Superselective coil embolization in gastrointestinal haemorrhage: early experience

Comparison of microcoils and polyvinyl alcohol particles in selective microcatheter angioembolization of non variceal acute gastrointestinal hemorrhage

Objectives:

To compare the efficacy of polyvinyl alcohol (PVA) particles with microcoils in angiembolisation of non variceal acute gastrointestinal haemorrhage.

Methods:

This is a retrospective cross-sectional study of patients who underwent transcatheter angioembolization from January, 1995 to December, 2013 at Aga Khan University Hospital, Karachi. Patients were divided into two groups on basis of use of either microcoils or PVA particles and compared in terms of technical success, clinical success, re-bleeding and ischemic complication rates. Chi (χ²) square and Fisher’s exact tests were applied and a P-value of less than 0.05 was considered statistically significant.

Results:

Fifty seven patients underwent angioembolization. Microcoil and PVA particles embolization was performed in 63% (36/57) and 35% (20/57) cases respectively. Technical success was achieved in all cases (100%). Clinical success rate was higher in microcoils group (92%) than PVA particles group (75%) with statistically significant P value (p=0.048). Ischemic complication was seen in one case (3%) in the microcoil group, while no such complications were seen in the PVA particles group.

Conclusion:

In angioembolization of non variceal acute gastrointestinal haemorrhage microcoils are better than Polyvinyl alcohol particles with higher clinical success and lower re-bleed rates.

N-butyl cyanoacrylate embolization as the primary treatment of acute hemodynamically unstable lower gastrointestinal hemorrhage

PURPOSE

To evaluate N-butyl cyanoacrylate (NBCA) embolization as the primary treatment for patients with severe and acute hemodynamically unstable lower gastrointestinal bleeding.

MATERIALS AND METHODS

Twenty-seven patients with acute, unstable hemodynamics caused by lower gastrointestinal bleeding underwent therapeutic NBCA microcatheter embolization over a period of 27 months. The inclusion criteria were hematochezia or melena and hypotension refractory to conservative treatment and requiring blood transfusion. Bleeding was localized to the rectum, colon, or small intestine in all nine such cases. Fifteen patients had severe underlying comorbidities, including sepsis, respiratory failure, malignancy, or renal failure.

RESULTS

The procedure was technically successful in all patients. Twenty-six patients were treated solely with NBCA, and one required microcoil embolization. Embolization was performed at the level of the arteria recta or as close as possible to the point of bleeding. Immediate hemostasis occurred in all cases. Four patients experienced repeat hemorrhage, one of whom died. The other three were treated successfully with repeat NBCA embolization. None of the surviving patients had evidence of bowel ischemia. In addition, none of the patients with severe underlying disease died during the follow-up period (range, 3 mo to 2 y).

CONCLUSIONS

The present findings suggest that NBCA embolization may be a safe alternative treatment for the management of lower gastrointestinal bleeding. Further studies are warranted to confirm the findings.

Embolization of Bleeding Duodenal Ulcer Using Amplatzer Vascular Plug II and Hydrogel Coils: Case Report

Purpose: To present a case of upper gastrointestinal bleeding (UGIB) that was treated with percutaneous endovascular embolization using Amplatzer vascular plug and hydrogel coils after failed endoscopic treatment. Case Report: A 78-year-old male was referred for endovascular treatment of massive recurrent UGIB from a duodenal ulcer. Attempts at endoscopic treatment were unsuccessful. Based on our knowledge of the site of the bleeder in the duodenum from prior endoscopy, we decided to empirically embolize the gastroduodenal artery (GDA) and the right gastroepiploic artery using a combination of coils (Azur peripheral hydrocoil; Terumo Medical Corporation, Somerset, New Jersey) and Amplatzer vascular plug II (AVP II; AGA Medical, Plymouth, Minnesota). Conclusion: We present this case of UGIB where effective, rapid, precise, and controlled embolization of the GDA was achieved using AVP II device in combination with coils. To our knowledge, the use of AVP II in embolization of GDA for treatment of emergent UGIB has not been described in the literature.

Angiography and transcatheter embolizaion for acute lower gastrointestinal hemorrhage: clinical value and influencing factors of diagnosis and treatment

AIM: To evaluate the clinical value of angiography and transcatheter embotherapy in patients with acute massive lower gastrointestinal (GI) hemorrhage, and to analyze the influencing factors.

METHODS: We retrospectively analyzed data of 39 cases with acute massive arterial hemorrhage of lower gastrointestinal tract, including such data as transfusion amount, blood pressure and hemoglobin (Hb) before and after embolization. Baseline, procedural, and outcome parameters were recorded in accordance with current Society of Interventional Radiology guidelines. Follow-up time was three to six months. Outcomes included technical success (Immediate disappearance of bleeding signs or obstruction of leaking-blood artery after embotherapy), clinical success (without rebleeding within 30 days), delayed rebleeding (more than 30 days), and major or minor complication rates.

RESULTS: Twenty-six patients of the 39 with acute massive lower GI hemorrhage received blood transfusion before embolization, and only 4 patents with HB below 40 g/L before embolization, received the transfusion post-embolization. The positive diagnostic rates of lower GI hemorrhage of angiograms were 31% with catheter-tips located at 2^nd-grade-blood vessels (superior mesenteric arteries, inferior mesenteric arteries), and 69% at 3^rd-grade-blood vessels (jejunal artery, iliac artery, iliac-cecal artery, cecal artery, and marginal artery), respectively. The total positive diagnostic rate of angiography about lower GI bleeding reached 100%. Embolization was performed with injection of gelatin sponge particles or thin strips via catheter following angiogram with angiographical catheter (5French size) or with microcatheter (3French size). Immediate cessation bleeding post-embolization was 92%. The technical success rates and clinical success rates reached 100% and 89.7%, respectively. Transient epigastric pains occurred to 4 patients because of superior mesenteric artery spasm, 2 cases were managed with medications, and the others were relieved spontaneously. Three days after transcatheter embolization, endoscopy examination of four patients showed the areas of mucosal erythema, swelling and pallor. None of major complications was found such as necrosis or serious ischemia of lower GI.

CONCLUSION: Angiography and transcatheter embolization are effective and safe methods to locate the bleeding spot and stop bleeding immediately, which can be considered as alternatives to diagnosis and treatment of acute massive lower GI hemorrhage. The positive-bleeding-diagnostic rates of angiograms in lower GI hemorrhage and the efficacy of embolization are influenced by varied factors.

Neurovascularization of the anterior jaw bones revisited using high-resolution magnetic resonance imaging

The anterior jaw bones are often considered relatively safe surgical sites. Nonetheless, the increasing rate of surgical interventions in that area, such as oral implant placement and bone grafting, has highlighted the potential risks and has raised the reported complications. A careful documentation of all anatomic variations in anterior jaw bone neurovascularization has thus become necessary. The present report attempts to revisit jaw bone neurovascularization, addressing typical anatomic appearances and variations. We summarize the results of various microanatomical studies carried out by high-resolution magnetic resonance imaging (HR-MRI) of the human anterior jaw bones. These studies reveal that edentulous and dentate anterior jaws present significant variation in the occurrence of the mandibular incisive canal and genial spinal foramina, as well as the maxillary nasopalatine canal. All of these canal structures contain a neurovascular bundle, whose diameter may be large enough to cause clinically significant trauma. A careful presurgical radiographic analysis of the anterior jaw bones is therefore advised.