Interventional Treatment of Bleeding

Kim, Yong Joo

Abstract

After the percutaneous transarterial technique was introduced by Seldinger in 1953, the percutaneous transcatheter embolization technique was developed. Autologous clot, first used by Doppman in 1968 to occlude a spinal arteriovenous malformation, was quickly adopted for management of gastrointestinal hemorrhage, genitourinary hemorrhage, traumatic hemorrhage, and hemoptysis. The notable improvement of the angiographic techniques rendered the interventional treatment the mainstay in the management of bleeding. Interventional treatment can be a life-saving procedure for massive bleeding or an important adjunct in reducing blood loss during operation and occasionally radical treatment of bleeding diseases. The goal of embolotherapy is to reduce the pulse pressure in the bleeding artery while maintaining an enough collateral flow to preserve the tissue viability. A variety of embolic materials have been proved safe and effective. Gelfoam pledget, polyvinyl alcohol, and coil are most commonly used. Gelfoam powder, extremely small polyvinyl alcohol, and absolute alcohol should be used carefully because of the risk of mucosal ischemia and necrosis.