Efficacy of Intra‐Arterial Treatment for Massive Gastrointestinal Bleeding in Hemodialysis Patients

Abstract

The incidence of acute nonvariceal massive gastrointestinal bleeding (GIB) is higher in hemodialysis (HD) patients than in healthy individuals, and this is often a life-threatening event. We evaluated the efficacy of intra-arterial treatment for GIB in HD patients. Between January 2006 and June 2012, eight HD patients with GIB were treated with superselective transarterial embolization. Of the eight cases, one was duodenal bleeding, two were jejunal bleeding, one was ileocecum bleeding, two were ascending colonic bleeding, and two were sigmoid colonic bleeding. After examining the site of bleeding by endoscopy or contrast-enhanced computed tomography (CT), embolizations with microcoils, gelatin sponges, or N-butyl cyanoacrylate were performed through interventional radiology (IVR). In all cases, blood transfusions were frequently administered. Six of the eight patients with GIB were successfully salvaged by transarterial embolization. In one case, duodenal bleeding was refractory to endoscopic treatment. Embolization was performed twice in this case; however, the patient died of an aneurysm rupture at the embolization site 24 days after the embolizations. In another case, massive jejunal bleeding and disseminated intravascular coagulation were identified at the time of the first examination, and the patient died of multiorgan failure 26 days after the embolization. On the basis of our experience, we established an effective treatment strategy for HD patients with acute nonvariceal massive GIB, by immediately identifying the exact site and degree of bleeding using contrast-enhanced computed tomography and performing early treatment with transarterial embolization.

Embolization of Nonvariceal Upper Gastrointestinal Hemorrhage Complicated by Bowel Ischemia

“…17 Patients on hemodialysis have been shown to have a higher rate of UGIB compared with the general population and transcatheter arterial embolization has been shown to be effective in controlling bleeding in this patient population as well. 18 Additionally, angiography and transcatheter arterial embolization have been shown to be effective in the treatment of hemobilia, a rare cause of UGIB. Causes of hemobilia include blunt hepatic trauma, laparoscopic cholecystectomy, iatrogenic from hepatobiliary intervention, vascular malformations, and hepatic artery pseudoaneurysm.…”

ACR Appropriateness Criteria ® Nonvariceal Upper Gastrointestinal Bleeding

“…TAE has been shown to be efficacious in controlling bleeding related to a wide array of etiologies, including gastric adenocarcinoma [47], nitinol stent placement [12], and life-threatening hemorrhagic pancreatitis [6], and in patients on hemodialysis, who have been shown to have a higher rate of UGIB than the general population [48]. TAE for bleeding related to postendoscopic biliary sphincterotomy results in diminished need for invasive surgical intervention [49]; the posterior pancreaticoduodenal artery is the main origin of the vessels involved with postendoscopic sphincterotomy bleeding.…”

Predicting the need for transfer and interventional angiography for patients with acute colonic haemorrhage in a regional setting

“…Patients with colonic bleeding are often referred for angioembolization if intravascular contrast extravasation (a ‘blush’) is demonstrated on computed tomography mesenteric angiography (CTMA), indicating active haemorrhage . Angioemenbolization has an important role in management in these instances, enabling localization of the bleeding source and targeted vessel occlusion, potentially avoiding the need for colonoscopy (which can be technically challenging in the presence of a blood‐filled and unprepared colon) or emergency proctocolectomy . Angioembolization, which has been extensively examined in centres with on‐site access to interventional angiography (IA) has an important role in its management; however, evidence is lacking in units without direct access to IA.…”