Superselective Arterial Embolization for the Treatment of Lower Gastrointestinal Hemorrhage

Bandi, Rupal; Shetty, P.C.; Sharma, Ranjana; Burke, Thomas H.; Burke, Matthew; Kastan, David J.

doi:10.1016/s1051-0443(07)61697-2

Cited by 174 publications

(114 citation statements)

References 16 publications

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“…Several recent reports describe the safety and efficacy of super-selective angioembolization, but the long-term outcomes after selective embolization remain poorly evaluated [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results

Rossetti

Buchs

Bréguet

et al. 2012

Int J Colorectal Dis

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Background Lower gastrointestinal bleeding represents 20 % of all gastrointestinal bleedings. Interventional radiology has transformed the treatment of this pathology, but the long-term outcome after selective embolization has been poorly evaluated. The aim of this study is thus to evaluate the short-term and long-term outcomes after selective embolization for colonic bleeding.Methods From November 1998 to December 2010, all acute colonic embolizations for hemorrhage were retrospectively reviewed and analyzed. The risk factors for post-embolization ischemia were also assessed. Results Twenty-four patients underwent colonic embolization. There were 6 men and 18 women with a median age of 80 years (range, 42-94 years). The underlying etiologies included diverticular disease (41.9 %), post-polypectomy bleeding (16.7 %), malignancy (8.2 %), hemorrhoid (4.1 %), and angiodysplasia (4.1 %). In 23 patients, bleeding stopped (95.8 %) after selective embolization. One patient presented a recurrence of bleeding with hemorrhagic shock and required urgent hemorrhoidal ligature. Four patients required an emergent surgical procedure because of an ischemic event (16.7 %). One patient died of ileal ischemia (mortality, 4.1 %). The level of embolization and the length of hypoperfused colon after embolization were the only risk factors for emergent operation. Mean hospital stay was 18 days (range, 9-44 days). After a mean follow-up of 28.6 months (range, 4-108 months), no other ischemic events occurred. Conclusion In our series, selective transarterial embolization for acute colonic bleeding was clinically effective with a 21 % risk of bowel ischemia. The level of embolization and the length of the hypoperfused colon after embolization should be taken into consideration for emergent operation.

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Section: Introductionmentioning

confidence: 99%

Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results

Rossetti

Buchs

Bréguet

et al. 2012

Int J Colorectal Dis

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“…[34][35][36] Selective coil embolization of the affected arteries is safe and effective. 37 In our case, the patient had a massive gastrointestinal hemorrhage that was initially controlled by angiography with selective embolization. Subsequently, massive gastrointestinal hemorrhaging not associated with use of the Flexi-Seal device occurred, and colonoscopy revealed a bleeding ulcer in the anterior part of the rectum.…”

Section: Discussionmentioning

confidence: 71%

Massive Gastrointestinal Hemorrhage as a Complication of the Flexi-Seal Fecal Management System

Mulhall

Jindal

2013

American Journal of Critical Care

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Use of the Flexi-Seal fecal management system, a safe and effective means of fecal diversion in patients with fecal incontinence and diarrhea, can be associated with rare, life-threatening complications. For example, a critically ill patient had 2 episodes of massive rectal bleeding associated with use of the system that required transfusion of blood products. Hemorrhage was controlled during the first episode by angiography with selective coil embolization; the second required colonoscopy with suture ligation of the affected lesion. A literature review revealed 9 other cases that were managed endoscopically, surgically, or with angiography.

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“…Bandi et al (12) reviewed the literature from the past two decades to determine the incidence of infarction after transcatheter embolization. Studies in the 1980s showed a 10%-20% incidence of post-embolization infarction, whereas later studies in the 1990s demonstrated few, if any, post-embolization infarction cases (12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

“…Studies in the 1980s showed a 10%-20% incidence of post-embolization infarction, whereas later studies in the 1990s demonstrated few, if any, post-embolization infarction cases (12)(13)(14). The reduction in postembolization infarction has been attributed to the development of finer coaxial systems and microcoils and the increased experience of the interventionalists.…”

Section: Discussionmentioning

confidence: 99%

Mesenteric angiography results in gastrointestinal tract hemorrhages: single center experience

Peynircioğlu

Erkus²,

Çil³

et al. 2010

Diagn Interv Radiol

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368G astrointestinal (GI) bleeding is one of the major causes of morbidity and mortality, and the incidence of hospital admittance for GI bleeding is 120 per 100 000 cases. Gastrointestinal bleeding primarily occurs in the upper GI tract above the Treitz ligament; however, 15% of GI bleedings occur in the lower GI tract. Although bleeding spontaneously stops in 80% of patients, it progresses or relapses in the other 20% (1). Although endoscopy is the primary diagnostic method to detect upper GI bleeding, scintigraphy is widely used for lower GI bleeding. Sulfur colloid scintigraphy can detect a bleeding in the range of 0.05-0.1 mL/min, and scintigraphic imaging with tagged red blood cells can detect a bleeding in the range of 0.2-0.4 mL/min (2). Consistent with recent technological advances, mesenteric computed tomography angiography (CTA) is a promising diagnostic approach for the detection of GI bleeding. CTA is less invasive than catheter angiography, but it is less sensitive than scintigraphy (0.1 mL/min for scintigraphy compared to 0.35 mL/min for CTA). However, there are several important advantages to CTA, namely that it can be performed 24 h a day in a matter of seconds (using multidetector CT equipment) and it can easily localize the bleeding. In addition, CTA can detect important findings that accompany the bleeding, such as bowel wall thickness, mass, and perforation, through its cross-sectional scanning ability (3).Although the limit of detection of the GI bleeding rate using transcatheter mesenteric angiography and the conventional film cassette technique is 0.5 mL/min, in vivo studies have shown that the limit of detection using digital subtraction angiography (DSA) is 5-9 times greater than conventional systems (2). However, both radiation exposure and the side effects of the contrast media used in nuclear medicine and radiological diagnostic methods must be considered when examining patients with GI bleeding. Although transcatheter mesenteric angiography is an invasive procedure, it is used in patients with massive GI bleeding because it not only detects the bleeding, but the underlying cause can be treated in the same endovascular session. The combination of mesenteric CT angiography and catheter angiography demonstrates that radiology plays a key role in the diagnosis and treatment of GI bleeding, which is a clinical problem requiring a multidisciplinary approach. Even after taking into account the different detection limits and the advantages and disadvantages of imaging, there is currently no defined, standard approach to treat GI bleeding (2).Medical or endoscopic coagulation, transcatheter embolization and surgical resection are the treatment options for GI bleeding. Although surgical resection is the definitive treatment, its mortality and morbidity rates are between 10%-15% (4). Colonoscopy is widely used for the diagnosis of lower GI bleeding, but very few patients benefit from endoscopic treatment (5). Transcatheter embolization is widely used throughout PURPOSEThis retrospective stud...

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Superselective Arterial Embolization for the Treatment of Lower Gastrointestinal Hemorrhage

Cited by 174 publications

References 16 publications

Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results

Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results

Massive Gastrointestinal Hemorrhage as a Complication of the Flexi-Seal Fecal Management System

Mesenteric angiography results in gastrointestinal tract hemorrhages: single center experience

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