title: Risk factors for recurrent hemorrhage after successful mesenteric arterial embolization.
abstract: The objective of this study was to describe the risk factors and to determine the outcomes after recurrent gastrointestinal hemorrhage after successful mesenteric arterial embolization A retrospective analysis was undertaken of a single-center experience with mesenteric arterial embolization performed for gastrointestinal hemorrhage over a 5-year period. Statistical analyses including Student's t test and Fisher's exact test were used to compare results. For the years 2001 through 2005, 36 patients (10 women; average age, 60.8 years) underwent 37 technically successful mesenteric embolizations for acute gastrointestinal hemorrhage. Two (5.4%) cases required surgical intervention for cessation of hemorrhage, and six (16.2%) patients died during their hospitalization after technically successful embolization. Nine (24.3%) patients experienced in-hospital rehemorrhage, and of these, five (55.6%) died. Risk factors for rehemorrhage included intra-abdominal malignancy (P < 0.05), transfusion requirement greater than 10 units before angiography (P < 0.05), and the source of hemorrhage other than solitary gastroduodenal artery hemorrhage (P < 0.05). The failure of initial embolization was associated with an increased incidence of death (55.6% vs 5.0%; P < 0.05) and operative intervention to cease hemorrhage (P < 0.05). The failure of technically successful mesenteric embolization is not uncommon and is associated with identifiable risk factors. Risk factor awareness should assist in patient selection for and timing of mesenteric embolization.
authors.affiliation: University of South Florida Division of Vascular and Endovascular Surgery, Tampa, USA.
authors.forename: W Brent
authors.initials: WB
authors.lastname: Keeling
authors.forename: Paul A
authors.initials: PA
authors.lastname: Armstrong
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Stone
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Zweibel
authors.forename: Bruce T
authors.initials: BT
authors.lastname: Kudryk
authors.forename: Brad L
authors.initials: BL
authors.lastname: Johnson
authors.forename: Martin R
authors.initials: MR
authors.lastname: Back
authors.forename: Dennis F
authors.initials: DF
authors.lastname: Bandyk
authors.forename: Murray L
authors.initials: ML
authors.lastname: Shames
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015642:Radiology, Interventional; D012008:Recurrence; D012189:Retrospective Studies; D017211:Treatment Failure