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Semin intervent Radiol 2017; 34(04): 387-397
DOI: 10.1055/s-0037-1608862
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Palliative Embolization for Refractory Bleeding

Andrew Niekamp
1   Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
,
Rahul A. Sheth
1   Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
,
Joshua Kuban
1   Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
,
Rony Avritscher
1   Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
,
Suvranu Ganguli
2   Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
› Author Affiliations
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Publication History

Publication Date:
14 December 2017 (online)

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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.

Keywords

embolization - palliative care - hemorrhage - malignancy - interventional radiology
 

  • References

  • 1 Pereira J, Phan T. Management of bleeding in patients with advanced cancer. Oncologist 2004; 9 (05) 561-570
    CrossrefPubMedGoogle Scholar
  • 2 Dutcher JP. Hematologic abnormalities in patients with nonhematologic malignancies. Hematol Oncol Clin North Am 1987; 1 (02) 281-299
    CrossrefPubMedGoogle Scholar
  • 3 Akhtar K, Byrne JP, Bancewicz J, Attwood SE. Argon beam plasma coagulation in the management of cancers of the esophagus and stomach. Surg Endosc 2000; 14 (12) 1127-1130
    CrossrefPubMedGoogle Scholar
  • 4 Patel U, Pattison CW, Raphael M. Management of massive haemoptysis. Br J Hosp Med 1994; 52 (2-3): 74-76 , 76–78
    PubMedGoogle Scholar
  • 5 Brundage MD, Bezjak A, Dixon P. , et al. The role of palliative thoracic radiotherapy in non-small cell lung cancer. Can J Oncol 1996; 6 (Suppl. 01) 25-32
    PubMedGoogle Scholar
  • 6 Ferris FD, Bezjak A, Rosenthal SG. The palliative uses of radiation therapy in surgical oncology patients. Surg Oncol Clin N Am 2001; 10 (01) 185-201
    CrossrefPubMedGoogle Scholar
  • 7 Knott-Craig CJ, Oostuizen JG, Rossouw G, Joubert JR, Barnard PM. Management and prognosis of massive hemoptysis. Recent experience with 120 patients. J Thorac Cardiovasc Surg 1993; 105 (03) 394-397
    CrossrefPubMedGoogle Scholar
  • 8 Wells I. Internal iliac artery embolization in the management of pelvic bleeding. Clin Radiol 1996; 51 (12) 825-827
    CrossrefPubMedGoogle Scholar
  • 9 Recordare A, Bonariol L, Caratozzolo E. , et al. Management of spontaneous bleeding due to hepatocellular carcinoma. Minerva Chir 2002; 57 (03) 347-356
    PubMedGoogle Scholar
  • 10 Nabi G, Sheikh N, Greene D, Marsh R. Therapeutic transcatheter arterial embolization in the management of intractable haemorrhage from pelvic urological malignancies: preliminary experience and long-term follow-up. BJU Int 2003; 92 (03) 245-247
    CrossrefPubMedGoogle Scholar
  • 11 Yamashita Y, Harada M, Yamamoto H. , et al. Transcatheter arterial embolization of obstetric and gynaecological bleeding: efficacy and clinical outcome. Br J Radiol 1994; 67 (798) 530-534
    CrossrefPubMedGoogle Scholar
  • 12 Hayes MC, Wilson NM, Page A, Harrison GSM. Selective embolization of bladder tumours. Br J Urol 1996; 78 (02) 311-312
    PubMedGoogle Scholar
  • 13 Jenkins CN, McIvor J. Survival after embolization of the internal iliac arteries in ten patients with severe haematuria due to recurrent pelvic carcinoma. Clin Radiol 1996; 51 (12) 865-868
    CrossrefPubMedGoogle Scholar
  • 14 Srivastava DN, Gandhi D, Julka PK, Tandon RK. Gastrointestinal hemorrhage in hepatocellular carcinoma: management with transheptic arterioembolization. Abdom Imaging 2000; 25 (04) 380-384
