Mesenteric Embolization for Lower Gastrointestinal Bleeding

• Published in: Diseases of the colon & rectum Vol. 53; no. 9; pp. 1258 - 1264
• Main Authors: Gillespie, Chris J, Sutherland, Andrew D, Mossop, Peter J, Woods, Rodney J, Keck, Jamie O, Heriot, Alexander G
• Format: Journal Article
• Language: English
• Published: Hagerstown, MDc The ASCRS 01-09-2010; Lippincott Williams & Wilkins
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Angiography; Biological and medical sciences; Chi-Square Distribution; Comorbidity; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - diagnostic imaging; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - therapy; Humans; Male; Medical sciences; Mesentery - blood supply; Middle Aged; Other diseases. Semiology; Prospective Studies; Recurrence; Retreatment; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Treatment Outcome; Mesenteric angiogram; Mesenteric embolization; Gastrointestinal bleeding; Lower gastrointestinal bleeding; Gastroenterology; Instrumentation therapy; Digestive diseases; Intestinal disease; Embolization; Mesentery
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/DCR.0b013e3181e10e90

PURPOSE:Mesenteric embolization is an established treatment for lower gastrointestinal bleeding. The aim of this study was to determine the outcome of angiography and embolization and its influencing factors.
METHODS:A prospective database of all mesenteric angiograms performed for lower gastrointestinal bleeding at a tertiary center between 1998 and 2008 was analyzed in combination with chart review.
RESULTS:There were 107 angiograms performed during 83 episodes of lower gastrointestinal bleeding in 78 patients. Active bleeding was identified in 40 episodes (48%), and embolizations were performed in 37 (45%). One patient without active bleeding on angiogram also underwent embolization, making a total of 38 embolizations. Overall mortality was 7% with 4 deaths due to rebleeding and 2 deaths due to a medical comorbidity (respiratory failure, pneumonia). Short-term complications of angiography were false aneurysm (1 patient) and Enterobacter sepsis (1 patient). Long-term complications were groin lymphocele (1 patient) and late rebleed from collateralization (1 patient). In 43 episodes, angiography did not demonstrate active bleeding. Twelve (28%) of these patients continued to bleed, 9 of whom had successful surgery. Of the 38 patients who had embolizations, all had immediate cessation of bleeding. Nine patients (24%) later rebled; 5 of these patients required surgery and 3 had reembolizations. Of the 3 patients who underwent reembolization, 2 developed ischemic bowel and 1 stopped bleeding; surgery was required in 1 patient.
CONCLUSIONS:Mesenteric angiography for lower gastrointestinal bleeding effectively identifies the site of bleeding in 48% of patients and allows embolization in 45%. Embolization achieves clinical success in 76% of patients but repeat embolization is associated with a high rate of complications.