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Zetner D, Rasmussen IR, Frykman CP, Jensen LR, Jensen RJ, Possfelt-Møller E, Taudorf M, Penninga L. Risk factors for rebleeding and mortality following prophylactic transarterial embolization for patients with high-risk peptic ulcer bleeding: a single-center retrospective cohort study. Surg Endosc 2024; 38:2010-2018. [PMID: 38413471 PMCID: PMC10978705 DOI: 10.1007/s00464-024-10709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/21/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND To investigate factors associated with risk for rebleeding and 30-day mortality following prophylactic transarterial embolization in patients with high-risk peptic ulcer bleeding. METHODS We retrospectively reviewed medical records and included all patients who had undergone prophylactic embolization of the gastroduodenal artery at Rigshospitalet, Denmark, following an endoscopy-verified and treated peptic Sulcer bleeding, from 2016 to 2021. Data were collected from electronic health records and imaging from the embolization procedures. Primary outcomes were rebleeding and 30-day mortality. We performed logistical regression analyses for both outcomes with possible risk factors. Risk factors included: active bleeding; visible hemoclips; Rockall-score; anatomical variants; standardized embolization procedure; and number of endoscopies prior to embolization. RESULTS We included 176 patients. Rebleeding occurred in 25% following embolization and 30-day mortality was 15%. Not undergoing a standardized embolization procedure increased the odds of both rebleeding (odds ratio 3.029, 95% confidence interval (CI) 1.395-6.579) and 30-day overall mortality by 3.262 (1.252-8.497). More than one endoscopy was associated with increased odds of rebleeding (odds ratio 2.369, 95% CI 1.088-5.158). High Rockall-score increased the odds of 30-day mortality (odds ratio 2.587, 95% CI 1.243-5.386). Active bleeding, visible hemoclips, and anatomical variants did not affect risk of rebleeding or 30-day mortality. Reasons for deviation from standard embolization procedure were anatomical variations, targeted treatment without embolizing the gastroduodenal artery, and technical failure. CONCLUSIONS Deviation from the standard embolization procedure increased the risk of rebleeding and 30-day mortality, more than one endoscopy prior to embolization was associated with higher odds of rebleeding, and a high Rockall-score increased the risk of 30-day mortality. We suggest that patients with these risk factors are monitored closely following embolization. Early detection of rebleeding may allow for proper and early re-intervention.
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Affiliation(s)
- Dennis Zetner
- Department of Radiology, North Zealand Hospital, Copenhagen University Hospital, Hilleroed, Denmark.
| | - Ida Roost Rasmussen
- Department of Surgery, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Lasse Rehné Jensen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ruben Juul Jensen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emma Possfelt-Møller
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikkel Taudorf
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Luit Penninga
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Farrell A, Biswal R. Ultrasound-guided percutaneous coil and thrombin embolization of a left gastric artery pseudoaneurysm. Radiol Case Rep 2023; 18:4281-4286. [PMID: 37771379 PMCID: PMC10522854 DOI: 10.1016/j.radcr.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023] Open
Abstract
Pseudoaneurysms are a commonly encountered pathology, though pseudoaneurysms of the visceral arteries are a less frequent, but potentially deadly entity. Transarterial embolization is the typical treatment of visceral pseudoaneurysms, but success is dependent on anatomy that is conducive to selecting the supplying vessel. Abdominal ultrasound is a viable method to effectively treat visceral pseudoaneurysms when transarterial embolization is not possible. It is also an excellent example of the growing utilization of ultrasound guidance in various interventional radiologic procedures. The usefulness of ultrasound is demonstrated in this case report, where a left gastric artery pseudoaneurysm was embolized through ultrasound guidance.
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Affiliation(s)
- Aidan Farrell
- Hackensack Meridian School of Medicine, 123 Metro Blvd, Nutley, NJ 07110, USA
| | - Rajiv Biswal
- Jersey Shore University Medical Center, 1945 NJ-33, Neptune, NJ 07753, USA
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Purg D, Hanžel J, Strniša L, Plut S, Finderle S, Ocepek A, Sever N. An unusual case of severe gastrointestinal bleeding. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023. [PMID: 37751771 DOI: 10.1055/a-2172-9437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
We present the case of a 58-year-old female with a history of a bleeding duodenal peptic ulcer. Endoscopic hemostasis was unsuccessful; therefore, a transcatheter arterial embolization of a culprit vessel was performed. She was admitted to the hospital two months later because of obstruction of the common bile duct with cholangitis. Attempts to endoscopically place a biliary stent failed. The treating medical team opted for a surgical choledocho-jejunostomy. After 20 months, she presented with a melena and a severe anemia. Diagnostic work-up revealed portal vein thrombosis with portal cavernoma and bleeding choledocho-jejunostomy varices. The case presents and discusses rare complications of duodenal ulcer disease, as well as possible causes and treatment options.
