Control of massive hemoptysis by embolization of intercostal arteries

The embolization of intercostal arteries for the control of massive hemoptysis is described in two patients with bronchopleural fistulas and in one patient with sarcoidosis. Hemoptysis was controlled by embolization in all three cases, but spinal cord infarction occurred in one patient as a result of the procedure. This complication can occur even in cases where no significant blood supply to the spinal cord can be seen on preliminary arteriography, which suggests that in some patients angiographically invisible small branches play an important role in the blood supply to the spinal cord. These branches may be particularly important in cases in which the spinal blood supply is already compromised by surgery, radiation therapy, or previous embolization procedures.