Transcatheter Embolization Of Hypogastric Branch Arteries in the Management of Intractable Bladder Hemorrhage

No AccessJournal of Urology1 Jan 1979Transcatheter Embolization Of Hypogastric Branch Arteries in the Management of Intractable Bladder Hemorrhage Erich K. Lang, Jules S. Deutsch, Jack R. Goodman, Troy F. Barnett, Joseph A. Lanasa, and Gorst H. Duplessis Erich K. LangErich K. Lang More articles by this author , Jules S. DeutschJules S. Deutsch More articles by this author , Jack R. GoodmanJack R. Goodman More articles by this author , Troy F. BarnettTroy F. Barnett More articles by this author , Joseph A. LanasaJoseph A. Lanasa More articles by this author , and Gorst H. DuplessisGorst H. Duplessis More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)56648-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Abstract: Transcatheter embolization with inert material was found to be an effective modality to control hemorrhage from the bladder and other pelvic organs. Hemorrhage in the 14 patients studied was attributable to a variety of traumatic, neoplastic and congenital conditions. Superselective catheter techniques permit selective engagement of branch vessels, such as the superior vesical artery, and, therefore, limit embolization to the supply area of 1 branch. In patients with multiple demonstrable bleeding points supplied from different branch vessels embolization is best done by releasing the infarct particles in midstream of the appropriate division of the hypogastric artery and relying on the siphoning effect of the bleeding lesion to channel particles into the appropriate branches. To facilitate superselective engagement of branch vessels an approach via the axillary artery or the contralateral femoral artery is favored. Fluoroscopic monitoring and fractional embolization with decreasing volumes of embolic material for the second and subsequent embolization attempts are imperative to limit embolization to the desired region and preclude inadvertent regurgitation of embolic material into the main vessels with attendant embolization of distant capillary beds. An excellent collateral network in the bladder muscularis assures an acceptable capillary flow to any segment in which the principle vascular supply has been embolized and, thus, prevents tissue necrosis. However, the reduced pressure gradient in the embolized system allows adequate clot formation at bleeding points. In general, transcatheter embolization should be done only after bleeding points have been identified (extravasation of contrast medium on the diagnostic arteriogram). However, in cases with hemorrhage from the bladder owing to carcinoma of the bladder or to direct extension of other pelvic neoplasms, specific bleeding points may not be identifiable. Embolization of the entire vascular supply of the vesical component of such neoplasms is, nonetheless, most effective in control of this type of hemorrhage and usually can be accomplished by midstream injection of absorbable gelatin sponge into the anterior division of the hypogastric artery. The propensity of arteriovenous malformations to refill and reform via collaterals may necessitate repeat embolization for permanent obliteration. © 1979 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByDelgal A, Cercueil J, Koutlidis N, Michel F, Kermarrec I, Mourey E, Cormier L, Krausé D and Loffroy R (2018) Outcome of Transcatheter Arterial Embolization for Bladder and Prostate HemorrhageJournal of Urology, VOL. 183, NO. 5, (1947-1953), Online publication date: 1-May-2010.de Vries C and Freiha F (2018) Hemorrhagic Cystitis: A ReviewJournal of Urology, VOL. 143, NO. 1, (1-9), Online publication date: 1-Jan-1990. Volume 121Issue 1January 1979Page: 30-36 Advertisement Copyright & Permissions© 1979 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Erich K. Lang More articles by this author Jules S. Deutsch More articles by this author Jack R. Goodman More articles by this author Troy F. Barnett More articles by this author Joseph A. Lanasa More articles by this author Gorst H. Duplessis More articles by this author Expand All Advertisement Loading ...