title: Super-Selective Mesenteric Embolization Provides Effective Control of Lower GI Bleeding.
abstract: Introduction. We aimed to assess the efficacy and safety of digital subtraction angiography (DSA) and super-selective mesenteric artery embolization (SMAE) in managing lower GI bleeding (LGIB).Method. A retrospective case series of patients with LGIB treated with SMAE in our health service. Patients with confirmed active LGIB, on either radionuclide scintigraphy (RS) or contrast-enhanced multidetector CT angiography (CE-MDCT), were referred for DSA +/- SMAE. Data collected included patient characteristics, screening modality, bleeding territory, embolization technique, technical and clinical success, short-term to medium-term complications, 30-day mortality, and progression to surgery related to procedural failure or complications.Results. There were fifty-five hospital admissions with acute unstable lower gastrointestinal bleeding which were demonstrable on CE-MDCT or RS over a 31-month period. Eighteen patients proceed to embolization, with immediate success in all. Eight patients (44%) had clinical rebleeding after intervention, warranting repeated imaging. Only one case (5.6%) demonstrated radiological rebleeding and was reembolized. Complication rate was excellent: no bowel ischaemia, ischaemic stricture, progression to surgery, or 30-day mortality.Conclusion. SMAE is a viable, safe, and effective first-line management for localised LGIB. Our results overall compare favourably with the published experiences of other institutions. It is now accepted practice at our institution to manage localised LGIB with embolization.
authors.affiliation: Colorectal Unit, Department of Surgery, Western Health, St Albans, VIC, Australia.
authors.forename: Toan
authors.identifier: 0000-0002-9133-4545
authors.initials: T
authors.lastname: Pham
authors.affiliation: Department of Radiology, Western Health, St Albans, VIC, Australia.
authors.forename: Bob Anh
authors.initials: BA
authors.lastname: Tran
authors.affiliation: Colorectal Unit, Department of Surgery, Western Health, St Albans, VIC, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Ooi
authors.affiliation: Department of Radiology, Western Health, St Albans, VIC, Australia.
authors.forename: Marcus
authors.initials: M
authors.lastname: Mykytowycz
authors.affiliation: Colorectal Unit, Department of Surgery, Western Health, St Albans, VIC, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: McLaughlin
authors.affiliation: Colorectal Unit, Department of Surgery, Western Health, St Albans, VIC, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Croxford
authors.affiliation: Colorectal Unit, Department of Surgery, Western Health, St Albans, VIC, Australia.
authors.forename: Iain
authors.initials: I
authors.lastname: Skinner
authors.affiliation: Colorectal Unit, Department of Surgery, Western Health, St Albans, VIC, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Faragher