Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

Abstract

Background: Ongoing gastrointestinal bleeding (GIB) following endoscopic therapy and deciding between mesenteric angiography and surgery often challenge surgeons. We sought to identify predictors of positive angiographic study (active contrast medium extravasation) and characterize outcomes of embolization for acute GIB. Methods:We retrospectively analyzed angiographies for GIB at 2 teaching hospitals from January 2005 to December 2008. The χ 2 , Wilcoxon rank sum and t tests determined significance. A Cox proportional hazards model was used for multivariate analyses.Results: Eighteen of 83 (22%) patients had active extravasation on initial angiog raphy and 25 (30%) were embolized. Patients with active extravasation had more packed red blood cell (PRBC; 5.3 v. 2.8 units, p < 0.001) and fresh frozen plasma (4.8 v. 1.7 units, p = 0.005) transfusions 24 hours preangiography and were more likely to be hemodynamically unstable at the time of the procedure (67% v. 28%, p = 0.001) than patients without active extravasation. Each unit of PRBC transfused increased the risk of a positive study by 30% (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.6 per unit). Embolization did not decrease recurrent bleeding (53% v. 52%) or length of stay in hospital (28.1 v. 27.5 d, p = 0.95), but was associated with a trend toward fewer emergency surgical interventions (13% v. 26%, p = 0.31) and greater 30-day mortality (33% v. 7%, p = 0.006) than nonembolization. Blind embolization was performed in 10 of 83 (12%) patients and was found to be an independent predictor of death in patients without active extravasation (HR 9.2, 95% CI 1.5-55.9). Conclusion:The number of PRBC units transfused correlates with greater likelihood of a positive study. There was a significant increase in mortality in patients who underwent angioembolization. Large prospective studies are needed to further characterize the indications for angiography and blind embolization.

Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

“…Their study, however, differed from ours in that they compared the average number of transfusions in an unspecified time in the two groups rather than comparing the number of transfusions in 12 or 24 h prior to the procedure as we did, and we believe this could have accounted for the difference in the outcome. Our study concur with a recent study by Lee et al [20] , in which the number of PRBC units transfused in 24 h pre-angiography correlates with the greater likelihood of a positive study. According to that study each unit of PRBC transfused increased the risk of a positive study roughly by 30%.…”

Time to Catheter Angiography for Gastrointestinal Bleeding after Prior Positive Investigation Does Not Affect Bleed Identification

“…is finding corroborates several prior studies, which have shown that as bleeding severity increases, demonstrated by a drop in hemoglobin and increasing transfusions, the probability of finding a bleed also increases. [5,12,13] Comparison between the two groups also demonstrated that a higher percentage of patients with negative angiograms was on some form of antiplatelet therapy at time of initial presentation. Overall, this difference was not felt to be clinically useful as a significant percentage of patients in both groups was on antiplatelet therapy and that these medications are largely held in the acute setting.…”

“…Overall, these studies have found that patients with more severe bleeds are more likely to have positive bleeding seen on catheter angiography. [1,[3][4][5][6] e purpose of this study is to determine if time to angiography from prior positive investigation affects, TAI findings, and outcomes. Other factors were also included to corroborate prior studies and to control for important variables.…”

Urgent surgical care for patients with colon cancer complicated by hemorrhage

“…Наш небольшой опыт использования ангиографии (2 больных) позволил подтвердить ее высокую информативность. Визуализация экстравазатов в качестве ангиографического признака кровотечения толстой кишки описана и другими клиницистами [9,15,19]. Практически полное отсутствие осложнений и 100% информативность ангиографии при толстокишечных кровотечениях подтверждены рядом исследователей [18,19].…”