Skip to main content

Advertisement

Log in

Evaluation of transarterial embolization for lower gastrointestinal bleeding

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

INTRODUCTION: Transcatheter arterial embolization has been used as a therapeutic maneuver for lower gastrointestinal bleeding. The availability of highly selective arteriography has made this procedure safer and warrants re-evaluation. METHODS: A retrospective chart review was done of all patients undergoing arteriography for presumed lower gastrointestinal bleeding at two acute-care community hospitals. Causes of bleeding, clinical outcome, and complications caused by transcatheter arterial embolization were recorded. RESULTS: There were 26 arteriographically identified bleeding sites in the colon and small bowel. The most frequent cause of bleeding was diverticulosis (12 patients), with the diagnosis being arteriovenous malformation in two, and one unknown colonic source. Transcatheter arterial embolization was attempted for 17 separate bleeding episodes in 16 patients. Transfusion requirements were an average (± standard deviation) of 7±1.43 units per patient. Transcatheter arterial embolization was successful in stopping bleeding in 14 cases (82 percent). Two patients had surgery after transcatheter arterial embolization: one for colonic necrosis and one for persisting bleeding. There were two more unsuccessful procedures; one had a successful repeated transcatheter arterial embolization, and one stopped spontaneously. One patient rebled during the same hospitalization and was controlled with intra-arterial vasopressin. There were two deaths, both secondary to sepsis unrelated to the transcatheter arterial embolization or the gastrointestinal tract. CONCLUSIONS: Transcatheter arterial embolization is a relatively safe and successful procedure in patients with massive lower gastrointestinal hemorrhage. It is an excellent choice of therapy for patients that are poor candidates for surgery, but its role in other patients remains to be defined.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Breen E, Murray JJ. Pathophysiology and natural history of lower gastrointestinal bleeding. Semin Colon Rectal Surg 1997;8:128–38.

    Google Scholar 

  2. Klas JV, Madoff RD. Surgical options in lower gastrointestinal bleeding. Semin Colon Rectal Surg 1997;8:172–77.

    Google Scholar 

  3. Nusbaum M, Baum S, Sakiyalak P,et al. Pharmacologic control of portal hypertension. Surgery 1967;62:299–310.

    Google Scholar 

  4. Molgaard CP. Mesenteric angiography for the diagnosis and treatment of lower gastrointestinal bleeding. Semin Colon Rectal Surg 1997;8:164–71.

    Google Scholar 

  5. Goldstein HM, Medellin H, Ben-Menachem Y, Wallace S. Transarterial embolization in the management of bleeding in the cancer patient. Radiology 1975;115:603–8.

    PubMed  Google Scholar 

  6. Jander HP, Russinovich NA. Transcatheter gelfoam embolization in abdominal, retroperitoneal and pelvic hemorrhage. Radiology 1980;136:337–44.

    PubMed  Google Scholar 

  7. Walker WJ, Goldin AR, Shaff MI, Allibone GW. Per catheter control of hemorrhage from the superior and inferior mesenteric arteries. Clin Radiol 1980;31:71–80.

    Article  PubMed  Google Scholar 

  8. Uflacker R. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding. Acta Radiol 1987;28:425–30.

    PubMed  Google Scholar 

  9. Goldberger LE, Bookstein JJ. Transcatheter embolization for treatment of diverticular hemorrhage. Radiology 1977;122:613–7.

    PubMed  Google Scholar 

  10. Matolo NM, Link DP. Selective embolization for control of gastrointestinal hemorrhage. Am J Surg 1979;138:840–4.

    Article  PubMed  Google Scholar 

  11. Chuang VP, Wallace S, Zornoza J, Davis L. Transcatheter arterial occlusion in the management of rectosigmoidal bleeding. Radiology 1979;133:605–9.

    PubMed  Google Scholar 

  12. Rosenkrantz H, Bookstein JJ, Bosen RJ, Goff WB II, Healy J. Postembolic colonic infarction. Radiology 1982;142:47–57.

    PubMed  Google Scholar 

  13. Guy GE, Shetty PC, Sharma RP, Burke MW, Burke TH. Acute lower gastrointestinal hemorrhage: treatment by superselective embolization with polyvinyl alcohol particles. AJR Am J Roentgenol 1992;159:521–6.

    PubMed  Google Scholar 

  14. Guy GE, Shetty PC, Sharma RP, Burke MW, Kastan DJ, Burke TH. Treatment of acute lower gastrointestinal hemorrhage with superselective delivery of polyvinyl alcohol particles: further observations and outcomes in 19 patients [abstract]. Radiology 1992;185(P):135.

    PubMed  Google Scholar 

  15. Gordon R, Ahl K, Kerlan R,et al. Selective arterial embolization for the control of lower gastrointestinal bleeding. Am J Surg 1997;174:24–28.

    Article  PubMed  Google Scholar 

  16. Görich J, Brambs HJ, Allmenröder C,et al. The role of embolization treatment of acute hemorrhage [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1993;159:379–87.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Funded in part by a grant from the Blodgett-Butterworth Healthcare Foundation (formerly Ferguson-Blodgett Foundation).

About this article

Cite this article

Luchtefeld, M.A., Senagore, A.J., Szomstein, M. et al. Evaluation of transarterial embolization for lower gastrointestinal bleeding. Dis Colon Rectum 43, 532–534 (2000). https://doi.org/10.1007/BF02237200

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02237200

Key words

Navigation