Predictive Factors of Survival in Patients with Iliopsoas and Anterior Abdominal Wall Hematomas: A 10-Year Retrospective Study Focused on Transarterial Embolization.

PURPOSE: To identify predictors of 30-day mortality and overall survival (OS) in patients with iliopsoas and/or abdominal wall hematomas, particularly those treated with transarterial embolization (TAE), in a context where evidence guiding escalation from conservative to interventional management remains limited.

MATERIALS AND

METHODS

This retrospective single-center study included 91 adult patients (median age, 70 years) treated at the authors' emergency department for iliopsoas and/or abdominal wall hematomas with available initial computed tomography (CT) scan between 2013 and 2023. Two radiologists collected clinical, biological, CT-based features, treatments, and patient outcomes. Statistical analyses comprised receiver operating characteristic curve, multivariable binary logistic, and exploratory Cox regressions. Subgroup univariable analysis was performed in TAE-treated patients and patients with iliopsoas hematoma.

RESULTS

Primary management consisted of monitoring (48.4%), TAE (40.7%), and surgery (11%). TAE was performed secondarily in 8.8% of patients. Technical failure occurred in 5.4% of primary and 11.1% of secondary TAEs. There were 6.6% deaths within 72 hours, 18.7% within 30 days (higher in TAE patients, P = .0038), and 23.1% within 6 months. TAE-treated patients showed higher rate of hemorrhagic shock, active bleeding on CT scan, fluid-blood levels, and higher hematoma volume (all P < .001). Age of ≥70 years and hematoma volume of >813 cm3 were independently associated with 30-day death (odds ratios, 5.06 [P = .0396] and 7.68 [P = .0145], respectively). In the TAE subgroup, hematoma volume of >813 cm3 and age of ≥70 years remained associated with mortality (P = .0061 and P = .0106, respectively), together with anticoagulant overdose (P = .0018). Hematoma volume of >813 cm3 was the sole independent OS predictor (hazard ratio, 2.63; P = .0173) in the entire cohort.

CONCLUSIONS

In patients with acute iliopsoas and/or abdominal wall hematomas, age and hematoma volume are key predictors of early mortality and potentially OS.