Gelfoam powder embolization of the left gastric artery in treatment of massive small-vessel gastric bleeding.

Abstract

Gelfoam (gelatin foam) powder was used for embolization therapy of massive gastric bleeding from small vessels in 14 patients with severe underlying medical problems. Bleeding was controlled in 10 patients with lesions localized in areas supplied by the embolized left gastric artery. In four patients with concurrent lesions in other portions of the stomach, bleeding decreased only (3 patients) or did not respond to embolization (1 patient). Complications developed in 2 patients with compromised vascular supply of the stomach: superficial ischemic ulcers that healed, and a large ulcer that perforated and required surgery. Microscopic studies demonstrated Gelfoam powder penetration mostly into vessels 100 to 200 microns in diameter and only occasionally into smaller vessels 50 to 60 microns, with occlusion of approximately 10 to 15% of the vasculature. It is concluded that Gelfoam fragments are the primary embolic material to be used for occlusion of the left gastric artery. Use of Gelfoam powder should be limited to occasional patients who have only little chance of responding to Gelfoam fragment embolization. Potential candidates for Gelfoam powder embolization include patients with major coagulopathies and/or uremia who massively hemorrhage from small-vessel lesions localized in upper portions of the stomach, exhibit significant mucosal hypervascularity, and do not respond to selective vasopressin treatment. An uncompromised vascular supply of the stomach is a precondition of a safe left gastric artery embolization.

Selective induction hyperthermia following transcatheter arterial embolization with a mixture of nano-sized magnetic particles (ferucarbotran) and embolic materials: feasibility study in rabbits

“…In contrast to lipiodol, gelatin particles embolize the more proximal side of the artery depending on their size. 21 The heating ratio of VX2 tumor tissue (IH-TAE group) was weaker than that in normal renal parenchyma (F-L group). Because the experimental VX2 tumor was relatively hypovascular relative to the surrounding renal parenchyma, the grade of accumulation of lipiodol and elevation ratio of the temperature were lower than those in the surrounding kidney (Fig.…”

Bariatric Embolization for Suppression of the Hunger Hormone Ghrelin in a Porcine Model

“…Embolization of the left gastric artery in humans was first reported in 1975 for control of upper gastrointestinal hemorrhage related to gastric ulcer disease and is still currently used to control benign and malignant sources of gastric hemorrhage (22). A wide variety of embolic materials have been reported in this distribution, including polyvinyl alcohol particles, coils, glue, autologous clot, and gelfoam powder (23)(24)(25). The considerable aggregate experience with embolization of the left gastric artery suggests that the concept and technique of bariatric embolization used in this study has the potential to be safely translatable to humans.…”

Role of transcatheter arterial embolization for massivebleeding from gastroduodenal ulcers

“…tissue adhesives such as cyanoacrylate) or very small particles (e.g. gelatine sponge powder) [41][42][43][44] . Although cases have been reported at the acute phase, post-embolization ischemia usually presents as duodenal stenosis at the chronic phase.…”