Episode # 3 • 17 Jan 2025
Managing Acute Hemorrhage with Liquid Embolics
How do you take control of an acute arterial bleed when the vessel arises straight off the aorta, the INR is 6.7, and coils depend on a clotting cascade the patient does not have? In this episode of the BackTable 2026 Liquid Embolics Creator Weekend™, Dr. Alexander Misono (Hoag Hospital, Newport Beach) and Dr. Oleksandra Kutsenko (Red Rock Radiology) join Dr. Kavi Krishnasamy to walk through real-world acute hemorrhage cases, from renal pseudoaneurysm to retroperitoneal and GI bleeds, where liquid embolization made the difference. The panel shares practical strategies for embolic selection, rapid triage, and owning the patient and outcome in high-stakes settings.
This podcast is supported by an educational grant from Sirtex.
Timestamps
00:00 - Introduction
01:57 - Case 1: Renal Bleed After Nephrostomy
02:38 - Deciding to Angiogram After CTA
05:00 - Owning the Patient and Aggressive Bleed Control
06:20 - Liquid Embolization Technique for Pseudoaneurysm
10:59 - Case 2: Lumbar Artery Bleed in Coagulopathy
13:10 - Skeletonizing the Retroperitoneum
15:23 - Embolizing Through High INR
20:11 - Case 3: Retroperitoneal and External Iliac Branch Bleed
22:24 - Case 4: PTBD Tract Bleeding
26:28 - Coil Backstop Before Liquid Embolic
29:07 - Closing Remarks
Resources
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More about this episode
The discussion turns on the decisions around the embolization rather than on the injection alone. The panel debates when a positive CTA actually earns an angiogram, why owning the tube and the patient changes how aggressively you pursue the bleed, and how far to skeletonize the retroperitoneum when several lumbar levels look suspicious. They compare femoral and prone transradial access, weigh active against passive closure in an anticoagulated patient, and work through a negative angiogram that hides a hepatic pseudoaneurysm. The session closes on whether a coil backstop still earns its place before a liquid embolic, and when flow and experience make it unnecessary.
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