Advertisement

International Journal of Colorectal Disease

, Volume 28, Issue 6, pp 777–782 | Cite as

Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results

  • Andrea Rossetti
  • Nicolas C. BuchsEmail author
  • Romain Breguet
  • Pascal Bucher
  • Sylvain Terraz
  • Philippe Morel
Original Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Colonic hemorrhage Arteriography Embolization Ischemia Surgery 

References

  1. 1.
    Zuccaro G Jr (1998) Management of the adult patient with acute lower gastrointestinal bleeding. American College of Gastroenterology. Practice Parameters Committee. Am J Gastroenterol 93:1202–1208PubMedCrossRefGoogle Scholar
  2. 2.
    Barnert J, Messmann H (2009) Diagnosis and management of lower gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol 6(11):637–646PubMedCrossRefGoogle Scholar
  3. 3.
    Peter DJ, Dougherty JM (1999) Evaluation of the patient with gastrointestinal bleeding: an evidence based approach. Emerg Med Clin North Am 17:239–261PubMedCrossRefGoogle Scholar
  4. 4.
    Jenson DM, Machicado GA, Jutabha R et al (2000) Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 342:78–82CrossRefGoogle Scholar
  5. 5.
    Angtuaco TL, Reddy SK, Drapkin S et al (2001) The utility of urgent colonoscopy in the evaluation of acute lower gastrointestinal tract bleeding: a 2-year experience from a single center. Am J Gastroenterol 96:1782–1785PubMedCrossRefGoogle Scholar
  6. 6.
    Bloomfield RD, Rockey DC, Shetzline MA (2001) Endoscopic therapy of acute diverticular hemorrhage. Am J Gastroenterol 96:2367–2372CrossRefGoogle Scholar
  7. 7.
    Eisen GM, Dominitz JA, Faigel D et al (2001) An annotated algorithmic approach to acute lower gastrointestinal bleeding. Gastrointest Endosc 53:859–863PubMedGoogle Scholar
  8. 8.
    Schuetz A, Jauch KW (2001) Lower gastrointestinal bleeding: therapeutic strategies, surgical techniques and results. Langenbecks Arch Surg 386(1):17–25PubMedCrossRefGoogle Scholar
  9. 9.
    Luchtefeld MA, Senagore AJ, Szomstein M et al (2000) Evaluation of transarterial embolization for lower gastrointestinal bleeding. Dis Colon Rectum 43:532–534PubMedCrossRefGoogle Scholar
  10. 10.
    Nicholson AA, Ettles DF, Hartley JE et al (1998) Transcatheter coil embolotherapy: a safe and effective option for major colonic haemorrhage. Gut 43:4–5CrossRefGoogle Scholar
  11. 11.
    Bandi R, Shetty PC, Sharma RP, Burke TH, Burke MW, Kastan D (2001) Superselective arterial embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 12:1399–1405PubMedCrossRefGoogle Scholar
  12. 12.
    Peck DJ, McLoughlin RF, Hughson MN et al (1998) Percutaneous embolotherapy of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 9:747–751PubMedCrossRefGoogle Scholar
  13. 13.
    Lipof T, Sardella WV, Bartus CM, Johnson KH, Vignati PV, Cohen JL (2008) The efficacy and durability of super-selective embolization in the treatment of lower gastrointestinal bleeding. Dis Colon Rectum 51(3):301–305PubMedCrossRefGoogle Scholar
  14. 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
  15. 15.
    Bookstein JJ, Chlosta EM, Foley D, Walter JF (1974) Transcatheter hemostasis of gastrointestinal bleeding using modified autogenous clot. Radiology 113:277–285PubMedGoogle Scholar
  16. 16.
    Funaki B, Kostelic JK, Lorenz J, Ha TV, Yip DL, Rosenblum JD, Leef JA, Straus C, Zaleski GX (2001) Superselective microcoil embolization of colonic hemorrhage. AJR Am J Roentgenol 177:829–836PubMedCrossRefGoogle Scholar
  17. 17.
    Junquera F, Quiroga S, Saperas E et al (2000) Accuracy of helical computed tomographic angiography for the diagnosis of colonic angiodysplasia. Gastroenterology 119:293–299PubMedCrossRefGoogle Scholar
  18. 18.
    Rajan R, Dhar P, Praseedom RK, Sudhindran S, Moorthy S (2004) Role of contrast CT in acute lower gastrointestinal bleeding. Dig Surg 21:293–296PubMedCrossRefGoogle Scholar
  19. 19.
    Kuhle WG, Sheiman RG (2003) Detection of active colonic hemorrhage with use of helical CT: findings in a swine model. Radiology 228:743–752PubMedCrossRefGoogle Scholar
  20. 20.
    Danzer D, Gervaz P, Platon A, Poletti PA (2003) Bleeding Meckel’s diverticulum diagnosis: an unusual indication for computed tomography. Abdom Imaging 28:631–633PubMedCrossRefGoogle Scholar
  21. 21.
    Burgess AN, Evans PM (2004) Lower gastrointestinal haemorrhage and superselective angiographic embolization. ANZ J Surg 74(8):635–638PubMedCrossRefGoogle Scholar
  22. 22.
    Gordon RL, Ahl KL, Kerlan RK, Wilson MW, LaBerge JM, Sandhu JS, Ring EJ, Welton ML (1997) Selective arterial embolization for the control of lower gastrointestinal bleeding. Am J Surg 174:24–28PubMedCrossRefGoogle Scholar
  23. 23.
    Silver A, Bendick P, Wasvary H (2005) Safety and efficacy of superselective angioembolization in control of lower gastrointestinal hemorrhage. Am J Surg 189:361–363PubMedCrossRefGoogle Scholar
  24. 24.
    Tan KK, Wong D, Sim R (2008) Superselective embolization for lower gastrointestinal hemorrhage: an institutional review over 7 years. World J Surg 32:2707–2715PubMedCrossRefGoogle Scholar
  25. 25.
    Skala K, Gervaz P, Buchs N, Inan I, Secic M, Mugnier-Konrad B, Morel P (2009) Risk factors for mortality–morbidity after emergency–urgent colorectal surgery. Int J Colorectal Dis 24(3):311–316PubMedCrossRefGoogle Scholar
  26. 26.
    Tan KK, Nallathamby V, Wong D, Sim R (2010) Can superselective embolization be definitive for colonic diverticular hemorrhage? An institution’s experience over 9 years. J Gastrointest Surg 14:112–118PubMedCrossRefGoogle Scholar
  27. 27.
    Gillespie CJ, Sutherland AD, Mossop PJ, Woods RJ, Keck JO, Heriot AG (2010) Mesenteric embolization for lower gastrointestinal bleeding. Dis Colon Rectum 53(9):1258–1264PubMedCrossRefGoogle Scholar
  28. 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

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Andrea Rossetti
    • 1
  • Nicolas C. Buchs
    • 1
    Email author
  • Romain Breguet
    • 2
  • Pascal Bucher
    • 1
  • Sylvain Terraz
    • 2
  • Philippe Morel
    • 1
  1. 1.Clinic for Visceral Surgery and Transplantation, Department of SurgeryUniversity Hospital of GenevaGenevaSwitzerland
  2. 2.Department of RadiologyUniversity Hospital of GenevaGenevaSwitzerland

Personalised recommendations