Should arterial embolization in recurrent spontaneous hemophilic hemarthroses refractory to intensive prophylaxis be the first invasive resort?

Should arterial embolization in recurrent spontaneous hemophilic hemarthroses refractory to intensive prophylaxis be the first invasive resort? Cardiovasc Hematol Disord Drug Targets. 2016 Dec 16; Authors: Rodriguez-Merchan EC Abstract This paper reviews the role of arterial embolization (AE) in recurrent spontaneous hemarthroses (RSH) that are refractory to intensive prophylaxis (RIP) in people with hemophilia (PWH). There are six articles in the literature on the topic. The total number of AEs performed so far is 78 in 69 patients. Four second AEs were required (4/78), and a third AE in one (1/78). No serious adverse effects have been reported except for a pseudoaneurym (1/78) of the femoral artery at the puncture site (that eventually required surgical repair) and for one patient (1/78) that had recurrence of bleeding for whom surgical exploration was required. The hemophilia literature states that AE is a good procedure for RSH that are RIP. However, AE seems to be too aggressive to be considered the first resort. My view is that radiosynovectomy (RS) must always be the first resort. AE should only be indicated in RSH that are RIP to 3 RSs (with 6 month intervals) followed by an arthroscopic synovectomy (AS). AE in hemophiliacs is technically challenging and should be performed by highly skilled interventional radiologists. PMID: 28044933 [PubMed - as supplied by publisher]
Source: Cardiovascular and Hematological Disorders Drug Targets - Category: Drugs & Pharmacology Tags: Cardiovasc Hematol Disord Drug Targets Source Type: research