Intractable Bladder Hemorrhage: Therapeutic Angiographic Embolization of the Hypogastric Arteries

Abstract

Malignant intractable bladder hemorrhage in an elderly, high risk patient was controlled effectively with bilateral hypogastric artery occlusion by angiographic placement of oxycel autologous clot emboli. Therapeutic alternatives for intractable bladder hemorrhage are reviewed briefly with particular emphasis on angiographic arterial occlusion. Appropriate anatomic and physiologic aspects of this therapy are discussed.

Superselective embolization of bladder arteries in the treatment of intractable bladder haemorrhage

“…Embolization has been successfully used for managing this intractable bleeding. A selective embolization is usually performed by introducing an angiographic catheter (4 Fr) into the internal iliac artery and employing reabsorbable Spongostan as embolization material 7 …”

Internal Iliac Artery Embolisation for the Control of Severe Bladder and Prostate Haemorrhage

“…Therapeutic embolisation for the control of bladder haemorrhage was first reported in 1974 by Hald and Mygind, and others have since found the technique of value in the treatment of this condition (Kobayashi et af., 1980;McIvor et al, 1982). Embolisation of both internal iliac arteries should be undertaken if embolisation of one side alone fails to control the bleeding (Schuhrke and Barr, 1976).…”

The management of intractable haematuria

“…Therapeutic embolization has been achieved by completely occluding the internal iliac artery with blood clot [41], Tachotop™[42], Gelfoam™ (gelatine sponge, Pharmacia and Upjohn, Sweden) [43,44], Histoacryl™ (Aesculap AG, Tuttlingen, Germany) [45] or isobutyl‐2‐cyanoacrylate [43,44]. A more selective approach was to identify the bleeding points and selectively catheterize the anterior division of the appropriate internal iliac artery, embolizing with a gelatine sponge [46].…”