Localization and Definitive Control of Lower Gastrointestinal Bleeding with Angiography and Embolization

Abstract

Angiography has long been a mainstay of lower gastrointestinal bleeding localization. More recently, angioembolism has been used therapeutically for bleeding control, but there are limited data on its efficacy. This study was designed to evaluate the efficacy of angiography and embolization for localizing and treating lower gastrointestinal bleeding as well evaluate the occurrence of bowel ischemia after embolization. This study is a retrospective descriptive review of all patients undergoing mesenteric angiography at a tertiary hospital over an eight-year period. Clinical data were recorded including patient demographics, causes of bleeding, procedures, and outcomes. Patients were excluded if the cause of bleeding was upper gastrointestinal bleeding or the medical record was missing data. Localization and definitive control of bleeding was the primary end point. One hundred fifty-nine angiograms were performed on 152 patients. Mean age was 72 years. Angiographic localization was successful in 23.7 per cent of patients. Although embolization after angiographic localization achieved definitive control of bleeding in 50 per cent of patients, the success rate was only 8.6 per cent of all patients who had angiography. One patient developed postembolization ischemia requiring laparotomy. Angiographic localization of lower gastrointestinal bleeding is successful in only 23.7 per cent of patients. Definitive hemostasis through embolization was successful in only 8.6 per cent of patients who underwent angiography for lower gastrointestinal bleeding.

Initial management for acute lower gastrointestinal bleeding

“…Angiography localizes the LGIB source in 24%-70% of cases[59,61]. Angiography requires blood loss rates > 0.5 mL/min to localize a bleeding site[62].…”

WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting

“…The rate of bowel ischemia following embolization was 1–4% in recent studies [ 85 , 86 ]. Angiography localizes the bleeding source in 24–70% of cases [ 87 ]. Angiography requires blood loss rates > 0.5 mL/min to localize a bleeding site [ 88 ].…”

ACR Appropriateness Criteria® Radiologic Management of Lower Gastrointestinal Tract Bleeding: 2021 Update

“…After superselective embolization of a distal branch at or near the vasa recta, collateralization that is known to prevent bowel necrosis can also cause rebleeding in the culprit lesion. In a recent series, although technical success rates of transcatheter embolization were higher, clinical success rates ranged from 63% to 96% [8][9][10][14][15][16][17][18]20], with rebleeding rates ranging from 11.1% to 50% [11][12][13]19,24]. In spite of this, transcatheter embolization has provided definitive treatment for 81% to 86% of patients [10,16].…”