Reteplase provocative visceral arteriography

To present the results of a new protocol for provocative visceral arteriography.

Acute lower gastrointestinal hemorrhage (LGIB) usually stops spontaneously. In the absence of an identifiable source, if bleeding is recurrent, provocative visceral arteriography has been advocated for diagnosis. Prior studies using Streptokinase, Urokinase, or tissue plasminogen activator have reported a 33% to 37.5% rate of identifying the site of hemorrhage.

We report a retrospective analysis of 9 patients in whom provocative visceral arteriography was performed using a new protocol with Reteplase as the fibrinolytic agent. All patients had recurrent, massive LGIB without definable source. Initial arteriography did not elicit a site of bleeding. Five units of Reteplase were administered over 1 minute into the inferior mesenteric artery, the superior mesenteric artery or both vessels sequentially. Arteriography was repeated after 5 to 10 minutes.

Colonic hemorrhage was induced in 89% of patients. There were no procedure-related complications.

Reteplase may prove safe and effective as a provocative agent, stimulating bleeding to allow localization, in patients with occult, recurrent, massive LGIB.