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Transcatheter arterial embolisation for acute lower gastrointestinal haemorrhage: a single-centre study

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To investigate the safety and efficacy of transcatheter arterial embolisation (TAE) in the management of lower gastrointestinal bleeding (LGIB) and to identify predictors of clinical outcomes.

Methods

Between December 2005 and April 2017, 274 patients underwent diagnostic angiography for signs and symptoms of LGIB; 134 patients with positive angiographic findings were retrospectively analysed. The technical success of TAE and clinical outcomes, including recurrent bleeding, major complications, and in-hospital mortality were evaluated. The associations of various clinical and technical factors with clinical outcomes were analysed. Predictors for clinical outcomes were evaluated using univariate and multivariate logistic regression analyses.

Results

A total of 134 patients (mean age, 59.7 years; range, 14–82 years) underwent TAE for LGIB. The bleeding foci were in the small bowel in 74 patients (55.2%), colon in 35 (26.1%), and rectum in 25 (18.7%). Technical success was achieved in 127 patients (94.8%). The clinical success rate was 63% (80/127). The rates of recurrent bleeding, major complications, and in-hospital mortality were 27.9% (31/111), 18.5% (23/124), and 23.6% (33/127), respectively. Superselective embolisation and the use of N-butyl cyanoacrylate (NBCA) were significant prognostic factors associated with reduced recurrent bleeding (OR, 0.258; p = 0.004 for superselective embolisation, OR, 0.313; p = 0.01 for NBCA) and fewer major complications (OR, 0.087; p ˂ 0.001 for superselective embolisation, OR, 0.272; p = 0.007 for NBCA).

Conclusions

TAE is an effective treatment modality for LGIB. Superselective embolisation is essential to reduce recurrent bleeding and avoid major complications. NBCA appears to be a preferred embolic agent.

Key Points

• Transcatheter arterial Embolisation (TAE) is a safe and effective treatment for lower gastrointestinal tract haemorrhage.

• Superselective embolisation is essential to improve outcomes.

• N-butyl cyanoacrylate (NBCA) appears to be a preferred embolic agent with better clinical outcomes.

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Abbreviations

CT:

Computed tomography

GIB:

Gastrointestinal bleeding

IIA:

Internal iliac artery

IMA:

Inferior mesenteric artery

LGIB:

Lower gastrointestinal bleeding

NBCA:

N-butyl cyanoacrylate

PVA:

Polyvinyl alcohol

SMA:

Superior mesenteric artery

TAE:

Transcatheter arterial embolisation

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Correspondence to Man-Deuk Kim.

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The scientific guarantor of this publication is Man-Deuk Kim, Severance hospital, Yonsei University.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Kwon, J.H., Kim, MD., Han, K. et al. Transcatheter arterial embolisation for acute lower gastrointestinal haemorrhage: a single-centre study. Eur Radiol 29, 57–67 (2019). https://doi.org/10.1007/s00330-018-5587-8

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  • DOI: https://doi.org/10.1007/s00330-018-5587-8

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