A single-center retrospective study published in CVIR Endovascular reports that transcatheter arterial embolization (TAE) achieved complete technical and clinical success in eight patients with traumatic adrenal hemorrhage and contrast extravasation on computed tomography. The research team, led by Tomoya Mori and colleagues, evaluated the feasibility, short-term outcomes, and technical considerations of this minimally invasive procedure. The study included consecutive patients from a 194-month period between December 2006 and February 2023, focusing specifically on cases where active bleeding was identified on imaging. The primary endpoints were technical success, defined as complete embolization of the bleeding artery without residual contrast extravasation, and clinical success, defined as in-hospital control of hemorrhage without additional hemostatic intervention.
Adrenal injury is an uncommon consequence of trauma, with a reported incidence of 0.5% to 4% in previous series, yet traumatic adrenal hemorrhage has been identified in up to 26% of autopsy cases of patients who died from severe blunt trauma to the chest or abdomen. This discrepancy suggests that adrenal hemorrhage is frequently underdiagnosed in clinical practice due to its nonspecific presentation and diagnostic challenges. The injury is associated with substantial overall injury burden, with mortality rates ranging from 10 to 33% in previous series. Active bleeding may result in hemodynamic instability and fatal outcomes if not promptly managed, highlighting the need for effective hemostatic interventions in selected patients.
The study cohort consisted of eight patients, four men and four women, with a median age of 78 years and an age range of 47 to 89 years. All patients demonstrated active contrast extravasation on pre-procedural contrast-enhanced CT, with a median maximum hematoma diameter of 43 mm. Right-sided adrenal hemorrhage was observed in six patients, while the remaining two had left-sided involvement; no bilateral cases were identified. All patients had multiple injuries, three required blood transfusions, and two were receiving antithrombotic therapy. The median hospitalization duration was 13.0 days, ranging from 8 to 44 days. During hospitalization, follow-up CT was obtained in seven of the eight patients, generally showing hematoma reduction or resorptive change without evidence of worsening active bleeding.
Technical success was achieved in all eight cases, with complete embolization of the bleeding artery and no residual contrast extravasation on post-embolization angiography. Clinical success was also 100%, with effective control of adrenal hemorrhage during the index hospitalization as evidenced by the absence of repeat embolization or surgery and no clinical or imaging evidence of persistent or recurrent bleeding. Gelatin sponge particles were used as the primary embolic material in all procedures. Single-artery embolization was sufficient in six patients, whereas two patients required embolization of multiple adrenal arteries. The median interval between contrast-enhanced CT and angiography was 89.5 minutes, and the median procedure time was 62.5 minutes.
The anatomical patterns of the adrenal arteries presented significant variability, which is a key technical consideration for embolization. In the cohort, the inferior phrenic artery originated from the renal artery in three patients, the aorta in two, and the celiac trunk in three. The superior adrenal artery consistently arose from the inferior phrenic artery in all cases. The middle adrenal artery arose from the aorta in two cases, from the inferior phrenic artery in four, and from the left gonadal artery in one; it was not detected in one case. The inferior adrenal artery most commonly arose from the renal artery in four patients, whereas it was not clearly visualized in the remaining four cases. This variability necessitates a systematic angiographic search strategy to identify the culprit vessel and minimize incomplete hemostasis.
One intraprocedural complication occurred: catheter-related perforation of the inferior phrenic artery, which was successfully treated with a mixture of n-butyl cyanoacrylate and ethiodized oil. No procedure-related mortality was observed. One patient died on hospital Day 8 of complications unrelated to adrenal hemorrhage. No overt clinical evidence of adrenal insufficiency was observed during hospitalization, and no patient required steroid supplementation. Although electrolyte abnormalities were observed in several patients, these findings were interpreted in the context of severe trauma, fluid resuscitation, and associated conditions rather than as definitive evidence of adrenal insufficiency.
The study highlights the complex and highly variable anatomy of the adrenal arteries, which makes embolization technically challenging. Each adrenal gland is supplied by three principal arteries: the superior, middle, and inferior adrenal arteries. These vessels show marked variability in origin, most commonly arising from the inferior phrenic artery, aorta, and renal artery, respectively. The middle adrenal artery demonstrates the greatest variability, potentially arising from the aorta or inferior phrenic artery or being absent altogether. Rare variants, including branches from the celiac axis, intercostal, polar renal, gonadal, or superior mesenteric arteries, necessitate a systematic angiographic search when initial selective studies are negative. Detailed knowledge of these branching patterns is critical for procedural planning.
