醫學研究

Inadvertent arterial & venous injury by bone marrow biopsy needle: case report on rescue embolization techniques.

Tsai CS, Yu SC. CVIR Endovasc. 2020 Nov 7;3(1):80. doi: 10.1186/s42155-020-00172-9. PMID: 33159602; PMCID: PMC7648822.

Abstract

Background: Bone marrow biopsy is a common medical procedure for diagnosis and characterization of haematological diseases. It is generally regarded as a safe procedure with low rate of major complications. Inadvertent vascular injury is however an uncommon but important complication of bone marrow biopsy procedure. The knowledge of a safe and effective embolization method is crucial for interventional radiologists to reduce significant patient morbidity and mortality, shall such inadvertent vascular injury occurs.

Case presentation: Bedside bone marrow biopsy was performed for an elderly gentleman to evaluate for his underlying acute leukaemia. Biopsy needle inadvertently injured the internal iliac artery and vein during the procedure. Coil embolization was carefully performed across injured arterial segment via the culprit biopsy needle until contrast cessation. Concomitant venous injury was subsequently confirmed on angiography when the needle was withdrawn for a short distance from the iliac artery. This venous injury was tackled by further withdrawing the biopsy needle to distal end of the bone marrow tract for tract embolization with coils and gelatin sponges. High caution was made to avoid coil dislodgement into the iliac vein, to prevent pulmonary embolism. Patient was clinically stable throughout the procedure. Post-procedure contrast CT shows no pelvic haematoma or contrast extravasation.

Conclusions: This case illustrates rescue embolization techniques for rare life-threatening concomitant internal iliac arterial and venous injuries by a bone marrow biopsy needle. Interventional radiologists can play an important role in carrying out precise embolization to avoid significant patient morbidity and mortality in the case of life-threatening haemorrhage.

Keywords: Embolotherapy; Therapeutic embolization; Vascular injury.

Fig. 1. Direct needle angiogram via the bone marrow biopsy needle showed opacification of the left internal iliac artery. A springe-like radio-opacity (white arrow) which belonged to an extracorporeal tubing was noted

Fig. 2. Direct needle angiogram showed contrast outlining the left iliac vein and lower inferior vena cava, thus confirming concomitant venous injury

Fig. 3. Further embolization of the bone marrow tract with coils and gelatin sponges. The same spring-like radio-opacity was again noted (white arrow) in reference to the pre-embolization angiogram, not to be confused with coil migration

Citation:

https://pubmed.ncbi.nlm.nih.gov/33159602/