Transcatheter arterial embolisation for acute lower gastrointestinal haemorrhage: a single-centre study

Kwon, Joon Ho; Kim, Man Deuk; Choi, Woo Sik; Kim, Yong Seek; Lee, Junhyung; Kim, Gyoung Min; Won, Jong Yun; Lee, Do Yun

doi:10.1007/s00330-018-5587-8

Cited by 39 publications

(67 citation statements)

References 37 publications

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“…TAE has been shown to be effective for colonic diverticular hemorrhage [2,4] and is considered for patients who have ongoing bleeding or rebleeding after endoscopic therapy [3,4]. There is a higher risk of ischemic complications in lower gastrointestinal bleeding than in upper gastrointestinal bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…There is a higher risk of ischemic complications in lower gastrointestinal bleeding than in upper gastrointestinal bleeding. Embolization of up to three vasa recta must be conducted, and of only the responsible vasa recta if possible because the smaller the number of embolizing vasa recta, the lower the risk of ischemia [4]. However, the vasa recta are often poorly separated due to anterior-posterior overlap on conventional angiography, as they arise from the marginal artery and pass beneath the serosa of the anterior or posterior wall in the distributing submucosal vascular plexus [5].…”

Section: Discussionmentioning

confidence: 99%

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Transcatheter Arterial Embolization Using Cone-beam Computed Tomography during Angiography and Automated Vessel Detection Software for Obscure Colonic Diverticular Hemorrhage after Unsuccessful Endoscopic Clipping: A Report of Two Cases

Kamei¹,

Yamamoto²,

Okada

et al. 2021

Interventional Radiology

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We report the usefulness of cone-beam computed tomography angiography (CBCTA) and automated vessel detection (AVD) software in transcatheter arterial embolization in two cases of obscure ascending colonic diverticular hemorrhage after unsuccessful endoscopic clipping. Arteriography of the superior mesenteric artery demonstrated no active bleeding. Considering the positional relationship of the clips, we could narrow the responsible vessel down to two candidates but could not definitively identify the responsible vessel. We performed CBCTA at the marginal artery of the right colic artery, and the responsible branch was identified using AVD. The responsible vessel could be embolized, and hemostasis was achieved with no ischemic complications. CBCTA and AVD software for colonic diverticular hemorrhage after endoscopic clipping were useful for identifying the responsible vessel and in performing selective embolization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transcatheter Arterial Embolization Using Cone-beam Computed Tomography during Angiography and Automated Vessel Detection Software for Obscure Colonic Diverticular Hemorrhage after Unsuccessful Endoscopic Clipping: A Report of Two Cases

Kamei¹,

Yamamoto²,

Okada

et al. 2021

Interventional Radiology

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“…The goal of angiography is to undergo transarterial embolization while allowing mucosal viability through collateral circulation 5 . In recent years, the development of microcatheters with a small caliber and various embolic materials have enabled super‐selective embolization 17 . Lower gastrointestinal bleeding can be rapidly treated at a high rate of success by angiography 9 .…”

Section: Discussionmentioning

confidence: 99%

“…5 In recent years, the development of microcatheters with a small caliber and various embolic materials have enabled super-selective embolization. 17 Lower gastrointestinal bleeding can be rapidly treated at a high rate of success by angiography. 9 A known disadvantage of angiography is the risk of intestinal ischemia.…”

confidence: 99%

Angiography versus colonoscopy in patients with severe lower gastrointestinal bleeding: a nation‐wide observational study

Miyakuni

Nakajima

Ohbe

et al. 2020

Acute Medicine & Surgery

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Clinical guidelines for acute lower gastrointestinal bleeding (LGIB) recommend non-endoscopic treatment when endoscopic treatment is difficult or the patient is hemodynamically unstable. The aim of this study was to investigate whether angiography should be prioritized as initial treatment for severe LGIB patients over colonoscopy. Methods: We undertook a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We compared adult patients who underwent colonoscopy or angiography within 1 day of admission for severe LGIB from 2010 to 2017. The primary outcome was in-hospital mortality. Secondary outcomes included surgery carried out within 1 day after admission and surgery carried out between 2 and 7 days of admission. Propensity score-matched analyses were undertaken to adjust for confounders. Results: We identified 6,546 eligible patients. The patients were divided into the colonoscopy group (n = 5,737) and angiography group (n = 809). After one-to-four propensity score matching, we compared 3,220 and 805 patients who underwent colonoscopy and angiography, respectively. The angiography group was not significantly associated with reduced in-hospital mortality compared with the colonoscopy group. In contrast, the number of patients who underwent surgery within 1 day of admission was significantly lower in the angiography group than in the colonoscopy group. Conclusions: The present study revealed that in-hospital mortality did not significantly differ between colonoscopy and angiography, even in severe LGIB patients. Although this study was unable to identify which subgroups should undergo angiography for primary hemostasis, angiography might be a better option than colonoscopy for initial hemostasis in more severe cases of LGIB.

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“…In this study, no patient developed bowel infarction. To avoid bowel infarction after embolization, careful technique and preparation for turning down the embolization are pivotal, particularly when a suitable catheter position cannot be achieved[14,18,19]. Nevertheless, it is also important to choose a suitable embolic agent.…”

Section: Discussionmentioning

confidence: 99%

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

2019

WJCC

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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.

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Transcatheter arterial embolisation for acute lower gastrointestinal haemorrhage: a single-centre study

Cited by 39 publications

References 37 publications

Transcatheter Arterial Embolization Using Cone-beam Computed Tomography during Angiography and Automated Vessel Detection Software for Obscure Colonic Diverticular Hemorrhage after Unsuccessful Endoscopic Clipping: A Report of Two Cases

Transcatheter Arterial Embolization Using Cone-beam Computed Tomography during Angiography and Automated Vessel Detection Software for Obscure Colonic Diverticular Hemorrhage after Unsuccessful Endoscopic Clipping: A Report of Two Cases

Angiography versus colonoscopy in patients with severe lower gastrointestinal bleeding: a nation‐wide observational study

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

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