Endovascular Therapy of Severe Non-Variceal Gastrointestinal Bleeding – One Decade Experience.

Abstract Introduction Severe non-variceal gastrointestinal bleeding is a life-threatening condition with complicated treatment if endoscopic rescue fails. In that case, transcatheter arterial embolization is recommended to stop the bleeding. The technical and clinical effects of this technique were analyzed in this group of patients, as well as its complication rate and 30-day mortality.Method Patient data of the one-decade period (from 2010 to 2019) were analyzed retrospectively. Twenty-seven patients (18 men and nine women, median age 61 years) treated by endovascular embolization in our institution with clinically significant gastrointestinal hemorrhage after unsuccessful or impossible endoscopic treatment were identified.Results The source of bleeding was found in 88% of patients, but embolization was performed in 96% of them. The technical success rate in the sample was 100%, and the clinical favorable outcome rate was 88.5%. The bleeding recurrence occurred in eight cases, five of whom had technically successful re-embolization in four cases. The incidence of recurrent bleeding was significantly higher in patients with two or more comorbidities with (p = 0.043). There was one serious complication (4%) in the group and minor difficulties occurred in 18% of patients; 30-day mortality reached 22%. Mortality was significantly higher in the group of patients with re-bleeding (p = 0.044).Discussion Our documented results in common are in the established rank of previously published results, which range from 62-100% for technical success, 52-94% for the clinical favorable outcome, 9-66% for re-bleeding and 4-46% for 30-day mortality.Conclusion Transcatheter arterial embolization is a safe mini-invasive method with high technical and clinical success in patients with endoscopically untreatable gastrointestinal bleeding. It is also suitable for high-risk cases. Mortality (to a significant extent) typically depends on the re-bleeding presence and the patient's comorbidity.

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Ultraselective transcatheter arterial embolization with small-sized microcoils for acute lower gastrointestinal bleeding

CVIR Endovascular ◽

10.1186/s42155-021-00215-9 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Mitsuhiro Kinoshita ◽

Hiroshi Kondo ◽

Suguru Hitomi ◽

Takuya Hara ◽

Ryusei Zako ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Clinical Success Rate ◽

Arterial Embolization ◽

Lower Gastrointestinal Bleeding ◽

Recurrent Bleeding ◽

Major Complications ◽

Vasa Recta

Abstract Purpose To evaluate the clinical outcome of ultraselective transcatheter arterial embolization (TAE) with small-sized microcoils for acute lower gastrointestinal bleeding (LGIB). Materials and methods The subjects were 17 consecutive patients (mean age, 69 years) with LGIB who were treated with ultraselective TAE using small-sized microcoils between December 2013 and December 2019. Ultraselective TAE was defined as embolization of one or both of the long or short branches of the vasa recta. The etiologies of bleeding were colonic diverticulosis in 16 patients (94%) and malignancy in one patient (6%). The bleeding foci were in the ascending colon in 11 patients (65%), transverse colon in 2 patients (12%), and sigmoid colon in 4 patients (23%). A total of 18 branches (diameter: range 0.5–1.5 mm, mean 1.1 mm) of the vasa recta in 17 patients were embolized with small-sized microcoils (size range 1–3 mm, mean combined lengths of all microcoils 7.6 cm). The mean follow-up period was 19 months (range 1–80 months). The technical and clinical success rate, recurrent bleeding rate, major complications and long-term clinical outcomes were retrospectively evaluated. Results Technical and clinical success was achieved in all patients (17/17). The rates of early recurrent bleeding (within 30 days of TAE) and major complications were 0% (0/17). Recurrent bleeding occurred in one patient at 2 months after TAE, but was stopped with conservative treatment. There were no other bleeding episodes or complications in the follow-up period. Conclusion Ultraselective TAE with small-sized microcoils is a highly effective and safe treatment modality for LGIB.

