, the historical background of artificial hemostasis has been included and the current research of hemostasis has been included in more detail. Secondly, the current research of hemostasis has been included on the oxidized cellulose-based hemostatic biomaterials such as starch based on composite cross-linking hemostatic networks, hemostatic materials on NHS-esters, hemostatic agent from local materials and biomaterials for hemostatic management. Thirdly, polysaccharide hemostatic materials, bio-inspired adhesive catechol-conjugated chitosan, mesoporous silica and bioactive glasses for improved hemostasis, minimally invasive hemostatic biomaterials and chitosan-base materials for hemostatic application have been included. Fourthly, the biological properties of natural hemostatic agent by plasma technology and the hemostatic agents based on gelatinmicrobial transglutaminase mixes have been also included. Conclusion: Current research on hemostasis includes hemostatic biomaterials such as cellulose-based hemostatic starch based on a complex cross-linked hemostatic network. It also includes polysaccharide hemostatic materials, biomimetic adhesive catechol-binding chitosan, mesoporous silica or physiologically active glass for hemostatic improvement, minimally invasive hemostatic chitosan-based materials, and gelatin-microbial transglutaminase-based hemostatic agents. Future studies should focus on modular combination of hemostatic imitation and reinforcement mechanisms of different materials and technologies to find the optimal system to promote and strengthen active platelet or platelet imitation aggregation in bleeding sites. The second optionally increases the production of thrombin and fiber formation at the site. Third, the formed fibrin biopolymer network has strengthened to reduce thrombosis and amplify hemostasis.

대퇴 동맥 천자 완료 후 지혈 방법의 정량적 비교 분석

이해각,조재환 순천향대학교 부설 산업기술연구소 2013 순천향 산업기술연구소논문집 Vol.19 No.1

This study assessed the advantages and shortcomings of methods for hemostasis in patients who had received angiography after femoral arterial puncture using manual, compression devices and a combination of manual and compression device. In addition, the success rates, complications, etc. were analyzed. One hundred and eighty patients who had undergone angiography after femoral arterial puncture were divided into three groups according to the method of hemostasis. For group A, immediately after angiography, Angioseal was placed in the punctuation area and compressed using a compression device. For group B, after angiography, the punctuation area was compressed with the hands directly. For group C, the punctuation area was compressed using a compression device for approximately 10 minutes, and the punctuation area was then compressed with the hands. The results showed a similar time to hemostasis regardless of gender or generation. The correlation between the hemoglobin value, platelet value, and the time to hemostasis was not significant. Group A showed the shortest mean time to hemostasis of the three groups (20.37 ± 8.23 minutes). No complications caused by the hemostasis method were detected in group B. Group A showed the highest incidence of complications caused by hemostasis.