Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results
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Lower gastrointestinal bleeding represents 20 % of all gastrointestinal bleedings. Interventional radiology has transformed the treatment of this pathology, but the long-term outcome after selective embolization has been poorly evaluated. The aim of this study is thus to evaluate the short-term and long-term outcomes after selective embolization for colonic bleeding.
From November 1998 to December 2010, all acute colonic embolizations for hemorrhage were retrospectively reviewed and analyzed. The risk factors for post-embolization ischemia were also assessed.
Twenty-four patients underwent colonic embolization. There were 6 men and 18 women with a median age of 80 years (range, 42–94 years). The underlying etiologies included diverticular disease (41.9 %), post-polypectomy bleeding (16.7 %), malignancy (8.2 %), hemorrhoid (4.1 %), and angiodysplasia (4.1 %). In 23 patients, bleeding stopped (95.8 %) after selective embolization. One patient presented a recurrence of bleeding with hemorrhagic shock and required urgent hemorrhoidal ligature. Four patients required an emergent surgical procedure because of an ischemic event (16.7 %). One patient died of ileal ischemia (mortality, 4.1 %). The level of embolization and the length of hypoperfused colon after embolization were the only risk factors for emergent operation. Mean hospital stay was 18 days (range, 9–44 days). After a mean follow-up of 28.6 months (range, 4–108 months), no other ischemic events occurred.
In our series, selective transarterial embolization for acute colonic bleeding was clinically effective with a 21 % risk of bowel ischemia. The level of embolization and the length of the hypoperfused colon after embolization should be taken into consideration for emergent operation.
KeywordsColonic hemorrhage Arteriography Embolization Ischemia Surgery
- 14.Drooz AT, Lewis CA, Allen TE, Citron SJ, Cole PE, Freeman NJ, Husted JW, Malloy PC, Martin LG, Van Moore A, Neithamer CD, Roberts AC, Sacks D, Sanchez O, Venbrux AC, Bakal CW (1997) Quality improvement guidelines for percutaneous transcatheter embolization. SCVIR Standards of Practice Committee. Society of Cardiovascular & Interventional Radiology. J Vasc Interv Radiol 8(5):889–895PubMedCrossRefGoogle Scholar
- 28.Koganemaru M, Abe T, Iwamoto R, Kusumoto M, Suenaga M, Saga T, Hayabuchi N (2012) Ultraselective arterial embolization of vasa recta using 1.7-French microcatheter with small-sized detachable coils in acute colonic hemorrhage after failed endoscopic treatment. AJR Am J Roentgenol 198(4):W370–W372PubMedCrossRefGoogle Scholar