J Korean Radiol Soc.  2006 Mar;54(3):167-173. 10.3348/jkrs.2006.54.3.167.

Superselective Transarterial Embolization for the Management of Acute Gastrointestinal Bleeding

• Lee IK
• Kim YM
• Kim J
• Shin SS
• Yoon W
• Cho CK
• Kim JK
• Park JG
• Kang HK

• KMID: 1834267
• DOI: http://doi.org/10.3348/jkrs.2006.54.3.167

Abstract

PURPOSE
We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding.
MATERIALS AND METHODS
We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management.
RESULTS
The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During the follow up period, six patients of the 79 clinically successful patients died due to disseminated coagulopathy or complications of their underlying diseases, and so the total mortality rate was 19% (18 of 97 patients). Postembolization complications such as bowel ischemia or infarction did not occur during the observation period.
CONCLUSION
Superselective transarterial embolization is an effective therapy for treating acute gastrointestinal hemorrhage, and it has a high technical rate and clinical success rate, and a low complication rate.

Keyword

Gastrointestinal tract, hemorrhage; Gastrointestinal tract, angiography; Arteries, embolism

MeSH Terms

Aneurysm, False
Angiography
Colon
Contrast Media
Diverticulum
Duodenum
Esophagus
Female
Follow-Up Studies
Gastrointestinal Hemorrhage
Gelatin Sponge, Absorbable
Hemobilia
Hemodynamics
Hemorrhage*
Humans
Infarction
Inflammatory Bowel Diseases
Ischemia
Male
Mallory-Weiss Syndrome
Mortality
Pancreatitis
Stomach
Ulcer
Contrast Media