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The Clinical and Technical Effectiveness of Endovascular Embolization in Patients with Nonvariceal Gastrointestinal Bleeding

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0037-1603564 ◽

2017 ◽

Vol 01 (01) ◽

pp. 005-012

Author(s):

Azadeh Elmi ◽

T. Walker ◽

Suvranu Ganguli ◽

Sanjeeva Kalva

Keyword(s):

Multivariate Analysis ◽

Gastrointestinal Bleeding ◽

Clinical Success ◽

Mortality Rates ◽

Therapeutic Endoscopy ◽

Endovascular Embolization ◽

Technical Success ◽

Selective Embolization ◽

Technical Success Rate ◽

Clinical Records

Background and Aim Endovascular embolization is a well-established option in the management of acute gastrointestinal bleeding (GIB) after failed therapeutic endoscopy; however, questions remain concerning the outcomes and the various predictors of clinical and technical success of this therapy. The authors aimed to assess the effectiveness of endovascular embolization in patients with nonvariceal GIB. Method Clinical records of 88 patients (mean age: 67.8 years) who underwent endovascular embolization for GIB were reviewed. Patient demographics, history, angiographic findings, treatment, and outcomes were recorded. The technical success of embolization, and the 24-hour and 30-day rebleeding and mortality rates were calculated. Multivariate analysis was performed to assess the factors associated with 24-hour and 30-day rebleeding. Results Angiography demonstrated signs of bleeding in 63 (71.6%) patients and all underwent selective embolization of the abnormal artery. Empiric embolization was performed in 25 patients. Embolization was performed with coils (n = 45), Gelfoam (n = 12), microparticles (n = 14), glue (n = 2), or a combination of these (n = 15). The technical success rate was 96.6%. The 24-hour and 30-day rebleeding occurred in 13 (14.7%) and 16 (18.2%) patients, respectively. The 24-hour and 30-day mortality rates were 9.1 and 11.3%, respectively. Ischemic complications following embolization were seen in three patients, of which two required surgery. Based on the multivariate analysis, the need for continued transfusion after embolization and prior GIB were independent variables associated with 24-hour and 30-day rebleeding, respectively. Conclusions Endovascular embolization has a high technical and clinical success in patients presenting with nonvariceal GIB.

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Transcatheter arterial embolization for unruptured renal angiomyolipoma using a 1.8-Fr tip microballoon catheter with a mixture of ethanol and Lipiodol

CVIR Endovascular ◽

10.1186/s42155-019-0095-8 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Kosuke Tomita ◽

Tomohiro Matsumoto ◽

Shunsuke Kamei ◽

Shota Yamamoto ◽

Satoshi Suda ◽

...

Keyword(s):

Success Rate ◽

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Clinical Success Rate ◽

Arterial Embolization ◽

Renal Angiomyolipoma ◽

Technical Success ◽

Technical Success Rate ◽

Median Volume ◽

Estimated Glomerular Filtration Rates

Abstract Background To evaluate the efficacy and safety of transcatheter arterial embolization for renal angiomyolipoma using a 1.8-French tip microballoon catheter and a mixture of ethanol and Lipiodol. Methods Seven consecutive patients with total of eight angiomyolipomas underwent this procedure between June 2014 and June 2017. A 1.8-French tip microballoon catheter was advanced to the feeding artery of the angiomyolipoma, and transcatheter arterial embolization was performed with a mixture of ethanol and Lipiodol under microballoon inflation. We retrospectively evaluated the characteristics of angiomyolipomas, technical success rate, clinical success rate, renal function, and adverse events. Technical success and clinical success were defined as complete embolization of all feeding arteries and reduction of tumor size, respectively. Results The median size of the angiomyolipomas was 46 mm (range, 40–64 mm). Transcatheter arterial embolization was successful in all eight angiomyolipomas. The median volume of the mixture of ethanol and Lipiodol was 6.0 ml (range, 2.0–14 ml). The median ratio of ethanol to Lipiodol was 71% (range, 71–75%). All eight angiomyolipomas shrank with a median shrinkage rate of 34% in diameter (range, 9–63%) and 77% in volume (range, 48–94%). The median follow-up period was 13 months (range, 9–54 months). Clinical success was achieved in all cases. Serum creatinine concentrations and the pre- and post-procedural estimated glomerular filtration rates did not change notably, and there were no major complications. Conclusion Transcatheter arterial embolization for renal angiomyolipoma using a 1.8-French tip microballoon catheter with a mixture of ethanol and Lipiodol is effective and safe.

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Superselective transcatheter arterial embolization for acute small bowel bleeding: clinical outcomes and prognostic factors for ischemic complications

Acta Radiologica ◽

10.1177/0284185120936258 ◽

2020 ◽

pp. 028418512093625

Author(s):

Yong Seek Kim ◽

Joon Ho Kwon ◽

Kichang Han ◽

Man-Deuk Kim ◽

Junhyung Lee ◽

...

Keyword(s):

Small Bowel ◽

Gastrointestinal Bleeding ◽

Hospital Mortality ◽

Clinical Outcomes ◽

Arterial Embolization ◽

Recurrent Bleeding ◽

Technical Success ◽

Major Complications ◽

Ischemic Complications ◽

Small Bowel Bleeding

Background Small bowel bleeding (SBB) accounts for 5%–10% of all cases of acute gastrointestinal bleeding. Transcatheter arterial embolization (TAE) plays an important role in the treatment of SBB. Purpose To evaluate the safety and efficacy of superselective TAE exclusively for SBB and to assess factors associated with clinical outcomes. Material and Methods From January 2006 to April 2017, 919 patients were admitted with signs and symptoms of gastrointestinal bleeding; 74 patients (mean age = 57.5 years; age range = 14–82 years) with positive angiographic findings for SBB were retrospectively analyzed. The technical success of TAE and clinical outcomes, including recurrent bleeding, major complications, and in-hospital mortality were evaluated. The associations of various clinical and technical factors with clinical outcomes were analyzed. Results The bleeding foci were in the ileum in 48 (65%) patients and the jejunum in 26 (35%). Technical success was achieved in 72 (97%) patients. The rates of recurrent bleeding, major complications, and in-hospital mortality were 12% (7/57), 21% (15/71), and 25% (18/72), respectively. Superselective embolization was a significant prognostic factor associated with fewer major complications (OR = 0.069; P = 0.003). The increased number of embolized vasa recta was significantly associated with a higher probability of major complications (OR = 2.64; P < 0.001). The use of N-butyl cyanoacrylate was associated with lower rates of major complication (OR = 0.257; P = 0.027). Conclusion TAE is a safe and effective treatment modality for SBB. In addition, whenever possible, TAE should be performed in a superselective manner to minimize ischemic complications.

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Effectiveness of TC-325 (Hemospray) for treatment of diffuse or refractory upper gastrointestinal bleeding – a single center experience

Endoscopy International Open ◽

10.1055/s-0043-118794 ◽

2017 ◽

Vol 05 (11) ◽

pp. E1159-E1164 ◽

Cited By ~ 11

Author(s):

Oscar Cahyadi ◽

Markus Bauder ◽

Benjamin Meier ◽

Karel Caca ◽

Arthur Schmidt

Keyword(s):

Gastrointestinal Bleeding ◽

Salvage Therapy ◽

Upper Gastrointestinal Bleeding ◽

Clinical Success ◽

Treatment Algorithm ◽

Endoscopic Hemostasis ◽

Ulcer Bleeding ◽

Recurrent Bleeding ◽

Technical Success ◽

Upper Gastrointestinal

Abstract Background and study aims TC-325 (Hemospray, Cook Medical) is a powder agent for endoscopic hemostasis in patients with upper gastrointestinal bleeding (UGIB). Although most publications are based on case-reports and retrospective studies, data on efficacy are promising. Here we report our experience with TC-325 for diffuse or refractory UGIB. Patients and methods Data on patients receiving TC-325 for endoscopic hemostasis from November 2013 to February 2017 at our center were analyzed retrospectively. Primary endpoints were technical success (successful immediate hemostasis) and clinical success (effective hemostasis and no recurrent bleeding). Secondary endpoints were recurrent bleeding within 3 and 7 days, hospital mortality and TC-325 associated complications. TC-325 was used for bleeding not amenable to standard endoscopic treatment (e. g. diffuse bleeding) or as salvage therapy after failure of conventional methods Results Fifty-two patients received TC-325 treatment. Most of the patients were treated for peptic ulcer bleeding (18/52 patients, 34.6 %) and post-interventional bleeding (13/52 patients, 25 %). Hemospray was used in 23/52 (44.2 %) patients as monotherapy and in 29/52 (55.8 %) patients as a salvage therapy. Application of the powder on the bleeding source was successful in all patients with no therapy-related adverse events (AEs). Immediate hemostasis was achieved in 51/52 (98.1 %) patients. Recurrent bleeding within 3 and 7 days was observed in 22/51 and 25/51 patients respectively (43.1 % and 49 %). The overall clinical success was 56.9 % on day 3 and 51 % on day 7. Total mortality was 15.4 % (8 patients), bleeding associated mortality was 3.8 % (2 patients). There were no therapy-related AEs. Conclusions TC-325 showed a high technical success rate as monotherapy for bleeding sources not amenable to standard methods or as an “add-on” therapy after unsuccessful hemostasis. However, rebleeding was frequent in this cohort and further studies are warranted to exactly define a treatment algorithm for TC-325 use.

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Safety of Transcatheter Arterial Embolization for Visceral Artery Pseudoaneurysms: Incidence of Intraprocedural Rupture

Vascular and Endovascular Surgery ◽

10.1177/1538574421992938 ◽

2021 ◽

Vol 55 (4) ◽

pp. 361-366

Author(s):

Masashi Shimohira ◽

Keiichi Nagai ◽

Kengo Ohta ◽

Yusuke Sawada ◽

Keita Nakayama ◽

...

Keyword(s):

Success Rate ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Major Complication ◽

Visceral Artery ◽

Technical Success ◽

Advanced Level ◽

Technical Success Rate ◽

A Minor

Introduction: Transcatheter arterial embolization is the first-line treatment for visceral artery pseudoaneurysms (VAPAs); however, the intraprocedural rupture of pseudoaneurysms is an important complication. The present study was performed to evaluate the safety of embolization for VAPAs, including the incidence of intraprocedural rupture. Methods: Among 56 consecutive patients with 57 VAPAs who underwent treatment between April 2009 and October 2020, 46 patients with 47 VAPAs underwent embolization. Complications related to embolization including intraprocedural rupture, the technical success rate, and clinical outcomes were evaluated. Complications that required extended hospitalization, an advanced level of care, or resulted in permanent adverse sequelae or death were classified as major complications, while the remainder were considered to be minor. Technical success was defined as the completion of embolization. Results: The intraprocedural rupture of pseudoaneurysms occurred in 3 out of 47 VAPAs treated with embolization (6%) and resulted in minor complications. One liver abscess requiring drainage was regarded as a major complication (2%). Focal infarction after embolization was observed as a minor complication in 20 cases. Complications occurred in 24 out of 47 cases (51%), comprising one major complication (2%) and 23 minor complications (48%). The technical success rate was 100% (47/47). Fifty-three out of 56 patients (95%) were alive in a median follow-up period of 18 months (range: 2 days-137 months). Conclusions: Embolization is safe and useful for the treatment of VAPAs; however, the intraprocedural rupture of pseudoaneurysms may occur, and, thus, care is needed during this procedure.

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Transcatheter arterial embolization for massive hemobilia with N-butyl cyanoacrylate (NBCA) Glubran 2

Acta Radiologica ◽

10.1177/0284185121992971 ◽

2021 ◽

pp. 028418512199297

Author(s):

Yadong Shi ◽

Liang Chen ◽

Boxiang Zhao ◽

Hao Huang ◽

Zhaoxuan Lu ◽

...

