Angiographic embolization is deployed routinely for colonic hemorrhage and hemobilia, but it has received limited attention for treating upper gastrointestinal tract bleeding. An international group of surgeons and radiologists evaluated the safety and efficacy of angiographic embolization for GI hemorrhage and found that it can be used in a select group of patients.
Angiographic embolization is deployed routinely for colonic hemorrhage and hemobilia, but it has received limited attention for treating upper gastrointestinal tract bleeding. An international group of surgeons and radiologists evaluated the safety and efficacy of angiographic embolization for GI hemorrhage and found that it can be used in a select group of patients.
Dr. George Poultsides and colleagues retrospectively reviewed 70 procedures performed in 57 patients from 1996 to 2006. Poultsides is from the surgery department at the University of Connecticut School of Medicine and the Hartford Hospital. His coauthors are from UConn's radiology department and the University of Athens in Greece. They published their results in the Archives of Surgery (2008;143:5:457-461).
The majority of patients had duodenal ulcer or postsphincterotomy bleeding. Comorbidities included the use of immunosuppresants and renal failure at presentation.
Angiograpic procedures were performed with standard percutaneous transfemoral catheterization using a 5-French or 6-Fr sheath. Embolic agents used were cellulose sponge plugs, vascular coils, platinum microcoils, and polyvinyl alcohol particles.
The results found that embolization reached a technical success rate of 94% (66 of 70 procedures). In most cases, the gastroduodenal arteries were embolized. Among the 66 successful procedures, permanent embolic agents were used in 33 cases.
A little more than half of the patients (51%) had in-hospital cessation of bleeding without additional endoscopic, radiologic, or surgical intervention. The primary clinical success rate was higher for duodenal ulcer and gastric cancer.
When embolization failed in 28 cases, the mean interval to rebleeding was 3.08 days, with 13 patients undergoing repeat embolization. Rebleeding occurred in 25 patients despite a repeat procedure. Of the 14 patients with angiographic failure, eight were salvaged with repeat endoscopy and six died. The authors noted that when embolization succeeded, the mortality rate was 9%. When it failed, that rate jumped to 36%.
A major predictor of outcome for embolization was a transfusion requirement of more than six units of blood prior to surgery. Coagulopathy has been shown to adversely affect the success rate of embolization, leading the authors to recommend that aggressive correction of coagulation parameters be enforced.
Despite the fact that bleeding occurred in nearly half of the patients, Poultsides' group said that emoblization was a viable option in poor candidates for surgery. In an accompanying commentary, however, surgeon Dr. Michael Zenilman from State University of New York Downstate Medical Center advised against using angiographic embolization as primary therapy (Arch Surg 2008;143:5:461-462).
"This article shows that angiography can be used as a nonoperative adjunct, but be careful," Zenilman wrote. "It is not as good as endoscopy, it does not always work, and it can be dangerous. Use it only in the patients with favorable anatomy or in those who have comorbidities that preclude surgery."
For more information from the Diagnostic Imaging archives:
Vascular intervention offers good growth opportunities
TACE plus RFA extends survival in liver cancer patients
MRI-Based AI Radiomics Model Offers 'Robust' Prediction of Perineural Invasion in Prostate Cancer
July 26th 2024A model that combines MRI-based deep learning radiomics and clinical factors demonstrated an 84.8 percent ROC AUC and a 92.6 percent precision-recall AUC for predicting perineural invasion in prostate cancer cases.
Breast MRI Study Examines Common Factors with False Negatives and False Positives
July 24th 2024The absence of ipsilateral breast hypervascularity is three times more likely to be associated with false-negative findings on breast MRI and non-mass enhancement lesions have a 4.5-fold likelihood of being linked to false-positive results, according to new research.
Can Polyenergetic Reconstruction Help Resolve Streak Artifacts in Photon Counting CT?
July 22nd 2024New research looking at photon-counting computed tomography (PCCT) demonstrated significantly reduced variation and tracheal air density attenuation with polyenergetic reconstruction in contrast to monoenergetic reconstruction on chest CT.