In Reply to: Re: Case 1299_02-- A Striking Radiographic Example of the Diagnosis and Treatment of Bronchial Hemorrhage posted by Pasteur Rasuli on December 12, 1999 at 22:46:01:
I agree with Pasteur; the handful of cases I see are life-threatening hemorrhages, and these patients are poor surgical candidates by definition. I get careful consent, and then do whatever is necessary to stop the bleeding. I have not caused a neurological complication, but do worry a lot...
I also agree with the concept of second sessions after re-bleeds. The last case I did was a sarcoid patient who had extensive connections from Bronchials to PA's, and possibly to PV's (flow was fast, and the LA filled very early). I embolized with Gelfoam because of this. She also had a big parasitized collateral from the subclavian which I embolized. She re-bled in a week, and on a repeat angio had two big intercostals parastized to the lung, also with communication to PA's. I embolized these, and she has not rebled in 6 weeks. If she re-bled now, I would do a third angio and embolize whatever was responsible.
I think that the only reason not to embolize in the face of a re-bleed would be failure to find or cannulate the offending vessel