REGULAR CONTENT
Final ID
406
Type
Original Scientific Research-Oral or Pos
Authors
B Contrella1, S Xie1, A Winick1
Institutions
1University of Virginia, Charlottesville, VA
Purpose
To evaluate appropriate injection sites for mesenteric angiography and safe sites for embolization within the mesenteric arterial vasculature for lower gastrointestinal bleeding.
Materials & Methods
Utilizing an IRB approved retrospective chart review over a 5 year period; all patients with a history of gastrointestinal bleeding were evaluated. The charts were reviewed for clinical presentation, angiographic studies and assessment of complications from the mesenteric arterial embolization.
Results
Of 384 angiograms, 69 were positive for active LGI bleeding. Prior imaging was useful when available to direct the catheter based injections. Main vessel injection demonstrated the bleeding site in 47 of the 69 patients. Peripheral injections yielded the active bleeding site in the remaining 22 patients. All attempts were made during the embolization procedure to get as far distal as possible. Microcatheterization of the vasa recta vessels as well as the marginal artery feeding the bleeding portion of the bowel was the goal. Of the 69 LGI studies, two patients had complications related to the procedure that necessitated surgical removal of the bowel embolized due to perforation and ischemia. In these patients, embolization was accomplished with gelfoam and coils in a more proximal location in the arcade than the marginal artery.
Conclusions
Arteriography for lower gastrointestinal hemorrhage is a common and safe procedure for patients. Prior localizing imaging is very helpful prior to arrival for any angiography. Central vessel injections can localize bleeding sites in 68% of patients. Subselective angiography, directed by prior imaging, can uncover bleeding sites in 32% of patients. Lower gastrointestinal hemorrhage can be treated with distal embolization using a variety of embolic material. The target vessel to embolize is the marginal artery adjacent to the mesenteric border of the loop of bowel that is bleeding. The vasa recta vessels are safe to embolize without undue risk of ischemia. If a more proximal territory is embolized, there is a higher risk of ischemia.
Final ID
406
Type
Original Scientific Research-Oral or Pos
Authors
B Contrella1, S Xie1, A Winick1
Institutions
1University of Virginia, Charlottesville, VA
Purpose
To evaluate appropriate injection sites for mesenteric angiography and safe sites for embolization within the mesenteric arterial vasculature for lower gastrointestinal bleeding.
Materials & Methods
Utilizing an IRB approved retrospective chart review over a 5 year period; all patients with a history of gastrointestinal bleeding were evaluated. The charts were reviewed for clinical presentation, angiographic studies and assessment of complications from the mesenteric arterial embolization.
Results
Of 384 angiograms, 69 were positive for active LGI bleeding. Prior imaging was useful when available to direct the catheter based injections. Main vessel injection demonstrated the bleeding site in 47 of the 69 patients. Peripheral injections yielded the active bleeding site in the remaining 22 patients. All attempts were made during the embolization procedure to get as far distal as possible. Microcatheterization of the vasa recta vessels as well as the marginal artery feeding the bleeding portion of the bowel was the goal. Of the 69 LGI studies, two patients had complications related to the procedure that necessitated surgical removal of the bowel embolized due to perforation and ischemia. In these patients, embolization was accomplished with gelfoam and coils in a more proximal location in the arcade than the marginal artery.
Conclusions
Arteriography for lower gastrointestinal hemorrhage is a common and safe procedure for patients. Prior localizing imaging is very helpful prior to arrival for any angiography. Central vessel injections can localize bleeding sites in 68% of patients. Subselective angiography, directed by prior imaging, can uncover bleeding sites in 32% of patients. Lower gastrointestinal hemorrhage can be treated with distal embolization using a variety of embolic material. The target vessel to embolize is the marginal artery adjacent to the mesenteric border of the loop of bowel that is bleeding. The vasa recta vessels are safe to embolize without undue risk of ischemia. If a more proximal territory is embolized, there is a higher risk of ischemia.