Treatment of Rectal Hemorrhage by Coil Embolization

Abstract

Three patients with chronic Stanford type B dissection presented with intermittent claudication (n ϭ 3), renal failure (n ϭ 3), and hypertension that was difficult to control (n ϭ 2). The obliterated supraceliac (n ϭ 2) and infrarenal portion of the aortic true lumen (n ϭ 1) were treated with Palmaz stents balloon-expanded to 12-20 mm. All three patients have had 14 -22 months of follow-up with aortography and/or CT. No periprocedural complications occurred and all symptoms subsided. In two patients the stented aortic true lumen had increased at follow-up examinations from the stented diameter of 12 mm to 20 mm and from 20 mm to 35 mm, respectively. The stents had not migrated. The increased true lumen diameter appeared to be secondary to shrinkage of the thrombosed false lumen. In the third patient, with a patent false lumen, the stent became slightly compressed. The patients have remained asymptomatic. Percutaneous placement of endovascular stents may be a safe and reliable way of relieving aortic true lumen obliteration in patients with peripheral ischemia. However, both stent compression and progressive widening of the true lumen resulting in partial detachment of the stents may occur. AbstractStent placement is a widely used bail-out treatment for dissection of peripheral arteries. Below the level of the superficial femoral artery permanent stenting is complicated by a high incidence of subacute thrombosis and restenosis. We present two cases of arterial occlusion due to acute iatrogenic dissection of the popliteal and distal fibular arteries. Successful treatment was achieved with a new bail-out procedure. Strecker stents were implanted to seal off the dissection flap. Stents were retrieved easily after 24 hr using a myocardial biopsy forceps. After stent retrieval the temporarily stented segments were patent and showed a larger lumen compared with segments treated by balloon dilatation alone. Temporary stenting is a simple and safe procedure and offers the advantage of tacking up dissection membranes and preventing recoil. Persistent presence of a metallic implant as a source of continued injury and stimulus for intimal proliferation is avoided. AbstractFour patients, aged 54 -84 years, presenting with life-threatening rectal bleeding from the superior hemorrhoidal artery, underwent percutaneous fibered platinum coil embolization via coaxial catheters. Pre-procedure sigmoidoscopy had failed to identify the source of hemorrhage, because the rectum was filled with fresh blood. Embolization was technically and clinically successful in all four patients. Subsequent sigmoidoscopy confirmed the diagnoses in three patients as a solitary rectal ulcer, iatrogenic traumatic ulceration following manual evacuation, and a rectal Dieulafoy's lesion. The other case was angiographically seen to be due to a rectal angiodysplasia. Emboliza- AbstractPercutaneous endovascular techniques were used to treat an arteriovenous fistula (AVF) associated with pancreatic transplantation. A pancreatic transplant superior mesenteric art...

Embolization of the superior rectal arteries for chronic bleeding due to haemorrhoidal disease

“…Because our approach is not far from DG-HAL, the fact that we find positive clinical results is encouraging [8][9][10][11][12]. Furthermore, previous studies of embolization to treat acute bleeding have demonstrated efficacy and an absence of ischaemic complications for the use of this technique to treat life-threatening rectal bleeding of various origins [13][14][15][16][17][18][19], as confirmed by the preliminary experience of our group with haemorrhoidal bleeding [2,3].…”

Rectal Dieulafoy’s lesion: a comprehensive review of patient characteristics, presentation patterns, diagnosis, management, and clinical outcomes

“…In our review, angiographic embolization was performed in four cases. Two patients were successfully treated with this modality while the other two required surgery for definitive hemostasis (57,(90)(91)(92).…”