Keyword(s):

Transcatheter Arterial Embolization ◽

Coil Embolization ◽

Treatment Time ◽

Clinical Success ◽

Arterial Embolization ◽

Technical Success ◽

Promising Alternative ◽

Major Complications ◽

Glubran 2

Background Massive hemobilia is a life-threatening condition and therapeutic challenge. Few studies have demonstrated the use of N-butyl cyanoacrylate (NBCA) for massive hemobilia. Purpose To investigate the efficacy and safety of transcatheter arterial embolization (TAE) using NBCA Glubran 2 for massive hemobilia. Material and Methods Between January 2012 and December 2019, the data of 26 patients (mean age 63.4 ± 12.6 years) with massive hemobilia were retrospectively evaluated for TAE using NBCA. The patients’ baseline characteristics, severities of hemobilia, and imaging findings were collected. Emergent TAE was performed using 1:2–1:4 mixtures of NBCA and ethiodized oil. Technical success, clinical success, procedure-related complications, and follow-up outcomes were assessed. Results Pre-procedure arteriography demonstrated injuries to the right hepatic artery (n = 24) and cystic artery (n = 2). Initial coil embolization distal to the lesions was required in 5 (19.2%) patients to control high blood flow and prevent end-organ damage. After a mean treatment time of 11.2 ± 5.3 min, technical success was achieved in 100% of the patients without non-target embolization and catheter adhesion. Clinical success was achieved in 25 (96.2%) patients. Major complications were noted in 1 (3.8%) patient with gallbladder necrosis. During a median follow-up time of 16.5 months (range 3–24 months), two patients died due to carcinomas, whereas none of the patients experienced recurrent hemobilia, embolic material migration, or post-embolization complications. Conclusion NBCA embolization for massive hemobilia is associated with rapid and effective hemostasis, as well as few major complications. This treatment modality may be a promising alternative to coil embolization.

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Urgent Transcatheter Arterial Embolization for Wunderlich Syndrome With Hypovolemic Shock Secondary to Ruptured Renal Angiomyolipoma

Frontiers in Surgery ◽

10.3389/fsurg.2021.704478 ◽

2021 ◽

Vol 8 ◽

Author(s):

Maofeng Gong ◽

Zhengli Liu ◽

Haobo Su ◽

Boxiang Zhao ◽

Jie Kong ◽

...

Keyword(s):

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Hypovolemic Shock ◽

Arterial Embolization ◽

Renal Angiomyolipoma ◽

Technical Success ◽

Embolic Agents ◽

Nontarget Embolization ◽

Glubran 2 ◽

Embolic Materials

Purpose: Wunderlich syndrome (WS) with hypovolemic shock secondary to ruptured renal angiomyolipoma (rAML) represents an urgent condition. Hence, we reported our experience with transcatheter arterial embolization (TAE) using different embolic materials under this condition.Methods: This retrospective study consisted of 22 patients. Embolic materials including particles, microcoils, and liquid embolic agents were selectively used based on the decisions of interventional radiologists. Technical success was defined as the complete occlusion of bleeding vessels on the final renal angiogram. Clinical success was defined as the absence of re-hemorrhage needed for repeat endovascular or surgery treatment after TAE.Results: The articulated materials were used when WS presented without aneurysms; a combination of particulate materials and microcoils or Glubran 2 alone were used for WS with aneurysms. The technical success based on 24 episodes of TAEs in 22 patients was 100% (24 of 24). Repeat TAE was achieved in two patients with hemorrhages re-occurring two days after the initial embolization with microcoils alone. The clinical success was 90.9% (20 of 22). No nontarget embolization or embolization-related complications occurred during the TAE procedure. Of the patients, 27.3% (6 of 22) experienced minor complications of post-embolization syndrome (PES). During a median follow-up time of 34 months, no recurrent hemorrhage that required repeat endovascular or surgical treatment for hemostasis occurred.Conclusion: Urgent TAE with the selective use of different embolic materials is an effective alternative to control WS with hypovolemic shock secondary to ruptured rAML. The condition of presenting with or without aneurysms may determine the embolic materials employed.

