ABSTRACT
UNLABELLED: Transarterial catheter embolization (TAE) is integral in the management of lower gastrointestinal bleeding (BLGIT). The efficacy of superselective embolization has reduced the need for emergent surgical resection as a treatment modality. OBJECTIVE: To determine the outcomes of TAE in the management of BLGIT in terms of efficacy rates, recurrent bleeding rates and long term results without the need for surgical intervention. METHOD: Patients who underwent TAE for BLGIT between September 2000 and May 2006 were analysed. Data were extracted from the records for analysis. RESULTS: Sixty-eight patients with a mean age of 76 years and equal gender distribution were analysed. Sixty-nine per cent presented with haematochezia, 40% with malena. Sixty-three patients had a prior RBC scan performed, all of which were positive. Colonoscopy was attempted in 18 patients of which four managed to localize the bleeding site. Embolization was performed in these patients using mainly polyvinyl alcohol particles and/or microcoils. The morbidity rate was 21%, comprising mainly fever and nonspecific abdominal pain with only four ischaemic complications and one report of colonic infarction. Early recurrent bleeding occurred in six patients. Three were treated with repeat embolization and two required surgery. There were no mortalities. After a mean follow-up of 12 months, 12 (17.6%) patients developed further episodes of BLGIT, necessitating further intervention. CONCLUSION: Transarterial catheter embolization is effective and safe in the acute management of BLGIT and reduces the need for further definitive surgery in a majority of patients.
Subject(s)
Embolization, Therapeutic , Endoscopy, Gastrointestinal/methods , Gastrointestinal Hemorrhage/therapy , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Intestine, Large/blood supply , Male , Middle Aged , Radiology, Interventional , Secondary PreventionABSTRACT
In September 1999, the Food and Drug Administration approved two devices for the endovascular repair of abdominal aortic aneurysms. The endografts are placed from within the arteries using fluoroscopic guidance. The minimally invasive technique is performed using bilateral femoral artery cut-downs and has significant advantages over open surgical repair, including a reduction in morbidity, hospital stay and blood loss, with a much quicker return to normal activities. Endoleaks are the main complication following endovascular repair, and close follow-up of patients with CT is recommended to confirm adequate exclusion of the aneurysm.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation , Aged , Aortic Aneurysm, Abdominal/diagnostic imaging , Humans , Male , Tomography, X-Ray ComputedABSTRACT
Transjugular intrahepatic portosystemic shunt placement is a new non-operative therapeutic procedure used by interventional radiologists to manage patients with variceal hemorrhage who are unresponsive to medical treatment. This procedure offers an alternative to surgical shunt procedures with a much lower morbidity and mortality and has a high success rate in controlling bleeding. The early experience at St. Vincent Infirmary Medical Center is discussed.
