Transcatheter Arterial Embolization of Vesical Arteries for Intractable Hematuria: Effectiveness and Safety in 36 Patients

Abstract

Purpose

To evaluate the technical success, safety, and clinical effectiveness of vesical artery and/or internal iliac artery (IIA) embolization in patients with intractable hematuria from bladder hemorrhage.

Materials and Methods

A retrospective review was conducted on 36 patients (aged 49–89 years; mean age, 73.9 years) who underwent vesical artery and/or IIA embolization for nontraumatic intractable hematuria between January 2012 and July 2023. The most common etiologies for bleeding were pelvic tumors (n = 20, 55.6%) and radiation cystitis (n = 14, 38.9%). Prior to embolization, 24 patients (66.7%) had undergone cystoscopic intervention. Most patients (n = 29, 80.6%) were hemodynamically stable, while 7 patients (19.4%) were unstable; nearly all (n = 35, 97.2%) required blood transfusions.

Results

Technical success was achieved in 100% of cases. Clinical success was achieved in 30 patients (83.3%), with 6 patients requiring further interventions. Bilateral superselective vesical artery embolization had a higher clinical success rate (90%) than unilateral superselective embolization (70.6%). When bilateral embolization of the vesical arteries and/or IIAs was performed, clinical success was achieved in 94.1% of patients. Additionally, when superselective vesical artery embolization was performed in conjunction with nonselective IIA embolization, clinical success reached 100%. No major adverse events or procedure-related mortality was noted.

Conclusions

Superselective vesical artery embolization was effective in arresting intractable bladder hematuria, with clinical success further improved by IIA embolization and bilateral embolization.