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Transcatheter Arterial Embolization Treatment for Bleeding Visceral Artery Pseudoaneurysms in Patients with Pancreatitis or following Pancreatic Surgery

Cancers ◽

10.3390/cancers12102733 ◽

2020 ◽

Vol 12 (10) ◽

pp. 2733

Author(s):

Isao Numoto ◽

Masakatsu Tsurusaki ◽

Teruyoshi Oda ◽

Yukinobu Yagyu ◽

Kazunari Ishii ◽

...

Keyword(s):

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Arterial Embolization ◽

Bleeding Complications ◽

Visceral Artery ◽

Recurrent Bleeding ◽

Success Rates ◽

Embolization Treatment ◽

Clinically Significant ◽

Ischemic Events

Purpose: To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for pseudoaneurysms occurring secondary to pancreatitis or because of leakage of pancreatic juice after pancreatectomy. Materials and Methods: This retrospective study included 42 consecutive patients (38 males and 4 females; mean age, 60 years; range, 33–80 years) who underwent TAE for bleeding visceral artery pseudoaneurysms between March 2004 and December 2018. The technical and clinical success rates, incidence of recurrent bleeding, complications, including pancreatitis, and overall survival after TAE were evaluated. Results: Of the 42 enrolled patients, 23 had bleeding due to a complication of pancreatectomy and 19 had bleeding as a complication of pancreatitis. TAE with N-butyl cyanoacrylate (NBCA) or NBCA plus microcoils recurrent bleeding or inability to control bleeding was 15.8% (3 of 19) following TAE with NBCA and 17.4% (4 of 23) following TAE with coils. No clinically significant ischemic events of the pancreas or duodenum were observed in the embolized areas. Serum amylase did not increase compared with the initial levels after any of the procedures. At 30 days after TAE, 32 patients were alive. Conclusion: TAE has a high success rate for the management of hemorrhage, with few complications. The procedure appears to be safe and effective for pseudoaneurysms associated with either pancreatitis or pancreatectomy.

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Successful treatment of gastric bleeding due to left-sided portal hypertension by transcatheter arterial embolization (clinical case report)

Курский научно-практический вестник «Человек и его здоровье» ◽

10.21626/vestnik/2021-1/01 ◽

2021 ◽

Vol 24 (1) ◽

pp. 4-9

Author(s):

Georgy I. Sinenchenko ◽

Vladimir G. Verbitsky ◽

Andrey E. Demko ◽

Aleksey N. Sekeev ◽

Sergey A. Alentyev ◽

...

Keyword(s):

Portal Hypertension ◽

High Risk ◽

Transcatheter Arterial Embolization ◽

Varicose Veins ◽

Clinical Success ◽

Clinical Success Rate ◽

Arterial Embolization ◽

Recurrent Bleeding ◽

Gastric Bleeding ◽

Stomach Fundus

Objective: to evaluate the results of transcatheter arterial embolization in patients with acute and chronic pancreatitis complicated by left-sided portal hypertension and bleeding from varicose veins of the stomach fundus and body. Materials and methods: 5 patients with left-sided portal hypertension were treated. Patients were admitted with a clinical picture of gastrointestinal bleeding, which was confirmed by laboratory and instrumental methods of research. Fibrogastroduodenoscopy revealed bleeding from varicose veins of the fundus and body of the stomach in all patients. The average age was 55.4±3.1 years. Results. All patients showed varicose veins of the fundus and body of the stomach, with signs of bleeding. Due to the high risk of recurrent bleeding, subtractive digital angiography with no signs of contrast agent extravasation was performed, followed by spiral embolization of the splenic artery in the proximal third until the blood flow was stopped. The technical and clinical success rate was 100%. Conclusion. Endovascular methods of treatment for left-sided portal hypertension syndrome are minimally invasive but highly effective methods of hemostasis. The indication for their use is unsuccessful endoscopic hemostasis or high risk of recurrence of bleeding from varicose veins of the fundus and body of the stomach.

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