Treatment of acute lower gastrointestinal hemorrhage by superselective transcatheter embolization.
OBJECTIVE
To evaluate the technical feasibility, success of hemostasis and complications of transcatheter embolization in the treatment of acute lower gastrointestinal (GI) bleeding.


METHODS
Retrospective review of 63 patients with acute lower GI bleed who had undergone transcatheter selective embolization of mesenteric arteries over a two-year period. Embolization was carried out only if the arteria recta leading to the bleed could be successfully catheterized (n=52). The lesions treated were located in the jejunum (n=13), ileum and ileo-cecal region (n=9), appendicular region (n=2) and colon (n=28). Embolization was performed with only polyvinyl alcohol particles (PVA) (250-500 microns) in 23 patients, only microcoils in 16 patients and both PVA particles and microcoils in 13 patients. Twenty-eight patients were evaluated for objective evidence of ischemia by colonoscopy (n=21) and/or histologic evidence in the surgical specimen (n=7); 23 patients were followed up clinically.


RESULTS
Immediate hemostasis was achieved in 61 of 63 patients; of the remaining 2 patients, one underwent surgery whereas the other died during the procedure. Recurrent bleeding occurred in 9 patients - 6 were managed surgically and 3 medically. Endoscopic evaluation showed mucosal ischemia in 7 patients but they remained asymptomatic on follow up. Embolization was the sole modality of treatment in 41 patients (78.9%).


CONCLUSIONS
Transcatheter superselective embolization is an effective and safe modality of treatment for acute lower GI bleeding.
Sheth
Rahul
R
Lilavati Hospital, Sir H N Hospital and Wockhardt Hospital, Mumbai, India. rahulsheth7@hotmail.com
Someshwar
Vimal
V
Warawdekar
Gireesh
G
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006801:Humans; D007410:Intestinal Diseases / Q000628:therapy*; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging; D008875:Middle Aged; D011859:Radiography; D012007:Rectum / Q000098:blood supply; D012189:Retrospective Studies; D016896:Treatment Outcome