Acute lower gastrointestinal hemorrhage: minimally invasive management with microcatheter embolization.
OBJECTIVE
To evaluate the efficacy of superselective embolization therapy in the management of acute lower gastrointestinal (LGI) hemorrhage, including any bleeding distal to the ligament of Treitz.


METHODS
Between June and August 2007, 20 patients with acute LGI bleeding underwent superselective transcatheter arterial embolization (TAE) at the authors' institution. The bleeding had different causes. All patients were treated with use of microcatheters. The following embolic agents were used: microcoils (n = 16), polyvinyl alcohol (PVA) particles (n = 2), and a combination of microcoils and PVA particles (n = 2). Outcome measures included technical success (complete cessation of bleeding as documented at completion angiography), clinical success (resolution of signs or symptoms of LGI bleeding within 30 days after TAE), and the rate of major and minor complications.


RESULTS
The identified bleeding sources were as follows: jejunal branch, branch of middle colic artery, branch of ileocolic artery, ileal branch, branch of left colic artery, branch of sigmoid artery, branch of the superior rectal artery, and branch of the middle rectal artery. Technical success with effective control of active bleeding was achieved in all patients (100%). Clinical success attributed to TAE was documented in 18 of the 20 patients (90%). Major complications included death due to pulmonary embolism, heart infarction, and multiorgan failure in the 3rd week after TAE; a procedure-related colonic infarction occurred in one patient. A minor complication occurred in one patient who developed a groin hematoma.


CONCLUSIONS
Superselective embolization may be used for effective, minimally invasive control of acute LGI bleeding.
Kickuth
Ralph
R
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Berne, Freiburgstrasse 20, CH-3010 Berne, Switzerland. ralph.kickuth@insel.ch
Rattunde
Henning
H
Gschossmann
Jürgen
J
Inderbitzin
Daniel
D
Ludwig
Karin
K
Triller
Jürgen
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome