Management of Arterial Bleeding in Critically Ill Cancer Patients

  • T. T. T. HuynhEmail author
  • R. A. Sheth
Reference work entry


Acute major arterial bleeding complications are rare in cancer patients but can be fatal. Bleeding is usually related to the advanced malignancy or occurs as a consequence of the cancer treatment. Large tumor size and location of the tumor in close proximity to a large artery are risk factors for major bleeding complications. Prompt diagnosis and treatment is paramount in the management of acute major hemorrhage. Treatment begins with volume and blood resuscitation, followed by timely intervention to control the bleeding. This chapter provides an overview of the current management of arterial bleeding with the primary focus on patients with solid tumors during and after oncologic treatment.


Artery Arterial bleeding Hemorrhage Blowout Cancer Malignancy Tumor Oncology Blood loss Pseudoaneurysm Aorto-enteric fistula 


  1. 1.
    Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH, Martel M, Sinclair P, International Consensus Upper Gastrointestinal Bleeding Conference Group. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101–13.CrossRefGoogle Scholar
  2. 2.
    Carlson KS, DeSancho MT. Hematological issues in critically ill patients with cancer. Crit Care Clin. 2010;26(1):107–32.CrossRefGoogle Scholar
  3. 3.
    Cartoni C, Niscola P, Breccia M, Brunetti G, D'Elia GM, Giovannini M, Romani C, Scaramucci L, Tendas A, Cupelli L, de Fabritiis P, Foa R, Mandelli F.Hemorrhagic complications in patients with advanced hematological malignancies followed at home: an Italian experience. Leuk Lymphoma. 2009;50(3):387–91.CrossRefGoogle Scholar
  4. 4.
    Fartoukh M, Khoshnood B, Parrot A, Khalil A, Carette MF, Stoclin A, Mayaud C, Cadranel J, Ancel PY. Early prediction of in-hospital mortality of patients with hemoptysis: an approach to defining severe hemoptysis. Respiration. 2012;83(2):106–14.CrossRefGoogle Scholar
  5. 5.
    Franchini M, Frattini F, Crestani S, Bonfanti C. Bleeding complications in patients with hematologic malignancies. Semin Thromb Hemost. 2013;39(1):94–100.PubMedGoogle Scholar
  6. 6.
    Gunn AJ, Patel AR, Rais-Bahrami S. Role of angio-embolization for renal cell carcinoma. Curr Urol Rep. 2018;19(10):76.CrossRefGoogle Scholar
  7. 7.
    Hang XF, Xu WS, Wang JX, Wang L, Xin HG, Zhang RQ, Ni W. Risk of high-grade bleeding in patients with cancer treated with bevacizumab: a meta-analysis of randomized controlled trials. Eur J Clin Pharmacol. 2011;67(6):613–23.CrossRefGoogle Scholar
  8. 8.
    Harris DG, Noble SI. Management of terminal hemorrhage in patients with advanced cancer: a systematic literature review. J Pain Symptom Manag. 2009;38(6):913–27.CrossRefGoogle Scholar
  9. 9.
    Larici AR, Franchi P, Occhipinti M, Contegiacomo A, del Ciello A, Calandriello L, Storto ML, Marano R, Bonomo L. Diagnosis and management of hemoptysis. Diagn Interv Radiol. 2014;20(4):299–309.CrossRefGoogle Scholar
  10. 10.
    Lee JH, Hwang DW, Lee SY, Hwang JW, Song DK, Gwon DI, Shin JH, Ko GY, Park KM, Lee YJ. Clinical features and management of pseudoaneurysmal bleeding after pancreatoduodenectomy. Am Surg. 2012;78(3):309–17.PubMedGoogle Scholar
  11. 11.
    McDonald MW, Moore MG, Johnstone PA. Risk of carotid blowout after reirradiation of the head and neck: a systematic review. Int J Radiat Oncol Biol Phys. 2012;82(3):1083–9.CrossRefGoogle Scholar
  12. 12.
    Niekamp A, Sheth RA, Kuban J, Avritscher R, Ganguli S. Palliative embolization for refractory bleeding. Semin Intervent Radiol. 2017;34(4):387–97.CrossRefGoogle Scholar
  13. 13.
    Pereira J, Phan T. Management of bleeding in patients with advanced cancer. Oncologist. 2004;9(5):561–70.CrossRefGoogle Scholar
  14. 14.
    Sandler AB, Schiller JH, Gray R, Dimery I, Brahmer J, Samant M, Wang LI, Johnson DH. Retrospective evaluation of the clinical and radiographic risk factors associated with severe pulmonary hemorrhage in first-line advanced, unresectable non-small-cell lung cancer treated with Carboplatin and Paclitaxel plus bevacizumab. J Clin Oncol. 2009;27(9):1405–12.CrossRefGoogle Scholar
  15. 15.
    Sengupta N, Cifu AS. Management of patients with acute lower gastrointestinal tract bleeding. JAMA. 2018;320(1):86–7.CrossRefGoogle Scholar
  16. 16.
    Sheth RA, Sabir S, Krishnamurthy S, Avery RK, Zhang YS, Khademhosseini A, Oklu R. Endovascular embolization by transcatheter delivery of particles: past, present, and future. J Funct Biomater. 2017;8(2):12.CrossRefGoogle Scholar
  17. 17.
    Spanos K, Kouvelos G, Karathanos C, Matsagkas M, Giannoukas AD. Current status of endovascular treatment of aortoenteric fistula. Semin Vasc Surg. 2017;30(2–3):80–4.CrossRefGoogle Scholar
  18. 18.
    Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016;111(4):459–74.CrossRefGoogle Scholar
  19. 19.
    Ubogagu E, Harris DG. Guideline for the management of terminal haemorrhage in palliative care patients with advanced cancer discharged home for end-of-life care. BMJ Support Palliat Care. 2012;2(4):294–300.CrossRefGoogle Scholar
  20. 20.
    Wandt H, Schaefer-Eckart K, Wendelin K, Pilz B, Wilhelm M, Thalheimer M, Mahlknecht U, Ho A, Schaich M, Kramer M, Kaufmann M, Leimer L, Schwerdtfeger R, Conradi R, Dolken G, Klenner A, Hanel M, Herbst R, Junghanss C, Ehninger G, Study Alliance L. Therapeutic platelet transfusion versus routine prophylactic transfusion in patients with haematological malignancies: an open-label, multicentre, randomised study. Lancet. 2012;380(9850):1309–16.CrossRefGoogle Scholar
  21. 21.
    Wong DJY, Donaldson C, Lai LT, Coleman A, Giddings C, Slater LA, Chandra RV. Safety and effectiveness of endovascular embolization or stent-graft reconstruction for treatment of acute carotid blowout syndrome in patients with head and neck cancer: case series and systematic review of observational studies. Head Neck. 2018;40(4):846–54.CrossRefGoogle Scholar
  22. 22.
    Wu LM, Xu JR, Yin Y, Qu XH. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding: a meta-analysis. World J Gastroenterol. 2010;16(31):3957–63.CrossRefGoogle Scholar
  23. 23.
    Zakai NA, Walker RF, MacLehose RF, Adam TJ, Alonso A, Lutsey PL. Impact of anticoagulant choice on hospitalized bleeding risk when treating cancer-associated venous thromboembolism. J Thromb Haemost. 2018 Dec;16(12):2403–2412. Epub 2018 Oct 24.

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Thoracic and Cardiovascular SurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Interventional RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations