Angiographic Management of Postoperative Bleeding

Arteriographic evaluation of postsurgical stomach

“…If the bleeding does not stop spontaneously and with conservative measures, however, radiologic or endoscopic diagnosis of its cause is warranted. In such cases arteriography provides a valuable method for localizing the bleeding site, its nonoperative management, and for the detection of various other postsurgical abnormalities [8][9][10][11][12][13]181.…”

“…However, mucosal sloughing along the suture line may cause delayed bleeding in the 2nd postoperative week. Several authors have emphasized the value of selective arteriography in the diagnostic and therapeutic management of this complication [4,8,9,14,20]. Among 11 cases studied by Athanasoulis et al [9], bleeding from the suture line occurred in the 1st postoperative day in 5, and during the 8th-10th days in 4 patients.…”

“…Several authors have emphasized the value of selective arteriography in the diagnostic and therapeutic management of this complication [4,8,9,14,20]. Among 11 cases studied by Athanasoulis et al [9], bleeding from the suture line occurred in the 1st postoperative day in 5, and during the 8th-10th days in 4 patients. All 9 patients had angiographic evidence of contrast extravasation and were successfully treated by intraarterial infusion of vasoconstrictive agents.…”

“…About half of these ulcerations are demonstrable on barium studies of the upper gastrointestinal tract, but many small and superficial ulcers escape detection [4][5][6]19]. Approximately 50% of the marginal ulcers present with bleeding which can be localized and controlled angiographically [8,9]. Another potential source of postoperative hemorrhage is stress ulceration in the junction of the 2nd and 3rd duodenal segments.…”

“…However, selective visceral arteriography can be used for the localization as well as the nonoperative control of the bleeding, often eliminating the need for surgical reexploration. This technique also provides information on the existence of arteriovenous fistulas and alterations of vascular architecture due to surgical intervention [8][9][10][11][12][13][14][15][16][17][18][19][20].…”