Safety and efficacy of emergency transarterial embolization for mesenteric bleeding

Abstract

Background Patients with spontaneous or traumatic active mesenteric bleeding cannot be treated endoscopically. Transarterial embolization can serve as a potential alternative to emergency surgery. Literature on transarterial embolization for mesenteric bleeding remains very scarce. The objective of this study was to evaluate the safety and efficacy of transarterial embolization for mesenteric bleeding. We reviewed all consecutive patients admitted for mesenteric bleeding to the interventional radiology department, in a tertiary center, between January 2010 and March 2021. Mesenteric bleeding was defined as mesenteric hematoma and contrast extravasation and/or pseudoaneurysm visible on pre-operative CT scan. We evaluated technical success, clinical success, and complications. Results Among the 17 patients admitted to the interventional department for mesenteric bleeding, 15 presented with active mesenteric bleeding requiring transarterial embolization with five patients with hemodynamic instability. Mean age was 67 ± 14 years, including 12 (70.6%) males. Technical success was achieved in 14/15 (93.3%) patients. One patient with technical failure was treated by percutaneous embolization with NBCA-Lipiodol mixture. Three patients (20%) had early rebleeding: two were treated by successful repeat embolization and one by surgery. One patient (6.7%) had early death within 30 days and two patients (13.3%) had late death after 30 days. Mean length of hospitalization was 12.8 ± 7 days. There were no transarterial embolization-related ischemic complications. Conclusion Transarterial embolization is a safe and effective technique for treating mesenteric bleeding even in patients with hemodynamic instability. Transarterial embolization doesn’t close the door to surgery and could be proposed as first intention in case of mesenteric bleeding.

Prospective Evaluation of the Safety and Feasibility of N-Butyl Cyanoacrylate Embolization

“…There have been reports on the use of NBCA as an intravascular embolic material for treating various diseases, such as embolization of aneurysms to prevent rupture 9) , hemostasis for severe bleeding [10][11][12][13] , embolization to control blood loss before surgical removal of hypervascular tumors 14,15) , embolization for vascular malformation [16][17][18] , arterial redistribution before transarterial treatment 19) , and embolization for endoleak after aortic stent placement 20,21) . The use of NBCA embolization to treat cerebrovascular disease 16,18) and varicose veins 22) has been reported by several prospective studies; however, only a few prospective studies have reported on its use to treat other diseases.…”