Efficacy of emergency transarterial embolization in acute lower gastrointestinal bleeding: A single-center experience

Abstract

TAE is a safe and effective treatment to control massive acute LGIB, especially in the emergency setting with a clinical success rate of 63%.

Cases report: severe colonic bleeding in ulcerative colitis is refractory to selective transcatheter arterial embolization

“…All of them were performed by the same experienced interventional radiologist (GRR). Reasons for unsuccessful transcatheter arterial embolization in this setting may include both technical failures and the development of complications such as bowel ischaemia [6–8]. The main cause for technical failure of transcatheter arterial embolization described in the literature is the inability to perform superselective catheterization of the bleeding vessels; in our series, technical success was accomplished in all three cases, as demonstrated by complete occlusion of the bleeding vessels confirmed by a control radiographic series.…”

“…The main cause for technical failure of transcatheter arterial embolization described in the literature is the inability to perform superselective catheterization of the bleeding vessels; in our series, technical success was accomplished in all three cases, as demonstrated by complete occlusion of the bleeding vessels confirmed by a control radiographic series. On the other hand, it is known that superselective embolization reduces the frequency of secondary colonic ischaemia to less than 13% [6–8], and none of our patients developed this complication. Clinical or anatomical factors related to rebleeding after colonic arterial embolization have not been clearly established, although the underlying diagnosis seems to be relevant.…”

“…Although the risk of colonic infarction after embolization is higher than in gastric and small bowel bleeding – because of the lack of an overlapping arterial blood supply in the colonic vasculature – the development of selective microcatheters and new embolization agents, such as microcoils and polyvinyl alcohol particles, as in these three cases reported herein, allows embolization of smaller vessels, reducing the risk of colonic infarction [6]. Thus, selective transcatheter embolization represents a safe, effective and widely employed alternative to surgery in endoscopically refractory lower gastrointestinal bleeding [6–8]. Management of this potentially life-threatening complication was decided in agreement with gastroenterologists, surgeons, radiologists, and patients.…”

“…Improvements in interventional radiology techniques treating lower gastrointestinal bleeding have increased the expectancy of conservative treatments in this complication. In this sense, several studies show excellent results concerning technical and clinical success of superselective transcatheter embolization in lower gastrointestinal bleeding, avoiding surgery in more than two-thirds of patients [6–8]. However, patients with inflammatory bowel disease (IBD) are generally excluded from these series; to our knowledge, only one case of a patient diagnosed with long-standing UC and a massive haemorrhage successfully treated with transcatheter arterial embolization has been published up to date [9].…”

Successful treatment for severe pancreatitis with colonic perforation using video-assisted retroperitoneal debridement: A case report

“…They treated by endoscopic clips and histoacryl glue injection instead of colectomy. It has been reported that colonic perforation due to ischemia after embolization could occur [ 17 ]. In the present case, ischemia due to embolization in addition to inflammation due to severe pancreatitis may have caused perforation of the colon near the splenic flexure.…”