Korean J Radiol.  2013 Apr;14(2):259-268. 10.3348/kjr.2013.14.2.259.

The Efficacy and Long-Term Outcome of Microcoil Embolotherapy for Acute Lower Gastrointestinal Bleeding

• Teng HC
• Liang HL
• Lin YH
• Huang JS
• Chen CY
• Lee SC
• Pan HB

• KMID: 1482785
• DOI: http://doi.org/10.3348/kjr.2013.14.2.259

Abstract

OBJECTIVE
To evaluate the clinical efficacy as well as long-term clinical outcomes of superselective microcoil embolization for lower gastrointestinal bleeding (LGIB).
MATERIALS AND METHODS
Between 1997 and 2009, 26 patients with intended transcatheter embolotherapy for LGIB were retrospectively reviewed. Embolization was performed only when the catheter could be advanced to or distal to the mesenteric border of the bowel. The main purpose of our study was to assess technical success, recurrent bleeding rate and complications. We also evaluated the long-term clinical outcome, including late recurrent LGIB, bowel ischemia and the survival rate.
RESULTS
Twenty-two bleeding sources were in the territory of superior mesenteric artery and four in the inferior mesenteric artery. Technical success was achieved in 22 patients (84.6%). The target vessel of embolization was vasa recta in seventeen patients and marginal artery in the remaining five patients. Early rebleeding occurred in two patients (7.7%) and bowel ischemia in two patients, of whom the embolized points were both at the marginal artery. Delayed recurrent bleeding (> 30 days) occurred in two angiodysplasia patients. Five patients (19.2%) died within the first 30 days of intervention. Long-term follow-up depicted estimated survival rates of 58.2 and 43.1% after one, and five years, respectively.
CONCLUSION
Transcatheter embolotherapy to treat LGIB is effective with low rebleeding and ischemic complications. Considering the advanced age and complex medical problems of these patients, the minimal invasive embolotherapy may be used as both a primary and potentially definitive treatment of LGIB.

Keyword

Lower gastrointestinal bleeding; Embolotherapy; Microcoil

MeSH Terms

Acute Disease
Adult
Aged
Aged, 80 and over
Colonoscopy
Embolization, Therapeutic/adverse effects/*methods
Endpoint Determination
Female
Gastrointestinal Hemorrhage/radiography/*therapy
Humans
Male
Middle Aged
Recurrence
Retrospective Studies
Survival Rate
Tomography, X-Ray Computed
Treatment Outcome

Figure

• 

  Fig. 1 36-year-old man with bleeding jejuna ulcer. A. CT angiography showing contrast extravasation (arrow), indicating active bleeding in the jejunum. B. Confirmation of contrast extravasation (arrow) in jejunum based on superior mesenteric artery angiogram. C. Bowel had moved to left upper abdomen during superselective catheterization. Arrow: contrast extravasation. D. Two straight microcoils (arrow) were placed in vasa recta. Immediate follow-up angiogram revealed no residual contrast extravasation. Patient is uneventful without recurrent lower gastrointestinal bleeding until end of study for 72-month follow up.

• 

  Fig. 2 61-year-old female with corrosive injury post gastrectomy. A. Superior meaenteric artery angiogram showing contrast extravasation (arrow) at proximal jejunum. B. After straight microcoils (arrow) embolization, no residual contrast extravasation on follow-up angiogram can be identified. C. Recurrent bleeding occurred 7 days after initial successful embolization. SMA angiogram showing contrast extravasation from another vasa recta branch (arrow). Previously embolized branch was occluded (curved arrow). D. After another microcoils embolization (arrow), no residual contrast extravasation can be identified on follow-up angiogram. No recurrent bleeding occurred in this patient, but unfortunately patient died due to multi-organ failure 1.5 months later.

• 

  Fig. 3 66-year-old man with cecal bleeding. A. Superior mesenteric artery angiogram showing contrast extravasation (arrow) in cecum. B. Superselective angiograms showing large amount of contrast extravasation (arrow) in cecum. C. 2 × 3 mm tornado microcoil (arrow) was placed in marginal artery with successful cessation of bleeding. D. Marked wall thickening of cecum (arrow) was noted on follow-up CT image 3 days after embolization. Abscess formation in pericecal (curved arrow) and subcutaneous region (arrow head) was also noted.

• 

  Fig. 4 72-year-old female with angiodysplasia. A. MDCT showing early opacification of right mesenteric veins (arrow) and segmental engorged submucosal vein (curved arrow) at distal ileum. No contrast extravasation on MDCT images can be identified. B. On superior mesenteric artery angiograms, no contrast extravasation can be identified but enlarged vascular tufts (arrow) in distal ileum are evident. C. Engorged submucosal vein (arrow) of distal ileum is also demonstrated in late arterial phase. D. After superselective microcoil embolization (arrow), follow-up angiograms showed disappearance of enlarged supplying artery and submucosal vein. MDCT = multidetector computed tomography

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  Fig. 5 Overall survival rates in twenty-six intended embolized patients and in twenty-one patients with survival for more than 30 days.

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