Arterial embolization as a first line treatment for bleeding giant gastroduodenal ulcers

Abstract

failure of gastric anastomoses. This study examines the degree of revascularization of the gastric fundus following BAE. Materials and Methods: The selection of fundal arteries for BAE was based on a celiac DSA C-arm CT (Siemens Artis Zee). From the celiac axis, fundal arteries were targeted, and an anti reflux microcatheter (Surefire mT) and 0.016-inch steerable guidewire were inserted. In five pigs, X-ray visible 50-micron BaSO 4 alginate-impregnated microbeads (XEB) were infused (BAE) with repeat angiography performed at one month. In two pigs, 300-500-micron Embospheres were infused (BAE) with repeat angiography performed at four months. All arteries were initially embolized to complete stasis. Angiograms were reviewed independently by two experienced interventional radiologists (CW, BH) and scored for degree of recanalization (yes/no/partial) or collateralization (yes/no). Results: Of the 11 arteries embolized with 50-micron XEB, seven demonstrated complete recanalization, three demonstrated partial recanalization, and one demonstrated collateralization at one month. Of the four arteries embolized with 300-500 micron Embospheres, three demonstrated complete recanalization, and one demonstrated collateralization at four months. Conclusion: Of the 15 arteries embolized, all demonstrated either complete or partial revascularization or robust collateralization. This provides preliminary data that following BAE, the gastric fundus regains adequate perfusion. This should begin to mitigate concerns in the surgical community that gastric bypass following BAE would be contraindicated. 4:33 PM Abstract No. 223Use of celiac angiography immediately after percutaneous transhepatic portal interventional radiological procedure to confirm injury of the hepatic artery