Angiographic Embolization of Nonvariceal Upper Gastrointestinal Bleeding: Predictors of Clinical Failure

Lundgren, Jessica A; Matsushima, Kazuhide; Lynch, Frank C.; Frankel, Heidi L.; Cooney, Robert N.

doi:10.1097/ta.0b013e318213faf1

Cited by 10 publications

(11 citation statements)

References 13 publications

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“…The use of anticoagulant or antiplatelet medication has been shown to be a significant risk factor for clinical failure in UGI bleeding (33), but this study found no statistically significant association between anticoagulant or antiplatelet medication and clinical success rate. The patients who had taken anticoagulant or antiplatelet medication only had a slightly lower clinical success rate than patients who had not taken these medications.…”

Section: Discussioncontrasting

confidence: 82%

Superselective Transarterial Embolization for Lower Gastrointestinal Bleeding: An Analysis of its Effectiveness and Safety

et al. 2016

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Section: Discussioncontrasting

confidence: 82%

Superselective Transarterial Embolization for Lower Gastrointestinal Bleeding: An Analysis of its Effectiveness and Safety

et al. 2016

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“…Our findings complement those of a recent study providing additional insights into the short-term outcomes of angiographic therapy and subsequent embolization in patients with GIB. [11][12][13] Management options for patients with acute nonvariceal upper GIB that does not respond to initial endoscopic treatment include repeat endoscopy, emergency surgery, and angiographic embolization. Several studies have compared the effectiveness of surgery to embolization in treating patients with GIB.…”

Section: Discussionmentioning

confidence: 99%

The Clinical and Technical Effectiveness of Endovascular Embolization in Patients with Nonvariceal Gastrointestinal Bleeding

Elmi

Walker

Ganguli

et al. 2017

J Clin Interv Radiol ISVIR

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IntroductionGastrointestinal bleeding (GIB) is a common problem that accounts for approximately 2% of hospital admissions. 1Although factors such as response to fluid resuscitation and/or transfusion, hypotension, the presence of shock, and coagulopathy are determinants of appropriate treatment strategy, 2 the majority of nonvariceal GIB resolves spontaneously.3 When bleeding persists, endoscopy is the mainstay for diagnosis and treatment and results in primary hemostasis in the majority of the cases. However, in a subset of patients, endoscopic therapy fails to halt bleeding, necessitating angiographic evaluation and transcatheter arterial embolization or surgery for bleeding control. 4 In patients who are poor surgical candidates or in those with an unclear source of bleeding, angiography cannot only provide information about the location and cause of bleeding but may allow therapeutic intervention to stop the Keywords ► gastrointestinal bleeding ► endoscopy ► angiography ► embolization AbstractBackground and Aim Endovascular embolization is a well-established option in the management of acute gastrointestinal bleeding (GIB) after failed therapeutic endoscopy; however, questions remain concerning the outcomes and the various predictors of clinical and technical success of this therapy. The authors aimed to assess the effectiveness of endovascular embolization in patients with nonvariceal GIB. Method Clinical records of 88 patients (mean age: 67.8 years) who underwent endovascular embolization for GIB were reviewed. Patient demographics, history, angiographic findings, treatment, and outcomes were recorded. The technical success of embolization, and the 24-hour and 30-day rebleeding and mortality rates were calculated. Multivariate analysis was performed to assess the factors associated with 24-hour and 30-day rebleeding. Results Angiography demonstrated signs of bleeding in 63 (71.6%) patients and all underwent selective embolization of the abnormal artery. Empiric embolization was performed in 25 patients. Embolization was performed with coils (n ¼ 45), Gelfoam (n ¼ 12), microparticles (n ¼ 14), glue (n ¼ 2), or a combination of these (n ¼ 15). The technical success rate was 96.6%. The 24-hour and 30-day rebleeding occurred in 13 (14.7%) and 16 (18.2%) patients, respectively. The 24-hour and 30-day mortality rates were 9.1 and 11.3%, respectively. Ischemic complications following embolization were seen in three patients, of which two required surgery. Based on the multivariate analysis, the need for continued transfusion after embolization and prior GIB were independent variables associated with 24-hour and 30-day rebleeding, respectively. Conclusions Endovascular embolization has a high technical and clinical success in patients presenting with nonvariceal GIB.

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“…19 The need for surgical intervention for patients with clinically unsuccessful arterial embolization is 15 to 20%. 19,30 One study found UGIB to be more resistant to hemostasis (with a higher rate of early rebleeding) than lower GI hemorrhage. 18 This was hypothesized to be secondary to refilling of injured vessels through collateral circulation distal to the point of embolization.…”

Section: Discussionmentioning

confidence: 99%

“…Factors associated with clinical failure of arterial embolization include the use of anticoagulants, underlying coagulopathy, longer time interval between onset of bleed and embolization, increased number of pRBC transfusions, hypovolemic shock and/or vasopressor use, corticosteroids, and the use of coils as the lone embolic agent. 18,19,30,31 The overall postembolization complication rate is 6 to 9%. 30 Complications include access site hematoma, arterial dissection, contrast nephropathy, and nontarget embolization.…”

Section: Discussionmentioning

confidence: 99%

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Role of Interventional Radiology in the Emergent Management of Acute Upper Gastrointestinal Bleeding

Navuluri

Patel

Kang

2012

Semin intervent Radiol

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Approximately 100,000 cases of upper gastrointestinal bleeding (UGIB) require inpatient admission annually in the United States. When medical management and endoscopic therapy are inadequate, endovascular intervention can be lifesaving. These emergent situations highlight the importance of immediate competence of the interventional radiologist in the preangiographic evaluation as well as the endovascular treatment of UGIB. We describe a case of UGIB managed with endovascular embolization and detail the angiographic techniques used. The case description is followed by a detailed discussion of the treatment approach to UGIB, with attention to both nonvariceal and variceal algorithms.

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Angiographic Embolization of Nonvariceal Upper Gastrointestinal Bleeding: Predictors of Clinical Failure

Abstract: AE clinical failure portends poor prognosis. Caution should be exercised when considering AE, particularly AE using coils, in patients with a history of anticoagulant, corticosteroid, or vasopressor use.

Cited by 10 publications

References 13 publications

Superselective Transarterial Embolization for Lower Gastrointestinal Bleeding: An Analysis of its Effectiveness and Safety

Superselective Transarterial Embolization for Lower Gastrointestinal Bleeding: An Analysis of its Effectiveness and Safety

The Clinical and Technical Effectiveness of Endovascular Embolization in Patients with Nonvariceal Gastrointestinal Bleeding

Role of Interventional Radiology in the Emergent Management of Acute Upper Gastrointestinal Bleeding

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