In Reply to: Re: Case 1299_02-- A Striking Radiographic Example of the Diagnosis and Treatment of Bronchial Hemorrhage posted by Moni Stein on December 07, 1999 at 08:37:56:
We see bronchial hemorrhage mainly in patients with cystic fibrosis. They always come back to repeat the embolization, therefore we never use coils and use mainly PVA ( approx. 250-300 microns).
We directly go for the bronchials and do an aortogram only if we can't find them quickly and suspect an anomalous origin.
There is not much to say. Our procedure is exactly the same as perfectly shown in the case presented; if one can pass beyond the take off of the anterior spinal artery, the embo can be done safely. I do not think that you have to look for the anterior spinal if you do not see it when you do a good selective bronchial angio.
Due to the possibility of collateral circulation as a cause of rebleeding, I would have repeated the embolization after the second episode. This would have probably spared the patients open surgery.