Refractory bleeding from gastroduodenal ulcers: arterial embolization in high-operative-risk patients.
OBJECTIVE
We evaluated the efficacy and medium-term outcomes of transcatheter embolization to control massive bleeding from gastroduodenal ulcers after failed endoscopic treatment in high-operative-risk patients.


METHODS
Retrospective study of 35 consecutive emergency embolization procedures in hemodynamically unstable patients (24 men, 11 women, mean age 71+/-11.6 y) referred from 1999 to 2006 for selective angiography after failed endoscopic treatment. Mean follow-up was 27 months.


RESULTS
Endovascular treatment was feasible in 33 patients and consistently stopped the bleeding. "Sandwich" coiling of the gastroduodenal artery was performed in 11 patients and superselective occlusion of the terminal feeding artery with glue, coils, or gelatine particles in 22 patients. Early rebleeding occurred in 6 patients and was managed successfully using endoscopy (n=2), reembolization (n=1), or surgery (n=3). No major complications related to catheterization occurred. Seven patients died within 30 days of embolization and 3 died later during the follow-up, but none of the deaths were due to rebleeding. No late bleeding recurrences were reported.


CONCLUSIONS
Selective angiographic embolization is safe and effective for controlling life-threatening bleeding from gastroduodenal ulcers, usually obviating the need for emergency surgery in critically ill patients, whose immediate survival depends on their underlying conditions.
Loffroy
Romaric
R
Department of Vascular and Interventional Radiology, Bocage Hospital, University Hospital Center, 2 boulevard Marechal de Lattre de Tassigny, Dijon Cedex, France. loffroy.romaric@neuf.fr
Guiu
Boris
B
Cercueil
Jean-Pierre
JP
Lepage
Côme
C
Latournerie
Marianne
M
Hillon
Patrick
P
Rat
Patrick
P
Ricolfi
Frédéric
F
Krausé
Denis
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017546:Angioscopy / Q000379:methods*; D001158:Arteries; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D000075202:Contraindications; D004381:Duodenal Ulcer / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D004386:Duodenum / Q000098:blood supply; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000098:blood supply; D013276:Stomach Ulcer / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome