Emergent Endovascular Management of Acute Arterial Bleeding after Initial Unsuccessful Surgical Control

Abstract

Background: Hemorrhage and the complications thereof have traditionally been managed surgically but over the last two decades endovascular techniques have been increasingly used. These include coiling, liquid and particle embolization among others. These minimally invasive techniques now available locally are safe and cost effective. They are however yet to be fully adopted in acute emergency settings. Methods: Fifty two patients with acute bleeding from known causes and whose first surgical intervention was not successful in controlling the bleeding were referred for emergent endovascular embolization. Results: The causes of the bleeding included post traumatic bleeds from intra-abdominal organ injury, iatrogenic pseudoaneurysms, massive hemoptysis among others. There was 100% technical and clinical success rate in hemorrhage control. None of the patients required a repeat endovascular procedure for bleeding control and no major complications were reported. Conclusion: Endovascular embolization was successful in controlling bleeding in all of the patients. It is effective, safe and available as a first line choice. It should be considered in all patients presenting with severe hemorrhage from known causes in the initial presentation.