Massive lower gastrointestinal hemorrhage from the surgical anastomosis in patients with multiorgan trauma : Treatment by subselective embolization with polyvinyl alcohol particles

• Published in: Cardiovascular and interventional radiology Vol. 22; no. 6; pp. 461 - 467
• Main Authors: BULAKBASI, N, KURTARAN, K, ÜSTÜNSÖZ, B, SOMUNCU, I
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01-11-1999; Berlin Springer Nature B.V
• Subjects: Adult; Anastomosis; Biological and medical sciences; Bleeding; Coagulation; Complications; Embolization; Embolization, Therapeutic; Female; FEVER; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - therapy; HEMORRHAGE; Humans; INJURIES; ISCHEMIA; Male; Medical sciences; Multiple Trauma - surgery; Other diseases. Semiology; PATIENTS; Polyvinyl Alcohol; Postoperative Hemorrhage - therapy; PVA; RADIOLOGY AND NUCLEAR MEDICINE; Safety; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; SURGERY; Trauma; Treatment Outcome; Human; Instrumentation therapy; Cardiovascular disease; Gastrointestinal; Hemorrhage; Vascular disease; Polyvinylalcohol; Treatment; Digestive diseases; Intestinal disease; Embolization; Technique; Bibliographic review; Gastric disease
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s002709900433

To evaluate the efficacy and safety of subselective arterial embolization with polyvinyl alcohol (PVA) particles with or without microcoil augmentation to control postoperative lower gastrointestinal (GI) bleeding.
Ten patients with clinical, scintigraphic, and angiographic evidence of postoperative lower GI bleeding were considered for subselective embolization. Subselective embolizations were performed through coaxial microcatheters with 355-500 micron PVA particles with or without additional coil embolization.
Embolization was technically successful in 9 of 10 (90%) patients. In one patient, subselective embolization was not possible; consequently no embolization was performed. Clinical success was achieved after a single embolization in 6 of 10 (60%) patients and after a second embolization in an additional 3 of the 10 (30%) patients. While there was no rebleeding in patients with normal coagulation parameters, all three patients (100%) with coagulopathy rebled, two of them from another source. Although no acute ischemic effects developed, no long-term sequela such as ischemic stricture were specifically looked for. Seven patients developed abdominal discomfort and/or fever within 24-48 hr. Four of 10 patients died of complications other than hemorrhage or ischemia.
Subselective PVA embolization with or without a microcoil embolization is an effective and safe means of managing postoperative lower GI hemorrhage in patients with multiorgan trauma.