title: Arterial embolization for iatrogenic life-threatening bleeding from subcutaneous hypervascular tumor in prone position.
abstract: Performing angiography in the prone position is a difficult technique; however it is useful in some emergency situation. We experienced a 60 years old male who was performed lipoma excision on his back in his family doctor's clinic. Since massive arterial bleeding could not be controlled with manual astriction, he transferred to our hospital in prone position with hemodynamic instability. Operating field was not kept because of massive bleeding; therefore surgical treatment was impossible. We planed emergency arterial embolization (AE) in prone position. Hence we chose the left radial artery for vascular access. The left subclavicle arteriography showed many major and minor feeding arteries from left subclavicular and axillary arteries and a massive extravasation of the contrast medium. Three major feeding arteries were performed AE with gelatin sponge and steel coils. After AE, massive bleeding was controlled. He could discharge from our hospital on the 5th hospital day without any complication. Arterial embolization for life-threatening bleeding from subcutaneous hypervascular tumor in the prone position is first report to our knowledge, and it is extremely rare. However we thought that this technique is useful for patients who could not turn in the supine position, e.g. massive bleeding during renal biopsy and penetrating trauma from back.
authors.affiliation: Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, 163 Shimokasuya Isehara-City Kanagawa, Japan. morita@is.icc.u-tokai.ac.jp
authors.forename: Seiji
authors.initials: S
authors.lastname: Morita
authors.forename: Tomoatsu
authors.initials: T
authors.lastname: Tsuji
authors.forename: Toru
authors.initials: T
authors.lastname: Sawamoto
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Aoki
authors.forename: Naoya
authors.initials: N
authors.lastname: Miura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Otsuka
authors.forename: Sadaki
authors.initials: S
authors.lastname: Inokuchi
mesh_terms: D000792:Angiography; D004621:Embolization, Therapeutic; D004632:Emergency Medical Services; D006801:Humans; D008067:Lipoma / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000628:therapy*; D016684:Prone Position