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OBJECTIVE. The major risk of transcatheter embolotherapy for acute hemorrhage in the lower gastrointestinal tract is irreversible intestinal ischemia. The authors studied the efficacy and safety of superselective transcatheter embolization with polyvinyl alcohol particles in arresting acute hemorrhage in the lower gastrointestinal tract. SUBJECTS AND METHODS. All patients with clinical or scintigraphic evidence of acute hemorrhage in the lower gastrointestinal tract were considered for superselective embolization. The nine patients with angiograms that showed active hemorrhage in the lower gastrointestinal tract underwent the procedure. Superselective embolization was done through a 3-French catheter and was accomplished by using 100-to 59O-m polyvinyl alcohol particles. The segments of the intestinal tracts involved in the embolizations were examined for the presence of ischemia by endoscopy (n = 7) or histologic evaluation of a surgical specimen (n = 2) 2-44 days (mean, 1 1 days) after embolization or by clinical evaluation (n = 1). RESULTS. The lesions treated by this method were located in the colon (n = 8) and jejunum (n = 1). Immediate hemostasis was achieved in every case. Three patients had recurrent lower gastrointestinal hemorrhage 1-24 days (mean, 9 days) after initial

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To evaluate its potential for differentiating benign from malignant breast lesions, digital subtraction angiography of the breast (DSAB) was performed in 23 women with mammographic evidence of disease, and the results were compared with surgical biopsy findings. The DSAB technique employed breast immobilization with modest compression and bolus injection; following the injection of contrast material, 30-40 sequential subtraction images were obtained over a 5-minute interval. The average technical settings were 50 k Vp and 10 mAs, resulting in an estimated radiation dose to the breast of 0.05 mrad (0.5 mu Gy) per exposure. DSAB consistently demonstrated retention of contrast material and abnormal vasculature in malignant lesions but not in benign lesions. In the 22 breast lesions for which there was histopathologic correlation, DSAB correctly categorized eight of nine malignant and 11 of 13 benign lesions. Although this series is small, the initial results of DSAB suggest its potential for differentiating benign from malignant lesions.

The authors have investigated digital subtraction angiography (DSA) for the differential diagnosis of breast lesions detected initially by mammography. Eighteen patients scheduled for biopsy first underwent digital subtraction angiography of the breast (DSAB). Criteria for malignancy included the presence of abnormal vessels and a "blush" in the area of the lesion. A total of 17 lesions are currently available for histopathologic correlation. Although this is a small series, the initial results of DSAB suggest its potential utility for differentiating between benign and malignant lesions.