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Affiliation(s)
- Darinka Purg
- University Medical Centre Maribor, Maribor, Slovenia
| | - Jurij Hanžel
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Luka Strniša
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Samo Plut
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sanjo Finderle
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Nejc Sever
- University Medical Centre Ljubljana, Ljubljana, Slovenia
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Mitrovic Jovanovic M, Tadic B, Jankovic A, Stosic K, Lukic B, Cvetic V, Knezevic D. Endovascular treatment of a pseudoaneurysm of the posterior inferior pancreaticoduodenal artery as a complication of chronic pancreatitis: a case report. J Int Med Res 2022; 50:3000605221083441. [PMID: 35225703 PMCID: PMC8987367 DOI: 10.1177/03000605221083441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A pancreatic pseudoaneurysm is a rare but life-threatening clinical entity. Prompt
diagnosis and appropriate treatment are of great clinical importance. We herein present an
unusual case of a pseudoaneurysm of the posterior inferior pancreaticoduodenal artery that
developed as a complication of chronic pancreatitis. It was detected in a timely manner
and successfully treated with minimally invasive endovascular therapy.
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Affiliation(s)
- Milica Mitrovic Jovanovic
- Centre for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, Belgrade 11000, Serbia
| | - Boris Tadic
- Clinic for Digestive Surgery, University Clinical Centre of Serbia, Dr Koste Todorovica No. 6, Belgrade 11000, Serbia
- Department for Surgery with Anesthesiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, Belgrade 11000, Serbia
| | - Aleksandra Jankovic
- Centre for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, Belgrade 11000, Serbia
| | - Katarina Stosic
- Centre for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, Belgrade 11000, Serbia
| | - Borivoje Lukic
- Centre for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, Belgrade 11000, Serbia
| | - Vladimir Cvetic
- Centre for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, Belgrade 11000, Serbia
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, Belgrade 11000, Serbia
| | - Djordje Knezevic
- Clinic for Digestive Surgery, University Clinical Centre of Serbia, Dr Koste Todorovica No. 6, Belgrade 11000, Serbia
- Department for Surgery with Anesthesiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, Belgrade 11000, Serbia
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Ali H, Sana M, Pamarthy R, Rahat E, Sarfraz S. Use of Endovascular Coiling to Stop Gastric Ulcer Bleeding in a Patient With Extensive Risk Factors. Cureus 2021; 13:e16164. [PMID: 34367774 PMCID: PMC8330615 DOI: 10.7759/cureus.16164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 11/25/2022] Open
Abstract
Peptic ulcer disease (PUD) can lead to life-threatening bleeding. Endoscopy is a primary intervention used to locate the site of bleeding and maintain hemostasis. When considering multiple risk factors to operative intervention or failed initial endoscopic procedure in patients, the preferred treatment for acute gastrointestinal bleeding remains endovascular coiling to embolize the culprit's vessel. We report a case of a 57-year-old female who presents with melena secondary to gastric ulcer not amenable to endoscopic interventions. Various embolization techniques are available demanding clinicians' attention towards their role in managing ulcer bleeds and their impact on the controlling bleeds.
