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Updated: Jan 6, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Mesenteric angiography for colonic diverticular bleeding: clinical and technical predictors of extravasation and
Ivan Dimov1, Kaiz Esmail2, Chantal Ferguson1
1Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
Insights
Prompt mesenteric angiography within 4 hours of CT angiogram (CTA) improves detection of active colonic diverticular bleeding. Targeted embolization reduces rebleeding and subsequent colonoscopies, improving patient outcomes.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Vascular Imaging
Background:
- Colonic diverticular bleeding is a significant cause of lower gastrointestinal bleeding.
- CT angiography (CTA) is used to identify active bleeding, but its diagnostic yield for subsequent angiography is debated.
- Predictors of active extravasation and outcomes of embolization are not well-established for this specific indication.
Purpose of the Study:
- To predict active extravasation during mesenteric angiography for colonic diverticular bleeding confirmed by CTA.
- To examine the effect of procedural factors on the diagnostic yield of angiography.
- To evaluate the impact of embolization on clinical outcomes, including rebleeding and need for colonoscopy.
Main Methods:
- Retrospective review of mesenteric angiograms performed for colonic diverticular bleeding diagnosed by CTA (2016-2025).
- Data collected included CTA-to-angiogram time, extravasation, inferior vena cava size, angiogram selectivity, and embolization techniques.
- Univariate and multivariate analyses identified predictors of active extravasation; clinical outcomes compared between embolized and non-embolized groups.
Main Results:
- Active extravasation was identified in 40% of angiograms.
- Independent predictors for active bleeding on angiography included CTA-to-angiogram time ≤ 4 hours (OR=2.95), inferior vena cava short axis ≥ 20 mm (OR=3.63), and patient age (OR=1.06).
- Sub-selective angiography showed higher bleeding rates (34% vs 21%). Targeted embolization resulted in significantly less rebleeding (10% vs 44%) and fewer post-procedure colonoscopies (17% vs 51%).
Conclusions:
- Mesenteric angiography has a 40% positivity rate for colonic diverticular bleeding following CTA.
- Higher diagnostic yield is achieved with angiography performed within 4 hours of CTA, using sub-selective techniques, and after adequate resuscitation.
- Targeted embolization effectively reduces rebleeding rates and the need for subsequent colonoscopies in patients with active diverticular bleeding.
Objectives:
To predict active extravasation during angiography for colonic diverticular bleeding confirmed by CT angiogram (CTA) and examine the effect of procedural factors on clinical outcomes.
Materials And Methods:
Mesenteric angiograms performed at three hospitals for colonic diverticular bleeding on CTA between 2016 and 2025 were retrospectively reviewed. Data collection included CTA-to-angiogram time, extravasation and inferior vena cava size, angiogram selectivity, provocative maneuvers, and embolization techniques. Univariate and multivariate analyses were used to find associations between pre-procedural variables and active extravasation on angiography. Clinical outcomes were compared between patients who were or were not embolized.
Results:
One hundred seventeen patients (median age, 76 years (IQR 16), 42 women) underwent 146 angiograms. Active extravasation was found in 40% of angiograms. CTA-to-angiogram time ≤ 4 h (OR = 2.95; CI: 1.17-7.73; p = 0.02), inferior vena cava short axis ≥ 20 mm (OR = 3.63; CI: 1.24-11.6, p = 0.02) and age (OR = 1.06; CI: 1.01-1.12; p = 0.01) were independent predictors for active bleeding on angiography in a multivariate logistic model (AUC: 0.81, CI: 0.72-0.89; p < 0.01). Angiography beyond the named arterial branch revealed more bleeding than main trunk angiography (34% vs 21%). 51/58 (88%) positive and 15 negative angiograms were embolized. Patients with targeted embolization had less rebleeding (10% vs 44%, p < 0.05) and post-procedure colonoscopies (17% vs 51%, p < 0.05).
Conclusion:
Mesenteric angiography had a 40% positivity rate for diverticular bleeding after CTA, with a higher yield if performed within 4 h, sub-selectively, and after resuscitation. Targeted embolization decreased rebleeding and post-procedure colonoscopies.
Key Points:
Question Colonic diverticular bleeding identified on CTA is treated with angiography and embolization, but diagnostic yield and embolization outcome are extrapolated from all-cause lower gastrointestinal bleeding. Findings Extravasation was identified in 40% of angiograms, with better yield if performed ≤ 4 h after positive CTA and sub-selectively. Targeted embolization reduced rebleeding and post-procedural colonoscopies. Clinical relevance Patients with colonic diverticular bleeding with active extravasation on CTA should be vigorously resuscitated and undergo prompt mesenteric angiography. This increases the likelihood of visualizing active extravasation and targeted embolization, leading to less rebleeding and further procedures.
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