title: Selective arterial embolization with ethylene-vinyl alcohol copolymer for control of massive lower gastrointestinal bleeding: feasibility and initial experience.
abstract: OBJECTIVE
  To evaluate the efficacy, safety, and clinical outcomes of superselective embolization using ethylene-vinyl alcohol copolymer (Onyx Liquid Embolic System; ev3 Neurovascular, Irvine, California) as the primary treatment for acute and massive lower gastrointestinal bleeding (LGIB).
  
  
  METHODS
  Between January 2008 and October 2013, all patients with focal massive LGIB who were treated by embolization were retrospectively analyzed. The study was approved by the hospital's ethics committee; informed consent was obtained in all cases. Onyx was chosen as the embolic agent in all cases in an intention-to-treat fashion. Embolization was indicated in 31 consecutive patients (mean age, 80 y ± 11.1). Multidetector computed tomography and digital subtraction angiography were performed in all patients.
  
  
  RESULTS
  Active bleeding was detected in all cases. A colonoscopy was performed in 11 patients. The correlation between multidetector computed tomography and angiography findings was 96.7%. The causes of bleeding were diverticula in 15 patients, iatrogenic in 7 patients, neoplasia in 3 patients, hemorrhoids in 2 patients, angiodysplasia in 2 patients, and unknown in 2 patients. Embolization was not possible in one patient, who required urgent left hemicolectomy. The technical success rate was 93.5%. The embolic material refluxed in one patient, causing an undesired embolization, without any clinical consequences. In the 30 patients who received embolization, the immediate bleeding control rate was 100%. Rebleeding at 30 days occurred in three patients (10%). There were no major complications, intestinal ischemia, or deaths attributable to the treatment. No patient needed surgery or new embolization during a mean follow-up period of 23.7 months (range, 1-71 mo).
  
  
  CONCLUSIONS
  Control of massive LGIB using superselective embolization with Onyx is feasible and safe.
authors.affiliation: Vascular and Interventional Radiology, Jiménez Díaz Foundation University Hospital, c/ Jalón no. 11, 28221 Majadahonda, Madrid, Spain. Electronic address: jurbano@fjd.es.
authors.forename: José
authors.initials: J
authors.lastname: Urbano
authors.affiliation: Vascular and Interventional Radiology, Jiménez Díaz Foundation University Hospital, c/ Jalón no. 11, 28221 Majadahonda, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Manuel Cabrera
authors.affiliation: Cardiac and Abdominal Radiology, Universidad Autonoma de Madrid, Madrid, Spain.
authors.forename: Angeles
authors.initials: A
authors.lastname: Franco
authors.affiliation: Vascular and Interventional Radiology, Jiménez Díaz Foundation University Hospital, c/ Jalón no. 11, 28221 Majadahonda, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Alonso-Burgos
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D003113:Colonoscopy; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D061330:Multidetector Computed Tomography; D011145:Polyvinyls / Q000008:administration & dosage* / Q000009:adverse effects; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011145:Polyvinyls; C020320:ethylene-vinyl alcohol copolymer