Super-selective arterial embolization in the control of acute lower gastrointestinal hemorrhage

Abstract

BACKGROUNDAcute gastrointestinal bleeding is an emergency condition that can lead to significant morbidity and mortality. Embolization is considered the preferred therapy in the treatment of lower gastrointestinal bleeding when it is unrealistic to perform the surgery or vasopressin infusion in this population. Treatment of acute lower gastrointestinal (GI) bleeding (any site below the ligament of Treitz) using this technique has not reached a consensus, because of the belief that the risk of intestinal infarction in this condition is extremely high. The purpose of the study is to evaluate the effectiveness and safety of this technique in a retrospective group of patients who underwent embolization for acute lower GI bleeding.AIMTo evaluate the efficacy and safety of super-selective arterial embolization in the management of acute lower GI bleeding.METHODSA series of 31 consecutive patients with angiographically demonstrated small intestinal or colonic bleeding was retrospectively reviewed. The success rate and complication rate of super-selective embolization were recorded.RESULTSFive out of thirty-one patients (16.1%) could not achieve sufficiently selective catheterization to permit embolization. Initial control of bleeding was achieved in 26 patients (100%), and relapsed GI bleeding occurred in 1 of them at 1 wk after the operation. No clinically apparent bowel infarctions were observed in patients undergoing embolization.CONCLUSIONSuper-selective embolization is a safe therapeutic method for acute lower GI bleeding, and it is suitable and effective for many patients suffering this disease. Importantly, careful technique and suitable embolic agent are essential to the successful operation.

Transcatheter arterial embolization followed by surgical laparotomy for hemorrhagic shock due to intestinal bleeding: a case report

“…Recently, TAE has been proven effective for the treatment of acute gastrointestinal bleeding, with high technical success and acceptable clinical success rates. Published studies have reported varying technical success rates ranging from 97 to 100% [ 4 – 8 , 14 – 17 ]. The major advantage of TAE is its ability to control severe bleeding without bowel preparation.…”

“…Kim et al showed that among 175 patients with lower gastrointestinal bleeding who achieved technical success, 86.1% and 6.1% achieved clinical success and developed major complications, respectively [ 15 ]. Bowel ischemia or infarction has been the most severe complication of TAE, although their published incidence rates have remained quite low [ 4 – 8 , 14 – 17 ]. One study showed that cases developing bowel infarction exhibit a 90% increase in their mortality rate during hospital stay [ 5 ].…”

Minimally Invasive Interventional Procedures for Metastatic Bone Disease: A Comprehensive Review

“…Arterial embolization (AE) is an angiographic technique aimed to reduce the vascular supply of a bone lesion by selectively occluding its feeding arteries [ 17 , 18 , 19 ]. The injection of embolizing material is performed in order to only occlude the feeding vessels of the lesion, avoiding damage to the adjacent structures [ 20 , 21 , 22 ]. As mentioned above, skeletal-related events in patients with bone metastases can affect the quality of life.…”

Lower Gastrointestinal Bleeding

“…The rate at which angiography detects an active bleeding site has been shown to depend on the bleeding rate, with the required bleeding rate of minimum 0.5 mL/min (Strate, 2005;Yoon et al, 2006). With technological improvements in super selective embolization of distal artery branches in interventional angiography, it has become an effective method for controlling upper GI bleeding quickly and safely (Hreinsson et al, 2016;Lv and Gu, 2019). However, significant complications may be seen in 3% of cases.…”