Empiric Transcatheter Arterial Embolization for Massive or Recurrent Gastrointestinal Bleeding: Ten-year Experience from a Single Tertiary Care Center

Abstract

Purpose In patients with massive or recurrent gastrointestinal bleeding (GIB) which is not amenable to endoscopic therapy, angiographic interventions are often employed. We report our ten-year experience of empiric transcatheter arterial embolization (TAE) for patients with massive or recurrent GIB. Methods All patients who had undergone empiric TAE at our hospital between March 2004 and June 2015 were identified using the institutional radiology information system. A retrospective chart review was performed using a structured pro forma. Technical success rate, 30-day clinical success rate, 30-day mortality rate, and rate of procedural complications were computed. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20. Results A total of 32 patients had undergone empiric TAE for GIB during the study period. The median age of subjects was 56 years and two-thirds of them were male (68.7%). Gastroduodenal (n=24), ileocolic (n=3), left gastric (n=2), right gastroepiploic (n=1), and branches of superior and middle rectal arteries (n=1) were embolized using microcoils (n=25), polyvinyl alcohol particles (n=25), and gelatin sponge (n=3)--either alone or in combination. Technical and 30-day clinical success rates were 96.9% (31/32) and 71.9% (23/32), respectively. The 30-day mortality rate for our cohort was 21.9% (7/32). One patient developed re-bleeding at two days after the initial procedure and required repeat embolization. Coil migration (n=3) and access site hematoma (n=1) were the observed procedural complications. Conclusion Empiric TAE can be a useful treatment option for selected patients with massive or recurrent GIB that is not amenable to endoscopic therapy.

The efficacy and clinical outcomes of transarterial embolization in acute massive upper gastrointestinal bleeding: a single-center experience

“…This is in agreement with previous studies reporting the technical success rate of TAE to be over 90% [7][8][9]. These high success rates can be attributed to the development of endovascular devices with the advancements in technology, growing experience of IRs, and the combined use of embolic agents [10]. Researchers stated that technical failure occurred most frequently due to difficult vascular anatomies, arterial dissection, vasospasm, false negatively read angiogram, multiple…”

“…In such cases, blind embolization can be performed on the arteries feeding the bleeding focus. Although blind embolization is controversial, most researchers argue that this procedure should be performed based on endoscopic findings [9,10]. Aina et al, [17], Loffroy et al, [18], and Padia et al [19] performed blind embolization of GDA using coils in those with and without positive angiography findings in their case series.…”

“…Various embolic agents, such as gelatin sponges, metallic coils, PVA, glue, N-butyl cyanoacrylate, and autologous blood clots can be used in the TAE procedure [3,9,10]. In this study, the combination of coil and PVA particles was most commonly used for embolization.…”

Transcatheter Arterial Embolization in Acute Non-Variceal Gastrointestinal Bleedings: A Ten-Year Single-Center Experience in 91 Patients and Review of the Literature

“…Gastrointestinal bleeding (GIB) is one of the major causes of hospitalization, responsible for 1–2% of all admissions and burdened with a high death rate of up to 25% [ 1 , 2 ].…”

“…Several studies have recently shown the safety and efficacy of TAE with the use of advanced tools and techniques for UGIB and LGIB, but to our knowledge, most of them have included a limited number of patients [ 2 , 4 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Coil embolization is the most used technique worldwide to treat GIB, avoiding bowel ischemic complications [ 2 , 4 ].…”