Usefulness of dual‐phase cone‐beam computed tomography during arteriography and automated tumour‐feeder detection software in transarterial embolization for obscure arterial bleeding in the abdomen

Abstract

We report the usefulness of dual-phase cone-beam computed tomography during angiography (CBCTA) and automated tumour-feeder detection software (AFD) in transarterial embolization (TAE) for three consecutive cases of obscure arterial bleeding in the abdomen. Two patients presented with lower gastrointestinal bleeding and one showed bleeding into the pancreatic pseudocyst. Superior mesenteric or common hepatic angiography did not demonstrate extravasation, but dual-phase CBCTA and AFD could identify extravasation and an access route to the bleeding point. TAE with gelatin sponge particles and a microcoil was successfully performed under AFD guidance in all patients without any complication, and haemostasis could be achieved.

Aberrant Inferior Pancreaticoduodenal Artery During Upper Gastrointestinal Bleed Embolization

“…CBCT has been known for its role in confirming segmental distribution of hepatocellular carcinoma during chemoembolization. However, CBCT has also provided more utility in identifying GI bleeds difficult to localize with digital subtraction angiography alone [11]. A greater interval between dual phases during CBCT and higher concentrated contrast material may increase the likelihood of detecting extravasation in an active bleed.…”

“…A greater interval between dual phases during CBCT and higher concentrated contrast material may increase the likelihood of detecting extravasation in an active bleed. While Carrafiello et al utilized a 15-second interval between the first and second phase of CBCT and 300 mg I/mL contrast material, Miyayama et al utilized a 30-second interval and 370 mg I/mL contrast concentration [11,12]. While Carrafiello et al found the active bleed in 19/20 of their patients using dual phase CBCT, Miyayama et al found the bleed in all three of their obscure GI bleed patients [11,12].…”