RETRACTED: The use of super-selective mesenteric embolisation as a first-line management of acute lower gastrointestinal bleeding

Abstract

IntroductionIn this study, we aim to assess the efficacy and safety of digital subtraction angiography (DSA) and super-selective mesenteric artery embolisation in managing lower gastrointestinal bleeding (LGIB) at a multi-centre health service in Melbourne (Australia).MethodA retrospective case series of patients with LGIB treated with superselective embolisation in our area health service. Patients with confirmed active LGIB, on either radionuclide scintigraphy (RS) or contrast-enhanced multi-detector CT angiography (CE-MDCT), were referred for DSA, and subsequently endovascular intervention. Data collected included patient characteristics; screening modality; bleeding territory; embolisation technique; technical and clinical success; short to mediumterm complications and mortality up to 30 days; and the need for surgery related to procedural failure or complications.ResultsThere were 55 hospital admissions with acute unstable lower gastrointestinal bleeding that were demonstrable on CE-MDCT or RS over a 30-month period (from 1 January 2014 to 30 June 2016). Of these, eighteen patients were embolised. Immediate haemostasis was achieved in all embolised cases. Eight patients (44%) had clinical re-bleeding postembolisation and warranted repeated imaging. However, only one case (5.6%) had active bleeding identified and was re-embolised. There was no documented case of bowel ischemia or ischemic-stricture and none progressed on to surgery. 30 day mortality was zero.ConclusionSuper-selective mesenteric embolisation is a viable, safe and effective first line management for localised LGIB. Our results overall compare favourably with the published experiences of other institutions. It is now accepted first-line practice at our institution to manage localised LGIB with embolisation.

Superselective microcoil embolization of the vasa recta of sigmoid artery for hemorrhaging after laparoscopic adnexectomy for corpus luteum hematoma with severe adhesion

“…Angiographic intervention has been known to be useful for treating acute lower gastrointestinal hemorrhaging . However, in the early developmental stage, the rate of bowel infarction is extremely high because of nonselective embolization . With recent advances in angiographic techniques due to the development of coaxial microcatheters, it has become possible to perform superselective catheterization of specific marginal arteries or even the vasa recta to deliver embolic materials close to the site of bleeding supplied by the sigmoid artery, as in the present case.…”

“…With recent advances in angiographic techniques due to the development of coaxial microcatheters, it has become possible to perform superselective catheterization of specific marginal arteries or even the vasa recta to deliver embolic materials close to the site of bleeding supplied by the sigmoid artery, as in the present case. Thus, the risk of infarction has been reduced, and the rate of secondary bleeding from collateral vessels has been minimized …”

“…Those include pelvic pain, a low‐grade fever, nausea, vomiting, loss of appetite and malaise in the first few days after TAE. Furthermore, specific complications associated with embolization of unusual vessels, such as the sigmoid artery, including bowel infarction, rebleeding and stricture formation secondary to ischemia, should be monitored …”

“…Angiographic intervention has been known to be useful for treating acute lower gastrointestinal hemorrhaging . However, in the early developmental stage, the rate of bowel infarction is extremely high because of nonselective embolization .…”

“…Emergency computed tomography (CT) demonstrated the significant extravasation of contrast medium from a small artery adjacent to the wall of the sigmoid colon (Fig. a, arrow), indicating bleeding from the vasa recta of the sigmoid artery . Management options, including exploratory laparotomy or an angiographic examination followed by embolization if applicable, were discussed with the patient and her husband.…”