ABSTRACT
BACKGROUND AND GOALS: Acute non-variceal gastrointestinal bleeding (NVGIB) is one of the most common medical emergencies, leading to significant morbidity and mortality without proper management. This study was to analyze the causes of NVGIB and to evaluate the safety, efficacy, and feasibility of transcatheter arterial embolization (TAE) for the treatment of NVGIB. STUDY: From November 2012 to October 2018, 158 patients with NVGIB underwent digital subtraction angiography, and TAE was performed for confirmed gastrointestinal bleeding. Patient characteristics, cause of bleeding, angiographic findings, technical and clinical success rates, complication rates, and outcomes were retrospectively analyzed. RESULTS: Bleeding was confirmed in 71.5% (113/158) of performed angiographies, and 68 patients had visible contrast extravasation on angiography, with the other 45 patients having indirect signs of bleeding. Among the 113 patients with confirmed gastrointestinal bleeding, TAE was technically successful in 111 patients (98.2%). The mean procedure time required for TAE was 116 ± 44 min (ranging from 50 to 225 min). The primary total clinical success rate of TAE was 84.7% (94/111). The primary clinical success rates of TAE for vascular abnormality, neoplastic disease, and iatrogenic condition were 84.5% (49/58), 84.1% (37/44), and 88.9% (8/9), respectively. Intestinal necrosis and perforation were found in two patients after TAE. CONCLUSIONS: The causes of NVGIB are complex and the onset, location, risk, and clinical presentations are variable. NVGIB can be generally divided into three types: vascular abnormality, neoplastic disease, and iatrogenic condition. TAE is a safe, effective, and fast procedure in the management of gastrointestinal bleeding.
Subject(s)
Angiography , Embolization, Therapeutic , Gastrointestinal Hemorrhage , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/therapy , Humans , Retrospective Studies , Treatment OutcomeABSTRACT
Hematochezia is a rare clinical presentation of congenital extrahepatic portosystemic shunt (CEPS). We describe a series of three patients with type II CEPS presenting as hematochezia that were treated by catheter embolization, followed by a brief review of published articles. Hematochezia of the patients was due to the giant inferior mesenteric vein, superior rectal vein and colonic varices. The catheter embolization was successfully accomplished in all of the patients. After a mean follow-up of 27 months, no serious adverse effects were observed. For unexplained massive hematochezia, CEPS needs to be considered as a differential diagnosis. Based on our present results and the review of the literature, transcatheter permanent embolization of the giant inferior mesenteric vein might be an effective and safe treatment for type II CEPS.Level of Evidence Level 4, case series.
Subject(s)
Embolization, Therapeutic/methods , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage/therapy , Vascular Malformations/complications , Vascular Malformations/therapy , Adult , Aged, 80 and over , Child, Preschool , Diagnosis, Differential , Diagnostic Imaging , Gastrointestinal Hemorrhage/diagnostic imaging , Humans , Male , Portal System/abnormalities , Portal Vein/abnormalities , Vascular Malformations/diagnostic imaging , Young AdultABSTRACT
BACKGROUND: The objective was to evaluate the safety and feasibility of temporary superior vena cava (SVC) filter combined with balloon dilatation and catheter-directed thrombolysis for the treatment of catheter-related thrombosis (CRT) caused by implanted ports. METHODS: Between February 2014 and October 2016, 13 patients with implanted port-related CRT in internal jugular vein, brachiocephalic vein, and/or subclavian vein were treated by temporary SVC filter, balloon dilatation, and catheter-directed thrombolysis. Clinical data were retrospectively analyzed with respect to clinical characteristics, SVC filter placement and retrieval, balloon dilatation, and catheter-directed thrombolysis. RESULTS: Filter placement and retrieval, balloon dilatation, and catheter-directed thrombolysis were successful in all patients with complete patency of the suffered vessels. No complications such as local infection, filter migration, bleeding, and pulmonary embolism were found. CONCLUSIONS: Based on the small number of patients, it appears that temporary SVC filter combined with balloon dilatation and catheter-directed thrombolysis is a safe and effective method for the treatment of CRT associated with malfunction of the implanted ports and complete obstruction of affected veins. Further studies are required to demonstrate the cost-effectiveness and complications compared to conventional therapy.