Transcatheter Arterial Embolization for Colonic Diverticular Bleeding: Outcomes and Risk Factors for Rebleeding

To evaluate transarterial embolization (TAE) outcomes in patients with diverticular bleeding and to identify factors associated with rebleeding.

This retrospective, single-center study included patients with colonic diverticular bleeding who showed active bleeding on contrast-enhanced computed tomography (CT) and underwent angiography between January 2008 and March 2021. Data included demographics, embolization details, and clinical outcomes. The primary outcome was rebleeding; secondary outcomes were ischemic adverse events and in-hospital mortality. Univariable analysis assessed rebleeding factors.

Among 132 patients (median age, 79 years; interquartile range, 71-84 years; 49% male), active bleeding was detected by angiography in 72% (n = 95) and 67% (n = 89) of patients who underwent TAE. Ninety-four (71%) patients had right-sided colonic bleeding, and 38 (29%) had left-sided colonic bleeding. Rebleeding occurred in 12% (n = 16/132) of patients. The rebleeding rate was significantly lower in patients who underwent TAE compared with who did not (3.4% [n = 3/89] vs 30% [n = 13/43], respectively; P < .001). The rebleeding rate was significantly higher in patients with right-sided than that in those with left-sided colonic bleeding (16% [n = 15/94] vs 2.6% [n = 1/38], respectively; P = .039). Among patients with right-sided colonic bleeding, the rebleeding rate was significantly lower in those who underwent TAE compared with those who did not underwent TAE (3.0% [n = 2/66] vs 46% [n = 13/28], respectively; P < .001). Adverse events were limited to grade 1, and no in-hospital deaths occurred.

TAE is a safe and effective treatment for colonic diverticular bleeding and may reduce rebleeding, particularly for bleeding from the right colon.