Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. Bronchial artery embolization (BAE) is a relatively safe treatment for refractory hemoptysis. However, non-bronchial systemic arteries can be a significant source of massive hemoptysis and a cause of recurrence after successful BAE. Moreover, a highly-advanced catheter technique is required because of the smaller arterial size, advanced patient’s age and a dangerous complication such as spinal cord injury. In this review, we discuss the indications and contraindications for IVR with the pathophysiologic features of massive bleeding, the importance of MD-CT and CTA before BAE, the technique with the characteristics of the various embolic agents used in the procedure, short-term and long-term results and possible complications.

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Non-traumatic arterial bleeding of gastrointestinal (GI) tract is associated with potential morbidity and mortality. When it fails to achieve hemostasis by an endoscopic measure, transcatheter arterial embolization (TAE) is a good treatment option with a high rate of hemostasis and a low rate of ischemic complication. Various kinds of embolic materials including gelatin sponge particles, metallic coils, and N-butyl-2-cyanoacrylate (NBCA) may be used. Each embolic agent has its own characteristics, benefits and drawbacks that interventionalists need to be familiar with. The choice of embolic agent depends on a combination of the bleeding location, vascular anatomy, achievable catheter position, and the operator’s preference. Evaluation of the angiographic findings is also important. Not only direct signs of GI bleeding like extravasation of contrast medium, but also indirect signs including pseudoaneurysm, vessel spasm or cutoff, and increased vascularity must not to be missed. Provocative angiography or empiric embolization may be useful when the bleeding site cannot be identified angiographically. Compared with TAE, intraarterial vasopressin infusion therapy has disadvantages of a high recurrent bleeding rate and a long-term placement of catheter, but is still probably preferable for diffuse lesions.

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Vascular embolization is now used as a surgical alternative for non-traumatic and traumatic arterial bleeding.
In this report, we describe the outline of percutaneous hemostatic procedures for non-traumatic hepatic or pancreatic arterial bleeding.

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Spontaneous retroperitoneal hemorrhage (SRH) is defined as a retroperitoneal hemorrhage that occurs without proceeding trauma or any underlying pathology. Survival of patients with SRH depends on rapid and accurate diagnosis followed by imperative management, as the bleeding is often insidious and initially unrecognized. Management had mainly consisted of conservative treatment including cessation or reversal of the anticoagulation, fluid resuscitation, and transfusion previously. Although endovascular intervention of transarterial embolization (TAE) for retroperitoneal hemorrhage caused by trauma or iatrogenic injury is an established procedure, TAE for SRH has been controversial due to its unknown pathophysiology and occult diffuse microvascular bleeding. There is therefore no contemporary consensus to suggest when to attempt transarterial embolization in the treatment of SRH.

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Transcatheter arterial embolization has become a major treatment modality in a variety of obstetric and gynecologic applications.
We describe three items mainly (1)The pitfall in IR obstetric hemorrhage (2)Selection of embolic material (3)Bleeding by tumor necrosis.

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Two cases of thoracic artery extravasation were treated with covered stents. Both cases who had advanced esophageal cancer after irradiation were in hemorrhagic shock condition, because of life-threatening hemorrhage. Enhanced CT revealed extravasation of the left common carotid artery, accompanied by right aberrant subclavian artery in one case. Endovascular repair using covered stents resulted in complete exclusion of the pseudoaneurysm and control of the bleeding. Endovascular treatment with covered stents for hemorrhage of common carotid and subclavian arteries can be a safe and helpful treatment.

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Here we describe the long-term survival of a patient with hepatic metastases from cutaneous malignant melanoma treated by repeated transcatheter arterial chemoembolization (TACE) and arterial infusion chemotherapy (TAIC). Hepatic metastases were observed as multiple nodular tumor stains without extrahepatic metastasis 29 months after surgery for cutaneous malignant melanoma. Successful control of the tumors was achieved in this patient, as was a high quality of life during chemotherapy. The patient died of multiple organ failure 36 months after the initial endovascular therapy. Understanding the form of liver metastases with digital subtraction angiography contributes to improved outcomes of endovascular therapy. The present case supports TACE/TAIC as an effective therapy against hepatic metastases from malignant melanoma, particularly those with a nodular appearance on angiography.

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