Superselective Microcoil Embolization for the Treatment of Lower Gastrointestinal Hemorrhage

Kuo, William T.; Lee, David E.; Saad, Wael E.A.; Patel, Nikhil C.; Sahler, Lawrence G.; Waldman, David L.

doi:10.1097/01.rvi.0000099780.23569.e6

Cited by 191 publications

(106 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Acute surgical intervention will eventually be required in 10%-15% of patients, 7 but is associated with a mortality of 25%. 8 Mesenteric angiography and angioembolization is a well described diagnostic and therapeutic option in the management of both acute UGIB [9][10][11][12] and LGIB [13][14][15][16] after endoscopic failure. The decision to perform mesenteric angiography or proceed directly with surgical intervention is often at the discretion of the attending surgeon.…”

mentioning

confidence: 99%

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

et al. 2012

View full text Add to dashboard Cite

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.

show abstract

mentioning

confidence: 99%

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

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Studies in the 1980s showed a 10%-20% incidence of post-embolization infarction, whereas later studies in the 1990s demonstrated few, if any, post-embolization infarction cases (12)(13)(14). The reduction in postembolization infarction has been attributed to the development of finer coaxial systems and microcoils and the increased experience of the interventionalists.…”

Section: Discussionmentioning

confidence: 99%

Mesenteric angiography results in gastrointestinal tract hemorrhages: single center experience

Peynircioğlu

Erkus²,

Çil³

et al. 2010

Diagn Interv Radiol

View full text Add to dashboard Cite

368G astrointestinal (GI) bleeding is one of the major causes of morbidity and mortality, and the incidence of hospital admittance for GI bleeding is 120 per 100 000 cases. Gastrointestinal bleeding primarily occurs in the upper GI tract above the Treitz ligament; however, 15% of GI bleedings occur in the lower GI tract. Although bleeding spontaneously stops in 80% of patients, it progresses or relapses in the other 20% (1). Although endoscopy is the primary diagnostic method to detect upper GI bleeding, scintigraphy is widely used for lower GI bleeding. Sulfur colloid scintigraphy can detect a bleeding in the range of 0.05-0.1 mL/min, and scintigraphic imaging with tagged red blood cells can detect a bleeding in the range of 0.2-0.4 mL/min (2). Consistent with recent technological advances, mesenteric computed tomography angiography (CTA) is a promising diagnostic approach for the detection of GI bleeding. CTA is less invasive than catheter angiography, but it is less sensitive than scintigraphy (0.1 mL/min for scintigraphy compared to 0.35 mL/min for CTA). However, there are several important advantages to CTA, namely that it can be performed 24 h a day in a matter of seconds (using multidetector CT equipment) and it can easily localize the bleeding. In addition, CTA can detect important findings that accompany the bleeding, such as bowel wall thickness, mass, and perforation, through its cross-sectional scanning ability (3).Although the limit of detection of the GI bleeding rate using transcatheter mesenteric angiography and the conventional film cassette technique is 0.5 mL/min, in vivo studies have shown that the limit of detection using digital subtraction angiography (DSA) is 5-9 times greater than conventional systems (2). However, both radiation exposure and the side effects of the contrast media used in nuclear medicine and radiological diagnostic methods must be considered when examining patients with GI bleeding. Although transcatheter mesenteric angiography is an invasive procedure, it is used in patients with massive GI bleeding because it not only detects the bleeding, but the underlying cause can be treated in the same endovascular session. The combination of mesenteric CT angiography and catheter angiography demonstrates that radiology plays a key role in the diagnosis and treatment of GI bleeding, which is a clinical problem requiring a multidisciplinary approach. Even after taking into account the different detection limits and the advantages and disadvantages of imaging, there is currently no defined, standard approach to treat GI bleeding (2).Medical or endoscopic coagulation, transcatheter embolization and surgical resection are the treatment options for GI bleeding. Although surgical resection is the definitive treatment, its mortality and morbidity rates are between 10%-15% (4). Colonoscopy is widely used for the diagnosis of lower GI bleeding, but very few patients benefit from endoscopic treatment (5). Transcatheter embolization is widely used throughout PURPOSEThis retrospective stud...

show abstract

“…Acute LGIB is generally evaluated with CT angiography or with technetiumtagged red blood cell scans, which have a different accuracy in detecting bleeding and its anatomic location [20][21][22]. Radiological hemostasis with either vasopressin infusion or coil embolization is generally carried out when bleeding is detected by angiography, while surgery is reserved for uncontrolled bleeding [23,24]. Colonoscopy is generally performed electively when bleeding has stopped spontaneously.…”

Section: Colonoscopy and Diverticular Bleedingmentioning

confidence: 99%

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

Tursi

2015

JGLD

View full text Add to dashboard Cite

Diverticulosis of the colon is frequently found on routine colonoscopy, and the incidence of diverticular disease and its complications appears to be increasing. The role of colonoscopy in managing this disease is still controversial.Colonoscopy plays a key role in managing diverticular bleeding. Several techniques have been effectively used in this field, but band ligation seems to be the best in preventing rebleeding. Colonoscopy is also effective in posing a correct differential diagnosis with other forms of chronic colitis involving colon harbouring diverticula (in particular with Crohn's disease or Segmental Colitis Associated with Diverticulosis). The role of colonoscopy to confirm diagnosis of uncomplicated diverticulitis is still under debate, since the risk of advanced colonic neoplasia in patients admitted for acute uncomplicated diverticulitis is not increased as compared to the average-risk population. On the contrary, colonoscopy is mandatory if patients complain of persistent symptoms or after resolution of an episode of complicated diverticulitis. Finally, a recent endoscopic classification, called Diverticular Inflammation and Complications Assessment (DICA), has been developed and validated. This classification seems to be a promising tool for predicting the outcome of the colon harboring diverticula, but further, prospective studies have to confirm its predictive role on the outcome of the disease.

show abstract

Superselective Microcoil Embolization for the Treatment of Lower Gastrointestinal Hemorrhage

Cited by 191 publications

References 30 publications

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

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

Mesenteric angiography results in gastrointestinal tract hemorrhages: single center experience

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

Contact Info

Product

Resources

About