Palliative Embolization for Refractory Bleeding

Abstract

Bleeding is a common and often challenging complication of malignancy. Etiologies of hemorrhage in this patient population vary, and bleeding may present as an acute, life-threatening emergency or a chronic, low-volume blood loss. For patients with advanced malignancies, interventions to manage bleeding must be balanced by the patient's life expectancy and quality of life. As such, minimally invasive procedures such as transarterial embolization are useful therapeutic options in appropriately selected patients. There is a rich history of palliative transarterial embolization for refractory bleeding in cancer patients. This technique was first applied in the 1970s and has since become an established treatment tool for malignancy-related bleeding throughout the body. While the preponderance of published data comprised case reports and small retrospective studies, the use of embolization continues to expand as experience grows and techniques are refined. In this review, we summarize the literature and provide our perspective on embolization for refractory bleeding in cancer patients.

Efficacy of interventional therapy and effect on inflammatory factors in patients with gastric cancer after chemotherapy

“…Research has shown that in the case of malignant tumor hemorrhage the expected survival and quality of life of patients should be considered. Since 1970s, arterial embolization has been used to treat refractory hemorrhage in cancer patients (34). A study has shown that patients with gastric cancer hemorrhage treated by endoscopy are prone to recurrence and re-hemorrhage; at this point, arterial embolization should be considered, which may lead to better efficacy (35).…”

The application of prostate artery embolization in the management of intractable prostate bleeding

“…With steadily published case reports and review papers, the embolization was improved and its reliability was strengthened. Thereby, the technique was continuously developed and the use of interventional radiology expanded [ 18 , 19 ].…”

“…Because vascularity in this area is highly diversified, it is particularly important to become familiarized with possible disparities and anastomoses. That enables to perform selective catheterization avoiding untargeted occlusion which yield undesirable ischemia [ 19 , 22 ]. According to current findings, the probability of the occurrence of single prostate artery from each pelvic side is 57% and double independent arteries arise from both sidewall occur in 43% of patients [ 26 ].…”

“…It frequently originates from the obturator artery and the anterior division of internal iliac artery (IIA) either in common trunk with the superior vesical artery or separately or inferiorly to it. Prostate arteries in their courses divide into two branches: anterior-lateral pedicle and posterior-lateral pedicle [ 19 , 26 , 27 , 28 ]. Knowledge of presented variants and some other rare patterns is very essential to complete the procedure successfully without non-target embolization complications ( Figure 1 ).…”

“…Non-target embolization can also be sometimes categorised as a major complications. It depends on necessity of the therapy, overnight admission, or prolonged hospitalization [ 19 , 31 , 32 ].…”