[Application of digital subtraction angiography and interventional treatment in gastrointestinal arterial hemorrhage]
Jia-Ping Li1, Guo-Sheng Tang, Yong-Hui Huang
1Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Insights
Digital subtraction angiography (DSA) is crucial for diagnosing gastrointestinal arterial hemorrhage. Interventional treatments like arterial embolization and drug infusion are safe and effective for managing bleeding and guiding further treatment.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Vascular Imaging
Background:
- Gastrointestinal arterial hemorrhage presents diagnostic and therapeutic challenges.
- Timely and accurate diagnosis is essential for effective management.
- Interventional techniques offer minimally invasive treatment options.
Purpose of the Study:
- To evaluate the clinical utility of digital subtraction angiography (DSA) in identifying sources of gastrointestinal arterial bleeding.
- To assess the efficacy and safety of interventional treatments, including arterial drug infusion and embolization, for gastrointestinal arterial hemorrhage.
Main Methods:
- Retrospective analysis of DSA and interventional treatment data from 78 patients with gastrointestinal arterial hemorrhage.
- Detailed review of diagnostic accuracy, procedural success rates, and clinical outcomes.
- Categorization of hemorrhage causes and assessment of complications.
Main Results:
- DSA achieved a diagnostic positive rate of 74%, with direct signs of contrast extravasation identified in 33% of patients.
- Arterial embolization demonstrated a technical success rate of 86% and a clinical success rate of 72%.
- Arterial drug infusion had lower success rates (60% technical, 40% clinical), with an overall rebleeding rate of 16% post-intervention.
Conclusions:
- Digital subtraction angiography is a vital tool for localizing and characterizing gastrointestinal arterial bleeding.
- Transarterial drug infusion and embolization are safe and effective interventions for managing gastrointestinal arterial hemorrhage.
- These interventional procedures facilitate selective treatment strategies and aid in managing complications.
Objective:
To investigate the clinical value of digital subtraction angiography (DSA) and interventional treatment in gastrointestinal arterial hemorrhage.
Methods:
DSA data and experiences of interventional treatment of 78 cases with gastrointestinal arterial hemorrhage were retrospectively analyzed.
Results:
The positive rate of DSA diagnosis was 74%(58/78). Contrast media overflow direct sign was found in 33%(26/78) patients. Contrast media overflow direct sign of postoperative anastomotic stoma was found in 83%(15/18) patients. Hemorrhage causes of 15 cases were duodenal ulcer, 5 stomach ulcer, 2 gastric cancer, 1 Dieulafoy disease, 9 vascular malformation and dysplasia, 8 in anastomotic stoma bleeding after gastrointestinal operation, 10 hepatic artery blow out and bleeding after operation of liver disease, 5 Crohn disease, 6 intestinal tract diverticulum hemorrhage, 6 enteritis or ulcer and 3 polyp of small intestine, 1 midrange malignant small intestinal interstitial tumor, 2 well differentiated small intestine leiomyosarcoma, 5 colon and rectal cancer. Fifteen cases received arterial drug infusion and 36 received arterial embolization. Twenty-seven cases underwent operation after DSA and interventional treatment, whose coincidence with pathology was 78%(21/27). Technical success rate of arterial embolization was 86%(31/36) and clinical success rate was 72%(26/36). Technical success rate of arterial drug perfusion was 60%(9/15) and clinical success rate was 40%(6/15). Rebleeding rate was 16%(8/51) after intervention treatment. During follow-up for 2-36 months, 1 rebleeding patient received gastroscope treatment after embolization, but failed and died later. There were no severe complications,such as ischemic necrosis,in all the cases.
Conclusion:
DSA is very important for the location and qualitation of gastrointestinal arterial hemorrhage. Transarterial drug infusion and embolization are safe and effective, and available to selective operation and complication handling.
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