    CrossrefPubMedGoogle Scholar
  • 15 Wholey MH, Chamorro HA, Rao G, Ford WB, Miller WH. Bronchial artery embolization for massive hemoptysis. JAMA 1976; 236 (22) 2501-2504
    CrossrefPubMedGoogle Scholar
  • 16 Najarian KE, Morris CS. Arterial embolization in the chest. J Thorac Imaging 1998; 13 (02) 93-104
    CrossrefPubMedGoogle Scholar
  • 17 Lorenz J, Sheth D, Patel J. Bronchial artery embolization. Semin Intervent Radiol 2012; 29 (03) 155-160
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Remy J, Voisin C, Ribet M. , et al. Treatment, by embolization, of severe or repeated hemoptysis associated with systemic hypervascularization. [in French]. Nouv Presse Med 1973; 2 (31) 2060
    PubMedGoogle Scholar
  • 19 Garcia-Olivé I, Sanz-Santos J, Centeno C. , et al. Results of bronchial artery embolization for the treatment of hemoptysis caused by neoplasm. J Vasc Interv Radiol 2014; 25 (02) 221-228
    CrossrefPubMedGoogle Scholar
  • 20 Walker CM, Rosado-de-Christenson ML, Martínez-Jiménez S, Kunin JR, Wible BC. Bronchial arteries: anatomy, function, hypertrophy, and anomalies. Radiographics 2015; 35 (01) 32-49
    CrossrefPubMedGoogle Scholar
  • 21 Ittrich H, Klose H, Adam G. Radiologic management of haemoptysis: diagnostic and interventional bronchial arterial embolisation. RoFo Fortschr Geb Rontgenstr Nuklearmed 2015; 187 (04) 248-259
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Burke CT, Mauro MA. Bronchial artery embolization. Semin Intervent Radiol 2004; 21 (01) 43-48
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 McPherson S, Routh WD, Nath H, Keller FS. Anomalous origin of bronchial arteries: potential pitfall of embolotherapy for hemoptysis. J Vasc Interv Radiol 1990; 1 (01) 86-88
    CrossrefPubMedGoogle Scholar
  • 24 Khalil A, Fedida B, Parrot A, Haddad S, Fartoukh M, Carette M-F. Severe hemoptysis: from diagnosis to embolization. Diagn Interv Imaging 2015; 96 (7-8): 775-788
    CrossrefPubMedGoogle Scholar
  • 25 Mal H, Rullon I, Mellot F. , et al. Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis. Chest 1999; 115 (04) 996-1001
    CrossrefPubMedGoogle Scholar
  • 26 Pelage JP, El Hajjam M, Lagrange C. , et al. Pulmonary artery interventions: an overview. Radiographics 2005; 25 (06) 1653-1667
    CrossrefPubMedGoogle Scholar
  • 27 Chen Y, Gilman MD, Humphrey KL. , et al. Pulmonary artery pseudoaneurysms: clinical features and CT findings. AJR Am J Roentgenol 2017; 208 (01) 84-91
    CrossrefPubMedGoogle Scholar
  • 28 Shin S, Shin T-B, Choi H. , et al. Peripheral pulmonary arterial pseudoaneurysms: therapeutic implications of endovascular treatment and angiographic classifications. Radiology 2010; 256 (02) 656-664
    CrossrefPubMedGoogle Scholar
  • 29 Dallaudière B, Hummel V, Pierre Laissy J. The use of covered stents for treatment of pulmonary artery pseudoaneurysms. J Vasc Interv Radiol 2013; 24 (02) 296-298
    CrossrefPubMedGoogle Scholar
  • 30 Van Landingham SB, Hendricks JC, Roberts JW. Spontaneous rupture of hepatocellular carcinoma. J Surg Oncol 1985; 29 (02) 129-131
    CrossrefPubMedGoogle Scholar
  • 31 Zhu LX, Wang GS, Fan ST. Spontaneous rupture of hepatocellular carcinoma. Br J Surg 1996; 83 (05) 602-607
    CrossrefPubMedGoogle Scholar
  • 32 Srinivasa S, Lee WG, Aldameh A, Koea JB. Spontaneous hepatic haemorrhage: a review of pathogenesis, aetiology and treatment. HPB 2015; 17 (10) 872-880
    CrossrefPubMedGoogle Scholar
  • 33 Leung KL, Lau WY, Lai PB, Yiu RY, Meng WC, Leow CK. Spontaneous rupture of hepatocellular carcinoma: conservative management and selective intervention. Arch Surg 1999; 134 (10) 1103-1107
    CrossrefPubMedGoogle Scholar
  • 34 Rosales A, Que FG. Spontaneous hepatic hemorrhage: a single institution's 16-year experience. Am Surg 2016; 82 (11) 1117-1120
    PubMedGoogle Scholar
  • 35 Kirikoshi H, Saito S, Yoneda M. , et al. Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study. BMC Gastroenterol 2009; 9 (01) 29
    CrossrefPubMedGoogle Scholar
  • 36 Goldstein HM, Medellin H, Ben-Menachem Y, Wallace S. Transcatheter arterial embolization in the management of bleeding in the cancer patient. Radiology 1975; 115 (03) 603-608
    CrossrefPubMedGoogle Scholar
  • 37 Kauffman CR, Mahvash A, Kopetz S, Wolff RA, Ensor J, Wallace MJ. Partial splenic embolization for cancer patients with thrombocytopenia requiring systemic chemotherapy. Cancer 2008; 112 (10) 2283-2288
    CrossrefPubMedGoogle Scholar
  • 38 Lee HJ, Shin JH, Yoon H-K. , et al. Transcatheter arterial embolization in gastric cancer patients with acute bleeding. Eur Radiol 2009; 19 (04) 960-965
    CrossrefPubMedGoogle Scholar
  • 39 Rosato Jr FE, Rosato EL. Current surgical management of intestinal metastases. Semin Oncol 2008; 35 (02) 177-182
    CrossrefPubMedGoogle Scholar
  • 40 Gordon B, Lossef SV, Jelinger E, Barth KH. Embolotherapy for small bowel hemorrhage from metastatic renal cell carcinoma: case report. Cardiovasc Intervent Radiol 1991; 14 (05) 311-313
    CrossrefPubMedGoogle Scholar
  • 41 Rustagi T, Rangasamy P, Versland M. Duodenal bleeding from metastatic renal cell carcinoma. Case Rep Gastroenterol 2011; 5 (01) 249-257
    CrossrefPubMedGoogle Scholar
  • 42 Thacker PG, Friese JL, Loe M, Biegler P, Larson M, Andrews J. Embolization of nonliver visceral tumors. Semin Intervent Radiol 2009; 26 (03) 262-269
    Article in Thieme ConnectPubMedGoogle Scholar
  • 43 Barnert J, Messmann H. Diagnosis and management of lower gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol 2009; 6 (11) 637-646
    CrossrefPubMedGoogle Scholar
  • 44 Busch ORC, van Delden OM, Gouma DJ. Therapeutic options for endoscopic haemostatic failures: the place of the surgeon and radiologist in gastrointestinal tract bleeding. Best Pract Res Clin Gastroenterol 2008; 22 (02) 341-354
    CrossrefPubMedGoogle Scholar
  • 45 Meehan T, Stecker MS, Kalva SP, Oklu R, Walker TG, Ganguli S. Outcomes of transcatheter arterial embolization for acute hemorrhage originating from gastric adenocarcinoma. J Vasc Interv Radiol 2014; 25 (06) 847-851
    CrossrefPubMedGoogle Scholar
  • 46 Almgård LE, Fernström I, Haverling M, Ljungqvist A. Treatment of renal adenocarcinoma by embolic occlusion of the renal circulation. Br J Urol 1973; 45 (05) 474-479
    CrossrefPubMedGoogle Scholar
  • 47 Mukund A, Gamanagatti S. Ethanol ablation of renal cell carcinoma for palliation of symptoms in advanced disease. J Palliat Med 2010; 13 (02) 117-120
    CrossrefPubMedGoogle Scholar
  • 48 Munro NP, Woodhams S, Nawrocki JD, Fletcher MS, Thomas PJ. The role of transarterial embolization in the treatment of renal cell carcinoma. BJU Int 2003; 92 (03) 240-244
    CrossrefPubMedGoogle Scholar
  • 49 Nurmi M, Satokari K, Puntala P. Renal artery embolization in the palliative treatment of renal adenocarcinoma. Scand J Urol Nephrol 1987; 21 (02) 93-96
    CrossrefPubMedGoogle Scholar
  • 50 Park JH, Kim SH, Han JK, Chung JW, Han MC. Transcatheter arterial embolization of unresectable renal cell carcinoma with a mixture of ethanol and iodized oil. Cardiovasc Intervent Radiol 1994; 17 (06) 323-327
    PubMedGoogle Scholar
  • 51 Loffroy R, Pottecher P, Cherblanc V. , et al. Current role of transcatheter arterial embolization for bladder and prostate hemorrhage. Diagn Interv Imaging 2014; 95 (11) 1027-1034
    CrossrefPubMedGoogle Scholar
  • 52 Smit SG, Heyns CF. Management of radiation cystitis. Nat Rev Urol 2010; 7 (04) 206-214
    CrossrefPubMedGoogle Scholar
  • 53 Bilhim T, Pisco JM, Rio Tinto H. , et al. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol 2012; 23 (11) 1403-1415
    CrossrefPubMedGoogle Scholar
  • 54 Loffroy R, Guiu B, Cercueil J-P, Krausé D. Endovascular therapeutic embolisation: an overview of occluding agents and their effects on embolised tissues. Curr Vasc Pharmacol 2009; 7 (02) 250-263
    CrossrefPubMedGoogle Scholar
  • 55 Liguori G, Amodeo A, Mucelli FP. , et al. Intractable haematuria: long-term results after selective embolization of the internal iliac arteries. BJU Int 2010; 106 (04) 500-503
    CrossrefPubMedGoogle Scholar
  • 56 Kobayashi T, Kusano S, Matsubayashi T, Uchida T. Selective embolization of the vesical artery in the management of massive bladder hemorrhage. Radiology 1980; 136 (02) 345-348
    CrossrefPubMedGoogle Scholar
  • 57 Pereira K, Halpern JA, McClure TD. , et al. Role of prostate artery embolization in the management of refractory haematuria of prostatic origin. BJU Int 2016; 118 (03) 359-365
    CrossrefPubMedGoogle Scholar
  • 58 Chen J-W, Shin JH, Tsao T-F. , et al. Prostatic arterial embolization for control of hematuria in patients with advanced prostate cancer. J Vasc Interv Radiol 2017; 28 (02) 295-301
    CrossrefPubMedGoogle Scholar
  • 59 Rastinehad AR, Caplin DM, Ost MC. , et al. Selective arterial prostatic embolization (SAPE) for refractory hematuria of prostatic origin. Urology 2008; 71 (02) 181-184
    CrossrefPubMedGoogle Scholar
  • 60 Korkmaz M, Şanal B, Aras B. , et al. The short- and long-term effectiveness of transcatheter arterial embolization in patients with intractable hematuria. Diagn Interv Imaging 2016; 97 (02) 197-201
    CrossrefPubMedGoogle Scholar
  • 61 Bilhim T, Tinto HR, Fernandes L, Martins Pisco J. Radiological anatomy of prostatic arteries. Tech Vasc Interv Radiol 2012; 15 (04) 276-285
    CrossrefPubMedGoogle Scholar
  • 62 Cizman Z, Isaacson A, Burke C. Short- to midterm safety and efficacy of prostatic artery embolization: a systematic review. J Vasc Interv Radiol 2016; 27 (10) 1487-1493.e1
    CrossrefPubMedGoogle Scholar
  • 63 Kim DH, Lee JH, Ki YK. , et al. Short-course palliative radiotherapy for uterine cervical cancer. Radiat Oncol J 2013; 31 (04) 216-221
    CrossrefPubMedGoogle Scholar
  • 64 Katzen BT, Rossi P, Passairello R, Simonetti G. Transcatheter therapeutic arterial embolization. Radiology 1976; 120 (03) 523-531
    CrossrefPubMedGoogle Scholar
  • 65 Riley J. The role of embolization in palliative care. Palliat Med 1996; 10 (02) 168
    CrossrefPubMedGoogle Scholar
  • 66 Pisco JM, Martins JM, Correia MG. Internal iliac artery: embolization to control hemorrhage from pelvic neoplasms. Radiology 1989; 172 (02) 337-339
    CrossrefPubMedGoogle Scholar
  • 67 Field K, Ryan MJ, Saadeh FA, Kamran W. Selective arterial embolisation for intractable vaginal haemorrhage in genital tract malignancies. Eur J Gynaecol Oncol 2016; 37 (03) 736-740
    PubMedGoogle Scholar
  • 68 Mann Jr WJ, Jander HP, Partridge EE. , et al. Selective arterial embolization for control of bleeding in gynecologic malignancy. Gynecol Oncol 1980; 10 (03) 279-289
    CrossrefPubMedGoogle Scholar
  • 69 Mihmanli I, Cantasdemir M, Kantarci F, Halit Yilmaz M, Numan F, Mihmanli V. Percutaneous embolization in the management of intractable vaginal bleeding. Arch Gynecol Obstet 2001; 264 (04) 211-214
    CrossrefPubMedGoogle Scholar