The utility of computed tomography-derived inferior vena cava parameters in predicting outcomes in patients with active bleeding undergoing transarterial embolization

The utility of computed tomography-derived inferior vena cava parameters in predicting outcomes in patients with active bleeding undergoing transarterial embolization

Inferior vena cava volume, Inferior vena cava diameter, CT, Active bleeding, Transarterial embolization,
Massive transfusion, Mortality

Abstract
Background The inferior vena cava (IVC) parameters are associated with prognostic significance in emergency
patients, but there is a lack of data using this parameter in patients with active bleeding.
Objectives To investigate the prognostic relevance of IVC parameters in patients with active bleeding.
Patients and methods A retrospective analysis was conducted on consecutive patients who underwent
transarterial embolization due to bleeding from different anatomical sites following computed tomography (CT)
imaging at a university medical center over a five-year period (2018–2022). The initial CT scan was used to determine
the IVC volume and IVC flatness index, which were then incorporated into multivariable regression analyses that
included demographic, hemodynamic, and laboratory data.
Results The analysis included 188 patients (75.3% male) with a median age of 50 years, and a massive transfusion rate
and an all-cause 30-day mortality rate of 26.6% each. Compared with female patients, male patients had a significantly
higher median IVC volume (25.45 vs. 15.8 cm3, p<0.001), whereas the median IVC flatness index was similar for
both sexes (14 vs. 14, p=0.414). Median IVC volumes were similar between 30-day survivors and nonsurvivors (21.6
vs. 20.2 cm3, p=0.382) and between patients who underwent massive transfusion and those who did not (21.2 vs.
21.5 cm3, p=0.567). A multivariable Cox proportional hazards model revealed a statistically significant association
between the IVC flatness index and 30-day mortality (hazard ratio, 1.27; 95% confidence interval, 1.01–1.59; p=0.038).
Additionally, logistic regression analysis revealed no significant association between the IVC flatness index and
massive transfusion (univariable odds ratio, 1.01; 95% confidence interval, 0.75–1.34; p=0.972).
Conclusions A higher IVC flatness index was associated with 30-day mortality in patients undergoing transarterial
embolization for active bleeding. Further studies are needed to determine the prognostic value of CT-derived IVC
parameters.

Hans-Jonas Meyer1* , Veronika Sotikova1

, Simon Riegelbauer1

, Sebastian Ebel1

, Holger Gößmann1
,

Matthias Mehdorn2

, Uwe Scheuermann2

, Hans-Michael Tautenhahn2

, Christian Kleber3

, Timm Denecke1
and

Manuel F. Struck4

https://doi.org/10.1186/s12245-025-01033-9

2025

Peri Irawan

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