Acute lower gastrointestinal hemorrhage: treatment by superselective embolization with polyvinyl alcohol particles.

Abstract

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

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

“…Acute surgical intervention will eventually be required in 10%-15% of patients, 7 but is associated with a mortality of 25%. 8 Mesenteric angiography and angioembolization is a well described diagnostic and therapeutic option in the management of both acute UGIB [9][10][11][12] and LGIB [13][14][15][16] after endoscopic failure. The decision to perform mesenteric angiography or proceed directly with surgical intervention is often at the discretion of the attending surgeon.…”

Angiography for Preoperative Evaluation in Patients With Lower Gastrointestinal Bleeding

“…33 The long-term consequences of angiographic control of hemorrhage are unknown, but the colon appears to be at increased risk for ischemia and colonic stricture after transcatheter embolization. 34,35 In our study, we found that 6 of the 20 patients who received vasopressin still required urgent operation after the infusion was initiated, and 8 of the remaining 14 patients ultimately underwent a colon resection. Seventy percent of our patients in this group, therefore, had surgery.…”

Colocutaneous fistula complicating therapeutic mesenteric embolisation

“…The use of superselective embolisation to deliver particulate size of 100 µm or larger 4 into the most distal arterial branches has resulted in a reduction of this complication with only 10% requiring surgery for ischaemia. 5 Moreover, the combination of particulate and microcoil superselective embolisation may be advantageous in controlling haemorrhage caused by diffuse lesions such as vascular malformations with minimal amount of embolysates, reducing further the risk of infarction. 6 Surgery is indicated for persistent haemorrhage, re-bleeding and signs of colonic ischaemia post embolisation.…”