Intra-Arterial Treatment in Patients with Acute Massive Gastrointestinal Bleeding after Endoscopic Failure: Comparisons between Positive versus Negative Contrast Extravasation Groups
Korean Journal of Radiology
;
: 568-578, 2011.
Article
in English
| WPRIM
| ID: wpr-121839
ABSTRACT
OBJECTIVE:
To determine whether treatment outcome is associated with visualization of contrast extravasation in patients with acute massive gastrointestinal bleeding after endoscopic failure. MATERIALS ANDMETHODS:
From January 2007 to December 2009, patients that experienced a first attack of acute gastrointestinal bleeding after failure of initial endoscopy were referred to our interventional department for intra-arterial treatment. We enrolled 79 patients and divided them into two groups positive and negative extravasation. For positive extravasation, patients were treated by coil embolization; and in negative extravasation, patients were treated with intra-arterial vasopressin infusion. The two groups were compared for clinical parameters, hemodynamics, laboratory findings, endoscopic characteristics, and mortality rates.RESULTS:
Forty-eight patients had detectable contrast extravasation (positive extravasation), while 31 patients did not (negative extravasation). Fifty-six patients survived from this bleeding episode (overall clinical success rate, 71%). An elevation of hemoglobin level was observed in the both two groups; significantly greater in the positive extravasation group compared to the negative extravasation group. Although these patients were all at high risk of dying, the 90-day mortality rate was significantly lower in the positive extravasation than in the negative extravasation (20% versus 42%, p < 0.05). A multivariate analysis suggested that successful hemostasis (odds ratio [OR] = 28.66) is the most important predictor affecting the mortality in the two groups of patients.CONCLUSION:
Visualization of contrast extravasation on angiography usually can target the bleeding artery directly, resulting in a higher success rate to control of hemorrhage.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Infusions, Intra-Arterial
/
Vasopressins
/
Hemostatics
/
Angiography
/
Radiography, Interventional
/
Acute Disease
/
Hemostasis, Endoscopic
/
Treatment Failure
/
Embolization, Therapeutic
/
Extravasation of Diagnostic and Therapeutic Materials
Type of study:
Prognostic study
Limits:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
Language:
English
Journal:
Korean Journal of Radiology
Year:
2011
Type:
Article
Similar
MEDLINE
...
LILACS
LIS