Transarterial Embolization of Acute Gastrointestinal Bleeding

Year 2021, Volume: 38 Issue: 2s, 56 - 60, 18.03.2021

Ayşegül İdil Soylu , Fatih Uzunkaya , Ümit Belet , Hüseyin Akan

Abstract

Introduction: Transarterial embolization (TAE) is a minimally invasive treatment method developed alternative to surgery for acute gastrointestinal bleeding (AGIB). The aim of this study was to evaluate the efficacy and outcome of TAE in AGIB patients.
Material and methods: The data of 30 patients who underwent TAE with complaint of AGIB between January 2007- May 2020 was collected retrospectively. The etiology of haemorrhage, localization and type of lesion, embolizing agent used, and postprocedural complications were recorded. Lesions were classified as pseudoaneurysm (PA), extravasation, pathological tumor vascularity and vasospasm.
Results: A total of 22 patients, 5 females, were included in the study. The most common underlying cause was tumors (n=15, %50). The most common lesion detected on angiograms was pathological tumor vascularity. Embolizing agents used were N-butyl-2-cyanoacrylate in 5 patients, coils in 3 patients, polyvinyl alcohol particles in 6 patients and microsphere in 7 patients. The technical success rate was 90.9%, and 2 patients developed rebleeding in the early postprocedural period.
Conclusion: TAE is a safe, effective and minimally invasive method in emergency treatment of patients with AGIB.