The authors reviewed 10 relevant original articles to contextualize their findings, extracting data only for TAE-treated patients from studies including mixed treatment modalities. Across these published cases, the culprit arteries were variable, with frequent involvement of adrenal branches from the inferior phrenic and renal arterial territories. Some cases involved multiple bleeding sources or required multi-artery embolization, supporting the need for a systematic angiographic search strategy. Although embolization of multiple adrenal arteries is sometimes required, adrenal insufficiency appears to be uncommon in unilateral injuries. However, adrenal insufficiency has been reported in bilateral adrenal trauma, underscoring the need for vigilant endocrine follow-up in such patients.
The study has several limitations that must be considered when interpreting the results. First, the retrospective single-center design, small sample size, and absence of a comparator group limit generalizability. Second, treatment effectiveness was assessed primarily on the basis of short-term in-hospital hemorrhage control. Because all patients had multisystem trauma, changes in hemoglobin level, transfusion requirement, overall clinical course, and post-embolization electrolyte trends may have been influenced by associated injuries, fluid resuscitation, and other trauma-related factors rather than adrenal hemorrhage alone. Third, endocrine assessment was based mainly on clinical course and routine laboratory findings, and formal hormonal testing such as serum cortisol measurement or ACTH stimulation testing was not uniformly performed.
Post-procedural decreases in hemoglobin level should be interpreted cautiously in the context of the overall clinical course, as they may partly reflect hemodilution related to fluid administration rather than ongoing or recurrent bleeding. Follow-up imaging was not protocolized, and post-discharge follow-up care was often provided at outside hospitals, limiting uniform evaluation of delayed rebleeding and late endocrine sequelae. The necessity of embolization and its comparative benefit over conservative management remain unclear. Currently, no consensus exists regarding the necessity or timing of intervention, with some authors advocating early treatment and others reporting favorable outcomes with conservative management. Persistent contrast extravasation may justify consideration of TAE even in initially hemodynamically stable patients, but indications should be individualized based on hemodynamics, concomitant injuries, and imaging findings.
In conclusion, transcatheter arterial embolization appears to be a technically feasible hemostatic option in selected patients with traumatic adrenal hemorrhage and CT-detected contrast extravasation, with favorable short-term in-hospital hemostatic outcomes in this small case series. Careful evaluation of the complex and variable adrenal arterial anatomy may facilitate identification of the culprit vessel and procedural planning. However, the small sample size, retrospective design, lack of a comparator group, and limited follow-up preclude definitive conclusions regarding comparative efficacy or long-term safety. The study provides a structured description of adrenal feeder anatomy and technical implications for embolization planning, contributing to the limited English-language evidence on this rare injury.
Subject of Research: Transcatheter arterial embolization for traumatic adrenal hemorrhage
Article Title: Transcatheter arterial embolization for traumatic adrenal hemorrhage with contrast extravasation: case series and literature review
Article References: Mori, T., Kawada, H., Nagata, S., Fukuta, T., Kanda, N., Miyake, T., Noda, Y., Kawai, N., Ando, T., Kaga, T., Suto, T., Asano, M., Seko, T., Imai, H., Elhelaly, A. E., Kato, H., Okada, H., & Matsuo, M. (2026). Transcatheter arterial embolization for traumatic adrenal hemorrhage with contrast extravasation: case series and literature review. CVIR Endovascular, 9(1), Article 100. https://doi.org/10.1186/s42155-026-00756-x
Image Credits: AI Generated
DOI: 10.1186/s42155-026-00756-x
Keywords: transcatheter arterial embolization, adrenal hemorrhage, trauma, interventional radiology, hemostasis, angiography, adrenal anatomy, clinical outcomes, Transcatheter, arterial, embolization, traumatic
News Source: Ophelia Keating. (November 10, 2026). Catheter Embolization Controls Bleeding in Traumatic Adrenal Hemorrhage. Scienmag.
