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[Angiographic diagnosis and therapy of acute and chronic gastrointestinal hemorrhages]
Insights
Visceral angiography aids diagnosis in acute gastrointestinal bleeding and offers treatment options like vasopressin infusion. Embolization is an alternative, but complications can arise, necessitating further material development.
Area of Science:
- Interventional Radiology
- Gastroenterology
Context:
- Gastrointestinal bleeding diagnosis and management.
- Role of angiography in acute and chronic bleeding.
Purpose:
- To review the diagnostic and therapeutic applications of visceral angiography in gastrointestinal bleeding.
- To compare angiography-based treatments like vasopressin infusion and embolization.
Summary:
- Visceral angiography is crucial for diagnosing persistent acute gastrointestinal bleeding.
- Vasopressin infusion via angiographic catheter is valuable for hemostasis, especially in high-risk patients, allowing surgery postponement.
- Embolization offers an alternative but has risks and requires further material development; electrical occlusion is experimental.
Impact:
- Highlights the dual role of interventional radiology in diagnosing and treating gastrointestinal bleeding.
- Provides insights into managing bleeding when surgery or anesthesia is not immediately feasible.
- Underscores the need for improved embolization materials and techniques.
Abstract:
In acute gastrointestinal bleeding visceral angiography has been showing its importance for years. It contributes to diagnosis especially in cases with persistent acute hemorrhage. In chronic gastrointestinal bleeding conventional radiographic procedures such as upper gastrointestinal series and barium enema will be preferred to angiography. The function of the radiologist goes beyond mere diagnosis of gastrointestinal bleeding. Treatment with vasopressin via the angiographic catheter has proven its clinical value. This method will be indicated especially in cases with high risk anesthesia and surgery. It will help to postpone necessary surgery to a more favorable moment following hemostasis. Side effects such as hypertension and antidiuresis are relatively rare and easy to manage. Numerous substances are used for embolization showing that ideal material has not been found yet and further development seems necessary. In contrast to vasopressin treatment, vascular occlusion is often irreversible, complications (unwanted reflux of embolization material, necrosis and plugging of the catheter) are more difficult to manage. Superselective visualization of a bleeding artery is always needed. Embolization is justified in cases when a possibility for anesthesia and surgery cannot be foreseen. The electrical vascular occlusion using direct current is still in the phase of animal experiments; its clinical value has not sufficiently been assessed as yet.