Acute lower gastrointestinal hemorrhage: treatment by superselective embolization with polyvinyl alcohol particles
| Autor: | G E Guy, Rajinder P. Sharma, T H Burke, Matthew W. Burke, PC Shetty |
|---|---|
| Rok vydání: | 1992 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Ischemia Superselective embolization Polyvinyl alcohol Endoscopy Gastrointestinal Colonic Diseases chemistry.chemical_compound Intestinal mucosa medicine Humans Radiology Nuclear Medicine and imaging Embolization Intestinal Mucosa Mesenteric arteries Aged Aged 80 and over medicine.diagnostic_test business.industry Jejunal Diseases General Medicine Middle Aged medicine.disease Embolization Therapeutic Mesenteric Arteries Surgery Endoscopy Radiography Catheter Rectal Diseases medicine.anatomical_structure chemistry Polyvinyl Alcohol Acute Disease Female Radiology Gastrointestinal Hemorrhage business Follow-Up Studies |
| Zdroj: | American Journal of Roentgenology. 159:521-526 |
| ISSN: | 1546-3141 0361-803X |
| DOI: | 10.2214/ajr.159.3.1503016 |
| Popis: | The major risk of transcatheter embolotherapy for acute hemorrhage in the lower gastrointestinal tract is irreversible intestinal ischemia. The authors studied the efficacy and safety of superselective transcatheter embolization with polyvinyl alcohol particles in arresting acute hemorrhage in the lower gastrointestinal tract.All patients with clinical or scintigraphic evidence of acute hemorrhage in the lower gastrointestinal tract were considered for superselective embolization. The nine patients with angiograms that showed active hemorrhage in the lower gastrointestinal tract underwent the procedure. Superselective embolization was done through a 3-French catheter and was accomplished by using 100- to 590-microns polyvinyl alcohol particles. The segments of the intestinal tracts involved in the embolizations were examined for the presence of ischemia by endoscopy (n = 7) or histologic evaluation of a surgical specimen (n = 2) 2-44 days (mean, 11 days) after embolization or by clinical evaluation (n = 1).The lesions treated by this method were located in the colon (n = 8) and jejunum (n = 1). Immediate hemostasis was achieved in every case. Three patients had recurrent lower gastrointestinal hemorrhage 1-24 days (mean, 9 days) after initial embolization. Two of these patients had surgery, while one had a successful second embolization. Two asymptomatic patients were found endoscopically to have small areas of ischemia involving only the mucosa. Only one patient was shown to have severe mucosal ischemia; this involved the colon in a distribution that suggested it was not caused by the embolization.Ten superselective embolization procedures that used polyvinyl alcohol particles successfully controlled hemorrhage in the lower gastrointestinal tract in nine patients. In no case was intestinal infarction induced by the procedure, and only two endoscopically proved cases of asymptomatic mucosal ischemia occurred. |
| Databáze: | OpenAIRE |
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