Outcomes of patients with continuous flow left ventricular assist device undergoing emergency endovascular treatment for atraumatic bleeding.

Bernardinello, Valentina; Barbiero, Giulio; Battistel, Michele; Dengo, Caterina; Stramare, Roberto; Folino, Giulio; Bejko, Jonida; Carrozzini, Massimiliano; Tarzia, Vincenzo; Gerosa, Gino; Bottio, Tomaso

INTRODUCTION Severe spontaneous bleeding is a significant complication in patients with continuous flow left ventricular assist devices; there is little evidence on endovascular treatment to support its use. MATERIALS AND METHODS We observed seven patients (five men, two women, age 43-67 years) with continuous flow left ventricular assist devices on antiaggregant/coagulant therapy, admitted to our hospital for uncorrectable symptomatic anemia; CT-angiography and diagnostic angiography confirmed the presence of atraumatic arterious bleeding from the gastrointestinal tract (six patients), from the intercostal artery and from the bronchial tree (one patient). RESULTS All patients where successfully treated via an endovascular approach with superselective embolization of the involved arterial branches with coils and particles. CONCLUSION Spontaneous atraumatic bleeding is a frequent complication in patients with continuous flow left ventricular assist devices; endovascular treatment represents a promising alternative to the surgical approach as it is less invasive, easily repeatable and associated to a reduced procedural risk.