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 11, 1999 at 14:16:41:
I am happy that you agree that this is a "rare" complication, and in your earlier comment you had indicated that you do not actively search for the spinal artery and "try" to embolize beyond it when you see one. This is basically what I said I do ( read to the end of my comment). The question is what to do if one is not successful in trying to pass beyond it. Should one embolize proximal or stop. In Tanaka's report the complication occured in one out of 24 patients who were embolized proximal to the spinal artery (an occurance of 4% not knowing the circumstances of the particular case, like how extensively and how aggressively they embolized, what size PVA or what type of contrast agent they used).
I am of the opinion that in such a case when facing a life threatening hemorrhage one should accept this very low risk of PERMANENT neurolgical complication (2 cases reported in the literature) and embolize perhaps with large size PVA (>750) proximal to the spinal artery.