Transcatheter arterial embolization of spontaneous rectus sheath haematoma in a Chinese woman.

Spontaneous extraperitoneal haemorrhage is a rare but well-described complication of anticoagulation therapy. We report a case of spontaneous rectus sheath haematoma in a 69-year-old Chinese woman who had received low-molecular-weight heparin for pulmonary embolism. She presented with sudden onset of lower abdominal pain, hypotension and a tender lower abdominal mass after 1 week of anticoagulation therapy. Computed tomography revealed a huge right rectus sheath haematoma extending into the pelvis, and angiography demonstrated active contrast extravasation from the right inferior epigastric artery. Arterial embolization with Gelfoam was performed and succeeded in stopping the bleeding. Transcatheter arterial embolization can be an effective and safe modality to localize and treat the bleeder in spontaneous extraperitoneal haematoma for high-risk patients.

Revascularization for post-transplant renal artery stenosis.

BACKGROUND: Percutaneous transluminal angioplasty has now been increasingly accepted as a primary treatment option for transplant renal artery stenosis. METHODS: This single-centre study evaluated the treatment effect of percutaneous transluminal angioplasty as primary intervention among 18 consecutive patients with angiographically demonstrated transplant renal artery stenosis. RESULTS: Patients (14 men and 4 women, mean age 49 +/- 9 years) were followed up for a mean duration of 21.6 months after procedure. Highly significant improvement was noted in the mean arterial pressure (from baseline 105.9 +/- 10.4 mmHg to 98.6 +/- 10.0 mmHg, P < 0.001), systolic blood pressure (148.5 mmHg to 137.1 mmHg, P = 0.002) and diastolic blood pressure (85.3 mmHg to 79.4 mmHg, P = 0.002). Estimated glomerular filtration rate before and 6 months after intervention was 41.4 +/- 16.8 mL/min per 1.73 m(2) and 42.0 +/- 16.2 mL/min per 1.73 m(2), respectively (P = 0.82). CONCLUSION: These findings show that percutaneous transluminal angioplasty in transplant renal artery stenosis appears to have a significant beneficial effect on hypertension but less impact on the improvement in renal function.