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Updated: Sep 16, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Provocative Mesenteric Angiography for Obscure Gastrointestinal Hemorrhage: An Update on Outcomes, Safety, and
Teresa A Benvenuti1, Miriam Chisholm1, Brendan Cline1
1Division of Interventional Radiology, Duke University Health System, Durham, North Carolina.
Purpose:
To confirm the safety and modest effectiveness of provocative mesenteric angiography (PMA) in patients with occult gastrointestinal hemorrhage and identify predictors of success.
Materials And Methods:
Retrospective review was performed on 119 provocative mesenteric angiograms on 109 patients (males, 73; mean age, 67.6 years; range, 7-94 years) over a 22-year period. PMA was defined as transcatheter administration of tissue plasminogen activator (tPA) into mesenteric arteries. Clinical, radiologic, and laboratory notes were reviewed. Adverse event rates within 30 days of the procedure were assessed.
Results:
Of 119 provocative mesenteric angiograms, active extravasation was induced in 33 (27.7%) of procedures. On univariable analysis, older age, admission for acute gastrointestinal bleeding (GIB), hematochezia, prior positive radiologic study for GIB, transfusion of 2 or more units of blood, estimated nitroglycerin concentration ratio, estimated tPA concentration ratio, and increasing vessel selectivity for tPA administration were significant predictors of positive PMA (P < .05 for each). However, on multivariable analysis, only hematochezia (P = .036) and prior positive radiologic study (P = .016) were significant predictors of positive PMA. No patients with melena and negative radiologic studies had a positive PMA. No major bleeding adverse events occurred.
Conclusions:
PMA yielded a modest 27.3% positivity rate without clinically significant hemorrhagic adverse events. Prior positive radiologic studies for GIB and character of stool (melena vs hematochezia) significantly predicted provocation of bleeding. PMA is not recommended for patients with melena and negative radiologic imaging studies.
Insights
Provocative mesenteric angiography (PMA) safely identified gastrointestinal bleeding in 27.3% of patients. Hematochezia and prior positive imaging studies predicted success, while melena with negative imaging did not.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Vascular Imaging
Background:
- Occult gastrointestinal hemorrhage (GIB) presents diagnostic challenges.
- Provocative mesenteric angiography (PMA) is a potential tool for diagnosing obscure GIB.
- Assessing the safety and effectiveness of PMA is crucial.
Purpose of the Study:
- To evaluate the safety and modest effectiveness of PMA in patients with occult GIB.
- To identify predictors of successful PMA in inducing bleeding.
Main Methods:
- Retrospective review of 119 PMAs in 109 patients over 22 years.
- PMA involved transcatheter administration of tissue plasminogen activator (tPA) into mesenteric arteries.
- Adverse events within 30 days were assessed.
Main Results:
- Active extravasation was induced in 27.7% of PMAs.
- Hematochezia and prior positive radiologic studies were significant predictors of positive PMA.
- No major bleeding adverse events were observed.
Conclusions:
- PMA has a modest positivity rate (27.3%) with a favorable safety profile.
- Hematochezia and positive prior imaging studies predict successful bleeding provocation.
- PMA is not recommended for patients with melena and negative imaging studies.
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