Pitfalls in the angiographic management of hemorrhage: hemodynamic considerations

Selective arterial infusions of vasopressin have often been successful in controlling arterial bleeding. When bleeding occurs in an area with a dual blood supply through a vascular arcade, situations may arise which can compromise angiographic management. These include: (1) artifacts caused by pressure injections of contrast material inaccurately depicting the usual distribution of blood flow in the arcade; (2) catheter-induced vasospasm altering the flow dynamics through the arcade; (3) vasopressin-induced constriction of the proximal portion of an arcade changing the origin of blood flow to the distal arcade; and (4) proximal occlusion of one limb of an arcade permitting continuation of bleeding through collateral channels. When angiographic techniques fail to control bleeding because of these circumstances, hemostasis may be achieved by treating both limbs of the vascular arcade.
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