Gastrointestinal bleeding: treatment with gastrointestinal arterial embolization.

Encarnacion, Carlos E.; Kadir, Saadoon; Beam, Craig A.; Payne, Cynthia S.

doi:10.1148/radiology.183.2.1561358

Cited by 130 publications

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“…Cancer-related bleeding seems to be much more difficult to control than other causes of bleeding, not only because of direct cancer invasion into adjacent vascular structures, but also because of severe mucositis caused by chemotherapy or radiation that can induce vascular erosion or tissue necrosis [25][26][27]. Several previous studies have analyzed the factors affecting clinical outcome after TAE using various embolic materials for gastrointestinal tract bleeding, and the results suggested that a high bleeding tendency was associated with a higher risk of early bleeding recurrence [28][29][30]. However, in our present study, a high bleeding tendency did not significantly decrease the clinical success rate of TAE.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

Koo

Shin

Kim

et al. 2015

American Journal of Roentgenology

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ing, renal arterial bleeding, and even gastrointestinal tract bleeding [2][3][4][5][6][7][8]. NBCA is highly penetrable because of its liquid nature and is less affected by coagulopathies; thus, it may be used as an adjunct to other embolic materials to ensure the embolic effect [9,10]. However, NBCA is difficult to handle effectively and safely and is inherently more prone to cause ischemic necrosis.Although there have been several reports on the use of TAE with NBCA for acute gastrointestinal tract bleeding, 9-84 patients were included in those studies, and neither long-term clinical data nor analyses evaluating clinical factors affecting the clinical success of NBCA were presented [11][12][13][14][15][16]. Therefore, studies in larger patient populations are warranted to determine the clinical effectiveness of NBCA in the setting of acute gastrointestinal tract bleeding, with or AJR 2015; 204:662-668 0361-803X/15/2043-662 © American Roentgen Ray Society E ndoscopy is a rapid diagnostic and therapeutic modality that is widely accepted as the preferred method for identifying and providing hemostasis at sites of gastrointestinal tract bleeding. In cases of endoscopic treatment failure or where the site of bleeding is inaccessible by endoscopy, such as distal small-bowel bleeding, transcatheter arterial embolization (TAE) may be an effective alternative to endoscopy. A previous study showed that TAE in the management of gastrointestinal tract bleeding is effective with good long-term clinical outcomes [1]. Va s c u l a r a n d I nt e r ve nt io n a l R a d io l og y • O r ig i n a l R e s e a rc hAmong the various embolic materials that have been evaluated, N-butyl-2-cyanoacrylate (NBCA) was first used to embolize cerebral aneurysms but now is widely used for controlling active bleeding, including intramuscular hemorrhage, uterine arterial bleed- OBJECTIVE. The purpose of this article is to evaluate the clinical effectiveness of transcatheter arterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA), with or without other embolic materials for acute nonvariceal gastrointestinal tract bleeding, and to determine the factors associated with clinical outcomes.MATERIALS AND METHODS. TAE using NBCA only or in conjunction with other materials was performed for 102 patients (80 male and 22 female patients; mean age, 61.3 years) with acute nonvariceal gastrointestinal tract bleeding. Technical success, clinical success, and clinical factors, including age, sex, bleeding tendency, endoscopic attempts at hemostasis, number of transfusions, and bleeding causes (i.e., cancer vs noncancer), were retrospectively evaluated. Univariate and multivariable logistic regression analyses were performed to evaluate clinical factors and their ability to predict patient outcomes. Survival curves were obtained using Kaplan-Meier analyses and log-rank tests.RESULTS. There were 36 patients with cancer-related bleeding and 66 with non-cancerrelated bleeding. Overall technical and clinical success rates were 100% (102/102) and 76.5% ...

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Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

Koo

Shin

Kim

et al. 2015

American Journal of Roentgenology

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“…Acute surgical intervention will eventually be required in 10%-15% of patients, 7 but is associated with a mortality of 25%. 8 Mesenteric angiography and angioembolization is a well described diagnostic and therapeutic option in the management of both acute UGIB [9][10][11][12] and LGIB [13][14][15][16] after endoscopic failure. The decision to perform mesenteric angiography or proceed directly with surgical intervention is often at the discretion of the attending surgeon.…”

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confidence: 99%

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

et al. 2012

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Background: Ongoing gastrointestinal bleeding (GIB) following endoscopic therapy and deciding between mesenteric angiography and surgery often challenge surgeons. We sought to identify predictors of positive angiographic study (active contrast medium extravasation) and characterize outcomes of embolization for acute GIB. Methods:We retrospectively analyzed angiographies for GIB at 2 teaching hospitals from January 2005 to December 2008. The χ 2 , Wilcoxon rank sum and t tests determined significance. A Cox proportional hazards model was used for multivariate analyses.Results: Eighteen of 83 (22%) patients had active extravasation on initial angiog raphy and 25 (30%) were embolized. Patients with active extravasation had more packed red blood cell (PRBC; 5.3 v. 2.8 units, p < 0.001) and fresh frozen plasma (4.8 v. 1.7 units, p = 0.005) transfusions 24 hours preangiography and were more likely to be hemodynamically unstable at the time of the procedure (67% v. 28%, p = 0.001) than patients without active extravasation. Each unit of PRBC transfused increased the risk of a positive study by 30% (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.6 per unit). Embolization did not decrease recurrent bleeding (53% v. 52%) or length of stay in hospital (28.1 v. 27.5 d, p = 0.95), but was associated with a trend toward fewer emergency surgical interventions (13% v. 26%, p = 0.31) and greater 30-day mortality (33% v. 7%, p = 0.006) than nonembolization. Blind embolization was performed in 10 of 83 (12%) patients and was found to be an independent predictor of death in patients without active extravasation (HR 9.2, 95% CI 1.5-55.9). Conclusion:The number of PRBC units transfused correlates with greater likelihood of a positive study. There was a significant increase in mortality in patients who underwent angioembolization. Large prospective studies are needed to further characterize the indications for angiography and blind embolization.

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“…High technical and clinical success rates of endovascular treatments for GI bleeding have been reported [7][8][9][10][11][12]. TAE is generally regarded as a safe procedure with few complications.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Walled-Off Necrosis Following Embolization with N-Butyl-2-Cyanoacrylate in a Patient with Upper Gastrointestinal Tract Bleeding

Moriya

Kakeda

Watanabe

et al. 2017

Interventional Radiology

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A 60-year-old man with a history of rheumatoid arthritis experienced bloody stool and presented in a state of shock. Emergency endoscopy showed upper gastrointestinal bleeding from a duodenal ulcer. Endoscopic hemostasis was attempted but failed. Gastroduodenal angiography revealed an extravasation from a duodenal branch of the anterior superior pancreaticoduodenal artery (ASPDA). Hemostasis was achieved by subsequent selective transarterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA) performed via the duodenal branch. Although no recurrent bleeding was observed, walled-off necrosis (WON) developed twice at 1 and 8 months after TAE due to localized necrotizing pancreatitis. WON is a rare but potentially serious complication of TAE with NBCA from a branch of the ASPDA.

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Gastrointestinal bleeding: treatment with gastrointestinal arterial embolization.

Cited by 130 publications

References 0 publications

Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

Recurrent Walled-Off Necrosis Following Embolization with N-Butyl-2-Cyanoacrylate in a Patient with Upper Gastrointestinal Tract Bleeding

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