Transcatheter embolization in management of hemorrhage from duodenal ulcer: long-term results and complications.
Effectiveness of transcatheter embolization for treatment of bleeding duodenal ulcers was evaluated in 57 patients followed up for at least 5 years. Terminal muscular branch vessel embolization was effective for initial control of bleeding in 27 of 28 cases, and gastroduodenal artery embolization was effective in 25 of 29 (P = .371). Terminal vessel embolization was more effective in attaining long-term control of bleeding (15 of 28 patients) than was gastroduodenal artery embolization (eight of 29) (P = .084). Occlusion of terminal vessels with 6-cyanoacrylate resulted in long-term control of bleeding in nine of 10 patients. With selective embolization of terminal vessels, late complications of duodenal stenosis occurred in seven of 28 patients; when occlusion was at the level of the gastroduodenal artery (P = .131), this developed in only two of 29. Occlusion of the proximal gastroduodenal artery by means of epsilon-aminocaproic acid-induced autologous clot was the most innocuous technique. Retrograde perfusion via the superior mesenteric and inferior pancreaticoduodenal artery (though at a reduced flow rate and pressure gradient) and reconstitution of flow after clot lysis are the theoretical advantages of this technique.
Lang
E K
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Department of Radiology, Louisiana State University Medical Center, New Orleans 70112-2822.
D004381:Duodenal Ulcer / Q000150:complications*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors