Emergency transcatheter arterial embolization for massive gastrointestinal arterial hemorrhage

Abstract

To evaluate the different arteriographic manifestations of acute arterial massive hemorrhage of the gastrointestinal (GI) tract and the efficacy of emergency transcatheter arterial embolization (ETAE).A total of 88 patients with acute massive GI bleeding who experienced failure of initial endoscopy and/or conservative treatment were referred to our interventional department for acute GI arteriography from January 2007 to June 2015. After locating the source of bleeding, appropriate embolic agents, such as spring coil, hydroxyl methyl acrylic acid gelatin microspheres, polyvinyl alcohol (PVA) particles, etc., were used to embolize the targeted vessels. The angiographic manifestations and the effects of embolization of acute arterial massive hemorrhage of the GI tract were retrospectively analyzed.Of the 88 patients, 54 were diagnosed with arterial hemorrhage of the upper GI tract and 34 with arterial hemorrhage of the lower GI tract. Eighty cases were associated with positive angiography, which showed the following: contrast extravasation (only); gastroduodenal artery stenosis; pseudoaneurysm (only); pseudoaneurysm rupture with contrast extravasation; pseudoaneurysms merged with intestinal artery stenosis; GI angiodysplasia; and tumor vascular bleeding. Eight cases were diagnosed with negative angiography. Seven-two patients underwent successful hemostasis, and a total of 81 arteries were embolized. The technical and clinical success rates (no rebleeding within 30 days) in performing transcatheter embolization on patients with active bleeding were 100% and 84.71%, respectively (72 of 85). Within 30 days, the postoperative rebleeding rate was 15.29% (13/85). Of these rebleeding cases, 2 patients were formerly treated with "blind embolization," 7 underwent interventional embolic retreatment, and 3 had surgical operations. All cases were followed-up for 1 month, and 3 patients died from multiple organ failure. No serious complications such as bowel ischemia necrosis were observed.ETAE is a safe, effective, and minimally invasive treatment; because of the diversified arteriographic manifestations of acute GI hemorrhage, the proper selection of embolic agents and the choice of reasonable embolization method are essential for successful hemostasis.

Transarterial Embolization of Acute Gastrointestinal Bleeding

“…None of the patients experienced intestinal ischemia or duodenal stenosis during the postprocedural period Barnert et al, 2009). Although the most common cause of AGIB is ulcers, it is noteworthy that tumoral etiology is more common in patients scheduled for endovascular treatment (Shi et al, 2017). Similarly, in our study, AGIB patients with tumoral causes were more common.…”

“…Various embolizing agents have been used for embolization including gelatin spongostan, PVA, cyanoacrylate, onyx, coil and combinations of these (Loffroy et al, 2015;Širvinskas et al, 2017;Shi et al, 2017). The effect of embolic agent type on clinical results is controversial and there is no consensus on the selection of embolic agent in the literature.…”

Multicenter retrospective study of transcatheter arterial embolisation for life-threatening haemorrhage in patients with uncorrected bleeding diathesis

“…In this study, microparticles were successfully used but only in combination with microcoils, and generally various combination of embolic agents was used in most cases (in order to enhance the occlusive effect, as previously described (Aina et al 2001 ). On the other hand, n-butyl cyanoacrylate glue and ethylene vinyl alcohol copolymer (Onyx®) have been proposed as the most effective embolic agents in patients with bleeding disorders, as polymerization (glue) and solidification (Onyx) abruptly occludes the target vessel independently from the coagulation process (Shi et al 2017 ; Toyoda et al 1996 ; Né et al 2018 ).…”

“…In every day clinical practice, although deranged clotting is not an absolute contraindication for TAE, many interventional radiologists refuse TAE for patients with uncorrected bleeding parameters, until INR value normalizes around 1.5, driven by the lack of evidence regarding patient safety, in combination with the documented insufficiency of specific embolic materials, such as metallic coils, to provoke blood clotting in the presence of haemostatic disorders (Patel et al 2012 ; Shi et al 2017 ). Data regarding the safety and efficacy of TAE in patients with severe, life-threatening haemorrhage and bleeding diathesis due to anticoagulation therapy or underlying coagulopathy, remain scarce as they are mainly based on subgroups of patients with coagulopathy included in single-center, retrospective series (Hur et al 2014 ; Shi et al 2017 ; Jaffe et al 2015 ; Baron et al 2013 ). The authors sought to investigate outcomes of emergency TAE, performed in three large European vascular centers, for the management of life-threatening hemorrhage in patients with uncorrected bleeding diathesis.…”

Immobilized thrombin on X-ray radiopaque polyvinyl alcohol/chitosan embolic microspheres for precise localization and topical blood coagulation

“…Minimally invasive procedures to treat a variety of cancerous and noncancerous diseases, such as unresectable hepatocellular carcinoma [ 1 ], benign prostatic hyperplasia [ 2 ], uterine fibroids [ 3 ], and acute hemorrhage [ 4 ], have gained much attention in the clinic. Particularly, trans -catheter arterial embolization (TAE) is generally considered safe and effective in interventional therapy, which selectively delivers the embolic agents to the target artery under X–ray guidance.…”