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Affiliation(s)
- Hassam Ali
- Internal Medicine, East Carolina University, Vidant Medical Center, Greenville, USA
| | - Momal Sana
- Internal Medicine, Dorevitch Pathology, Heidelberg, AUS
| | - Rahul Pamarthy
- Internal Medicine, East Carolina University, Vidant Medical Center, Greenville, USA
| | - Eiman Rahat
- Internal Medicine, Ziauddin University, Karachi, PAK
| | - Shiza Sarfraz
- Anesthesiology, Bahawal Victoria Hospital, Quaid-E-Azam Medical College, Bahawalpur, PAK
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Ruiz Belmonte LM, Colás-Ruiz E, García Caparrós CM, Vilchez Mira MDM. Gastroduodenal artery pseudoaneurysm. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 44:306-307. [PMID: 32778358 DOI: 10.1016/j.gastrohep.2020.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/18/2020] [Accepted: 04/02/2020] [Indexed: 10/23/2022]
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Brahmbhatt AN, Baah NYO. Embolization for acute gastrointestinal hemorrhage secondary to post-transplant lymphoproliferative disorder. Radiol Case Rep 2020; 15:396-399. [PMID: 32071658 PMCID: PMC7013145 DOI: 10.1016/j.radcr.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 11/25/2022] Open
Abstract
Gastrointestinal manifestations of post-transplant lymphoproliferative disorder (GI-PTLD) encompasses a spectrum of mucosal inflammation and ulceration that can present as severe acute gastrointestinal bleed. This case report describes a case of GI-PTLD in a 19-year-old female status postcardiac transplant. This patient presented with extensive gastrointestinal hemorrhage secondary to PTLD involving the duodenum. The patient was treated with extensive embolization of the gastroduodenal artery and the pancreaticoduodenal arcades. Embolization was used to mitigate gastrointestinal bleeding, thus preventing the need for surgical resection and extensive reconstruction. This case report demonstrates the utility of embolization as potential therapeutic option in the setting of GI-PTLD in addition to medical and endoscopic therapy.
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Wang CY, Hu J, Sheth RA, Oklu R. Emerging Embolic Agents in Endovascular Embolization: An Overview. PROGRESS IN BIOMEDICAL ENGINEERING (BRISTOL, ENGLAND) 2020; 2:012003. [PMID: 34553126 PMCID: PMC8455112 DOI: 10.1088/2516-1091/ab6c7d] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Courtney Y. Wang
- The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin St., Hourson, TX 77030, USA
| | - Jingjie Hu
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ 85259, USA
| | - Rahul A. Sheth
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ 85259, USA
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Kaminskis A, Ivanova P, Kratovska A, Ponomarjova S, Ptašņuka M, Demičevs J, Demičeva R, Boka V, Pupelis G. Endoscopic hemostasis followed by preventive transarterial embolization in high-risk patients with bleeding peptic ulcer: 5-year experience. World J Emerg Surg 2019; 14:45. [PMID: 31516544 PMCID: PMC6734378 DOI: 10.1186/s13017-019-0264-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/29/2019] [Indexed: 12/29/2022] Open
Abstract
Background Upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease is one of the leading causes of death in patients with non-variceal bleeding, resulting in up to 10% mortality rate, and the patient group at high risk of rebleeding (Forrest IA, IB, and IIA) often requires additional therapy after endoscopic hemostasis. Preventive transarterial embolization (P-TAE) after endoscopic hemostasis was introduced in our institution in 2014. The aim of the study is an assessment of the intermediate results of P-TAE following primary endoscopic hemostasis in patients with serious comorbid conditions and high risk of rebleeding. Methods During the period from 2014 to 2018, a total of 399 patients referred to our institution with a bleeding peptic ulcer, classified as type Forrest IA, IB, or IIA with the Rockall score ≥ 5, after endoscopic hemostasis was prospectively included in two groups—P-TAE group and control group, where endoscopy alone (EA) was performed. The P-TAE patients underwent flow-reducing left gastric artery or gastroduodenal artery embolization according to the ulcer type. The rebleeding rate, complications, frequency of surgical interventions, transfused packed red blood cells (PRBC), amount of fresh frozen plasma (FFP), and mortality rate were analyzed. Results From 738 patients with a bleeding peptic ulcer, 399 were at high risk for rebleeding after endoscopic hemostasis. From this cohort, 58 patients underwent P-TAE, and 341 were allocated to the EA. A significantly lower rebleeding rate was observed in the P-TAE group, 3.4% vs. 16.2% in the EA group; p = 0.005. The need for surgical intervention reached 10.3% vs. 20.6% in the P-TAE and EA groups accordingly; p = 0.065. Patients that underwent P-TAE required less FFP, 1.3 unit vs. 2.6 units in EA; p = 0.0001. The mortality rate was similar in groups with a tendency to decrease in the P-TAE group, 5.7% vs. 8.5% in EA; p = 0.417. Conclusion P-TAE is a feasible and safe procedure, and it may reduce the rebleeding rate and the need for surgical intervention in patients with a bleeding peptic ulcer when the rebleeding risk remains high after primary endoscopic hemostasis.
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Affiliation(s)
| | | | - Aina Kratovska
- 1Riga East University Hospital, University of Latvia, Riga, Latvia
| | | | | | | | | | | | - Guntars Pupelis
- 1Riga East University Hospital, University of Latvia, Riga, Latvia.,2Riga Stradins University, Riga, Latvia
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