Keywords

acute gastrointestinal bleeding, Transarterial, embolization

References

• Aina R., Oliva V.L., Therasse E., Perreault P., Bui B.T., Dufresne M.P., Soulez G., 2001. Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol. 12(2):195-200. doi: 10.1016/s1051-0443(07)61825-9.
• Arber N., Tiomny E., Hallak A., Santo M., Moshkowitz M., Konikoff F.M., Shumla V., Rozen P., Gilat T., Rattan J. 1994. An eight year experience with upper gastrointestinal bleeding: diagnosis, treatment and prognosis. J Med. 25:261–269.
• Barnert J., Messmann H., 2009. Diagnosis and management of lower gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol 6: 637-646.
• Chan V., Tse D., Dixon S., Shrivastava V., Bratby M., Anthony S., Patel R., Tapping C., Uberoi R., 2015. Outcome following a negative CT Angiogram for gastrointestinal hemorrhage. Cardiovasc Intervent Radiol. 38:329–335.
• Eriksson LG, Sundbom M, Gustavsson S., Nyman R., 2006. Endoscopic marking with a metallic clip facilitates transcatheter arterial embolization in upper peptic ulcer bleeding. J Vasc Interv Radiol. 17: 959-964
• Frattaroli F.M., Casciani E., Spoletini D., Polettini E., Nunziale A., Bertini L., Vestri A., Gualdi G., Pappalardo G. 2009. Prospective study comparing multi-detector row CT and endoscopy in acute gastrointestinal bleeding. World J Surg. 33(10):2209–17.
• Hreinsson J.P., Kalaitzakis E., Gudmundsson S., Björnsson E.S., 2013. Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting. Scand J Gastroenterol. 48: 439-447.
• Jae H.J., Chung J.W., Jung A.Y., Lee W., Park J.H., 2007. Transcatheter arterial embolization of nonvariceal upper gastrointestinal bleeding with N-butyl cyanoacrylate. Korean J Radiol. 8(1):48-56. doi: 10.3348/kjr.2007.8.1.48.
• Lang E.K., 1992. Transcatheter embolization in management of hemorrhage from duodenal ulcer: long-term results and complications. Radiology. 182(3):703-7. doi: 10.1148/radiology.182.3.1535883.
• Lee C.W., Liu K.L., Wang H.P., Chen S.J., Tsang Y.M., Liu H.M., 2007. Transcatheter arterial embolization of acute upper gastrointestinal tract bleeding with N-butyl-2-cyanoacrylate. J Vasc Interv Radiol. 18(2):209-16. doi: 10.1016/j.jvir.2006.12.003.
• Lee E.W., Laberge J.M., 2004. Differential diagnosis of gastrointestinal bleeding. TechVascIntervRadiol. 7(3):112–122.
• Loffroy R., 2013. Management of nonvariceal upper gastrointestinal bleeding resistant to endocopic hemostasis: will transcatheter embolization replace surgery? Eur J GastroenterolHepatol. 25:118.
• Loffroy R., Favelier S., Pottecher P., Estivalet L., Genson P.Y., Gehin S., Cercueil J.P., Krausé D., 2015. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes. Diagn Interv Imaging. 96(7-8):731-44. doi: 10.1016/j.diii.2015.05.002. Epub 2015 Jun 6.
• Loffroy R., Guiu B., 2009. Role of transcatheter arterial embolization for massive bleeding from gastroduodenal ulcers. World J Gastroenterol. 15(47):5889–97.
• Loffroy R., Guiu B., D'Athis P., Mezzetta L., Gagnaire A., Jouve J.L., Ortega-Deballon P., Cheynel N., Cercueil J.P., Krausé D., 2009. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrhage: predictors of early rebleeding. Clin Gastroenterol Hepatol. 7(5):515-23. doi: 10.1016/j.cgh.2009.02.003.
• Manning-Dimmitt L.L., Dimmitt S.G., Wilson G.R., 2005. Diagnosis of gastrointestinal bleeding in adults. Am Fam Physician. 71: 1339-1346.
• Nusbaum M., Baum S., Blakemore W.S., 1969. Clinical experience with the diagnosis and management of gastrointestinal hemorrhage by selective mesenteric catheterization. Ann Surg. 170(3):506–514.
• Padia S.A., Geisinger M.A., Newman J.S., Pierce G., Obuchowski N.A., Sands M.J., 2009. Effectiveness of coil embolization in angiographically detectable versus non-detectable sources of upper gastrointestinal hemorrhage. J Vasc Interv Radiol. 20(4):461-6. doi: 10.1016/j.jvir.2009.01.006.
• Peynircioğlu B., Erkuş F., Cil B., Ciftçi T., Durhan G., Balkanci F., 2011. Mesenteric angiography of patients with gastrointestinal tract hemorrhages: a single center study. Diagn Interv Radiol. 17:368–373.
• Rösch J., Dotter C.T., Brown M.J., 1972. Selective arterial embolization. A new method for control of acute gastrointestinal bleeding. Radiology. 102:303–306.
• Shi Z.X., Yang J., Liang H.W., Cai Z.H., Bai B., 2017. Emergency transcatheter arterial embolization for massive gastrointestinal arterial hemorrhage. Medicine (Baltimore). 96(52): e9437. doi: 10.1097/MD.0000000000009437.
• Širvinskas A., Smolskas E., Mikelis K., Brimienė V., Brimas G., 2017. Transcatheter arterial embolization for upper gastrointestinal tract bleeding. Wideochir Inne Tech Maloinwazyjne. 12(4):385-393. doi: 10.5114/wiitm.2017.72319. Epub 2017 Dec 29.
• Sos T.A., Lee J.G., Wixson D., Sniderman K.W., 1978. Intermittent bleeding from minute to minute in acute massive gastrointestinal hemorrhage: arteriographic demonstration. AJR Am J Roentgenol. 131:1015– 1017.
• Walker T.G., Salazar G.M., Waltman A.C., 2012. Angiographic evaluation and management of acute gastrointestinal hemorrhage. World J Gastroenterol. 18:1191–1201.
• Walsh R.M., Anain P., Geisinger M., Vogt D., Mayes J., Grundfest-Broniatowski S., Henderson J.M.,1999. Role of angiography and embolization for massive gastroduodenal hemorrhage. J Gastrointest Surg. 3(1):61-5; discussion 66. doi: 10.1016/s1091-255x (99)80010-9.
• Weldon D.T., Burke S.J., Sun S., Mimura H., Golzarian J., 2008. Interventional management of lower gastrointestinal bleeding. EurRadiol. 18:857–67.
• Whitaker S.C., Gregson R.H., 1993. The role of angiography in the investigation of acute or chronic gastrointestinal haemorrhage. Clin Radiol. 47(6):382-8. doi: 10.1016/s0009-9260(05)81057-8.