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Superselective catheterization and embolization as first-line therapy for lower gastrointestinal bleeding.
Heather B Neuman1, Ben L Zarzaur, Anthony A Meyer
1Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7228, USA.
The American Surgeon
|August 11, 2005
Summary
Superselective catheterization and embolization (SSCE) is an effective first-line therapy for lower gastrointestinal bleeding (LGIB). This endovascular technique offers a low mortality rate and manageable complication profile for LGIB patients.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Vascular Surgery
Background:
- Emergent operative intervention for lower gastrointestinal bleeding (LGIB) carries significant morbidity and mortality risks.
- Advancements in endovascular techniques enable superselective catheterization and embolization (SSCE) of small visceral arteries.
Purpose of the Study:
- To evaluate the efficacy and safety of SSCE as a first-line therapy for LGIB.
- To assess the mortality and complication rates associated with SSCE for LGIB.
Main Methods:
- Retrospective review of patients undergoing visceral angiography between 1997 and 2003.
- Analysis of patients with documented LGIB treated with SSCE as initial therapy.
- Documentation of bleeding site identification, early complications, and long-term outcomes.
Main Results:
- SSCE identified a definitive bleeding site in 95% of patients (22/23).
- Early complications occurred in 48% of patients, including recurrent bleeding (n=5) and femoral pseudo-aneurysm (n=2).
- Long-term follow-up showed recurrent LGIB in 22% and colonic ischemia in 13% of patients; no mortality was observed.
Conclusions:
- SSCE is an effective first-line therapy for managing lower gastrointestinal bleeding.
- The rates of rebleeding and ischemia following SSCE are low.
- SSCE offers a viable alternative to emergent surgery for LGIB with acceptable outcomes.