title: Provocative mesenteric angiography for lower gastrointestinal hemorrhage: results from a single-institution study.
abstract: OBJECTIVE
  To determine the diagnostic capability, complication rate, and potential predictors of success for provocative mesenteric angiography in patients with obscure and recurrent lower gastrointestinal (GI) hemorrhage.
  
  
  METHODS
  Thirty-four patients (age, 7-92 years; 22 men) underwent 36 provocative mesenteric angiograms between January 2002 and December 2008. Provocative mesenteric angiography consisted of systemic anticoagulation with heparin followed by selective transcatheter injection of vasodilator and tissue plasminogen activator into the arterial distribution of highest suspicion. Medications were administered incrementally until active extravasation was visualized or until the operator deemed the outcome negative. The pertinent clinical, radiologic, surgical, laboratory, and pathologic notes were retrospectively reviewed.
  
  
  RESULTS
  Among 36 provocative mesenteric angiograms, 11 resulted in angiographically visible extravasation (31%) and an additional procedure resulted in angiographic visualization of an undiagnosed hypervascular mass, resulting in the identification of a source of a hemorrhage in 33% overall. In 10 of the 11 cases with visualized extravasation, transcatheter embolization successfully controlled recurrent hemorrhage, while the hypervascular mass without extravasation was successfully resected. Therefore, a total of 11 of 36 studies (31%) resulted in successful definitive treatment of recurrent hemorrhage. One embolization-related complication occurred, resulting in surgical resection of perforated ischemic bowel. No hemorrhagic complications were identified. Patients with melena and patients admitted for reasons other than acute lower GI hemorrhage were significantly less likely to benefit from provocative mesenteric angiography.
  
  
  CONCLUSIONS
  In this series, provocative mesenteric angiography was safe and effective for eliciting the source of occult lower GI hemorrhage, leading to definitive therapy in about one third of patients.
authors.affiliation: Department of Radiology, Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA. charles.kim@duke.edu
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Kim
authors.forename: Paul V
authors.initials: PV
authors.lastname: Suhocki
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Miller
authors.forename: Mazhar
authors.initials: M
authors.lastname: Khan
authors.forename: Gemini
authors.initials: G
authors.lastname: Janus
authors.forename: Tony P
authors.initials: TP
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D002648:Child; D003287:Contrast Media; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging*; D006493:Heparin; D006801:Humans; D041741:Lower Gastrointestinal Tract / Q000000981:diagnostic imaging*; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D010959:Tissue Plasminogen Activator; D055815:Young Adult
chemical_list: D003287:Contrast Media; D006493:Heparin; D010959:Tissue Plasminogen Activator