Embolization of a Bleeding Intercostal Artery
Alan B Lumsden
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
OBJECTIVES: Using step by step demonstration of this procedure, we will increase familiarity and comfort level in undertaking the following procedure.
METHODS: As vascular surgeons have greatly expanded their endovascular skill set, we are occasionally confronted with challenges, which are unique and unusual. However, with good foundational training, many of these challenges can be met with the simple application of knowledge of the underlying pathology, vascular anatomy and advanced catheter and wire skills. In this report, we demonstrate the procedure for identification and embolization of a bleeding intercostal artery following thoracentesis
RESULTS: Vascular was consulted by thoracic surgery for a huge chest wall hematoma which had developed following thoracentesis. The patient had received 8 units of blood, was unstable and had extensive ecchymosis along the left chest wall. A CT scan demonstrated the impressive extent of the bleeding and likely actively bleeding site in the 8th intercostal space. We used selective intercostal artery injection to localize the bleeding site. Once localized, onyx injection successfully occluded the feeding vessel. No further transfusion was required. The entire success of this procedure was the use ion a MIK catheter, widely used in neuroradiology for the evaluation of spinal AVMís. CONCLUSIONS: This minimally invasive approach precluded a difficult chest exploration thoracotomy in this unstable elderly male. The methods and techniques demonstrated well within the armamentarium of well-trained vascular surgeons.
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