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Lower gastrointestinal haemorrhage and superselective angiographic embolization
Adele N Burgess1, Peter M Evans
1Department of Surgery, Alfred Hospital, Melbourne, Prahran, Victoria 3181, Australia.
ANZ Journal of Surgery
|August 19, 2004
Summary
Superselective transcatheter embolization is effective for acute lower gastrointestinal bleeding when active bleeding is identified. However, it is not recommended if no active bleeding site is found during angiography due to high risks.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Vascular Surgery
Background:
- Limited surgical literature exists on superselective embolization for bleeding distal to the ligament of Treitz.
- The efficacy and outcomes of this treatment for lower gastrointestinal hemorrhage are not well-established.
Purpose of the Study:
- To evaluate the experience of Alfred Hospital with superselective transcatheter embolization for acute lower gastrointestinal hemorrhage.
- To assess the outcomes and risks associated with this interventional procedure.
Main Methods:
- An uncontrolled case series analysis of 15 patients treated between July 1998 and January 2003.
- Patients underwent arterial embolization for bleeding distal to the ligament of Treitz.
Main Results:
- Satisfactory hemostasis was achieved in 93% of patients (14/15).
- Rebleeding occurred in 53.3% within 24 hours.
- Outcomes differed significantly based on angiographic findings: active bleeding sites (67% of patients) had lower rates of ischemia and mortality compared to those without identified bleeding sites (33% of patients).
Conclusions:
- Superselective angiographic embolization is a viable alternative to emergency resection for high-risk patients with identified active bleeding.
- Embolization is not recommended when active bleeding cannot be identified angiographically due to increased risks of ischemia and mortality.