Angiography for Preoperative Evaluation in Patients With Lower Gastrointestinal Bleeding

Cohn, Stephen M.; Moller, Beth A.; Zieg, Paul M.; Milner, Kerry A.; Angood, Peter B.

doi:10.1001/archsurg.133.1.50

Cited by 64 publications

(32 citation statements)

References 32 publications

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“…This routine is controversial. In Cohn et al the number of blood transfusions did not predict the likelihood of extravasation (3±2 units in positive and 3±3 units in negative angiographic findings) [16]. Leitman et al noted a mean of 6.8 units of Packed Cells transfused in negative vs 4.9 units in positive studies [20].…”

Section: Discussionmentioning

confidence: 97%

“…A negative arteriography fails to guide emergency surgery and delays operative decision making, which might be responsible for organ failure and death, as countered recently by Cohn et al [16]. Although rebleeding after a normal arteriography might occur in up to 60% of events [17,18], the impact of rebleeding on clinical outcome and survival is not well known.…”

mentioning

confidence: 99%

“…Although rebleeding after a normal arteriography might occur in up to 60% of events [17,18], the impact of rebleeding on clinical outcome and survival is not well known. In lower-GI-bleeding, reported mortality rates after a negative arteriographic study might range from 0 to 17% [12,16,19,20]. In upper-GI-bleeding, studies reporting outcome of patients with a negative arteriography are rare and inconsistent [21,22].…”

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confidence: 99%

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Outcome of acute nonvariceal gastrointestinal haemorrhage after nontherapeutic arteriography compared with embolization

et al. 2003

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In acute nonvariceal gastrointestinal (GI) bleeding, immediate arteriographic haemostasis is presently assumed to be a therapeutic advantage. This study assesses whether the risk of a delayed haemostasis, caused by arteriographic findings precluding embolization, might influence patient outcome. We performed a 5.5-year retrospective database search to find all patients referred for arteriography to arrest acute nonvariceal GI bleeding with embolization. The embolized and nonembolized patients were compared for differences in baseline characteristics and bleeding parameters. In both groups the outcome of all endoscopic or surgical interventions after catheterization was included in the follow-up. Clinical success (at 30 days, after all therapy) and in-hospital mortality in the embolized and nonembolized group were compared. We retrieved 63 nonembolized bleedings in 58 patients and 49 embolized bleedings in 49 patients. In the nonembolized group, transfusion need and haemodynamic instability were significantly less severe. Forty-two of 63 (66%) nonembolized bleedings persisted requiring haemostasis by surgery (n=23), endoscopy (n=13) or supportive transfusions. Thirteen of 49 (27%) embolized bleedings recurred and were managed by surgery (n=7), endoscopy (n=3) or transfusion. Overall clinical success rate was 88.9% (56 of 63) in the nonembolized and 87.8% (43 of 49) in the embolized group. Mortality rate was 17.2% (10 of 58) in the nonembolized vs 30.6% (15 of 49) in the embolized patients (P=0.115). Whether or not arteriographic findings afforded the opportunity to embolize, outcome of acute nonvariceal GI bleeding did not differ significantly; however, patients undergoing embolization were more critically bleeding and ill.

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Section: Discussionmentioning

confidence: 97%

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confidence: 99%

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confidence: 99%

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Outcome of acute nonvariceal gastrointestinal haemorrhage after nontherapeutic arteriography compared with embolization

et al. 2003

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“…To some extent, this might also be possible if typical flow patterns are seen in angiography. The sensitivity of angiography is estimated in the literature to be between 40 and 86%, with higher sensitivities in stronger bleedings [56,82,83]. When it comes to therapy, TAE has established itself more and more as an alternative to surgical interventions, especially in poor surgical candidates with several comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Radiographic techniques for the localization and treatment of gastrointestinal bleeding of obscure origin

Friebe

Wieners

2011

Eur J Trauma Emerg Surg

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“…Although this offers the additional benefit of treatment in certain cases [9], the technique is invasive, availability may be limited in the acute setting, and it may be challenging in unstable post-operative patients [10]. CT overcomes some of these issues and provides additional diagnostic information about the bowel wall, solid intra-abdominal organs and vessel walls.…”

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confidence: 99%

Multidetector CT findings in patients with mesenteric ischaemia following cardiopulmonary bypass surgery

Barrett¹,

Upponi²,

Benaglia³

et al. 2013

BJR

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Objective: To investigate CT findings in patients with pathologically proven mesenteric ischaemia postcardiopulmonary bypass surgery and compare them with the control group of patients without ischaemia. Methods: 68 patients were identified by a search of local surgical and pathological databases; these patients met the inclusion criteria of a laparotomy within 1 month of a procedure requiring cardiopulmonary bypass and a CT abdomen/pelvis within 1 week of the pathological diagnosis. Two radiologists independently reviewed the studies, evaluating 17 separate findings relating to the bowel, the vasculature or other structures; consensus was subsequently reached. The diagnostic value of CT findings was assessed using logistic regression. Results: 52 of 68 patients had pathologically proven ischaemia. Portal venous gas, mesenteric venous gas and small bowel faeces sign all had specificities of .0.94 for ischaemia but low sensitivity (,0.27). Differential mural enhancement had high sensitivity (0.92) but poor specificity (0.50). The combination of pneumatosis, bowel loop dilatation and differential mural enhancement predicted bowel ischaemia with a probability of 98%. The hardest signs to interpret based on poor interreader kappa agreement were bowel wall thinning, mesenteric stranding and differential mural enhancement. Conclusion: A combination of CT signs was predictive of ischaemic bowel; however, the more specific findings lacked sensitivity. If clinical suspicion is high for bowel ischaemia, prompt surgical intervention is warranted, regardless of CT findings. Advances in knowledge: Arterial occlusion was uncommon and venous occlusion was not present, which is supportive of a predominantly non-occlusive aetiology for ischaemia in this patient group.

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Angiography for Preoperative Evaluation in Patients With Lower Gastrointestinal Bleeding

Cited by 64 publications

References 32 publications

Outcome of acute nonvariceal gastrointestinal haemorrhage after nontherapeutic arteriography compared with embolization

Outcome of acute nonvariceal gastrointestinal haemorrhage after nontherapeutic arteriography compared with embolization

Radiographic techniques for the localization and treatment of gastrointestinal bleeding of obscure origin

Multidetector CT findings in patients with mesenteric ischaemia following cardiopulmonary bypass surgery

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