ANGIOGRAPHY FOR PREOPERATIVE EVALUATION IN PATIENTS WITH LOWER GASTROINTESTINAL-BLEEDING - ARE THE BENEFITS WORTH THE RISKS

Objective: To evaluate the benefits and risks of selective angiography for the evaluation of acute lower gastrointestinal (GI) bleeding to i dentify the site of bleeding and theoretically limit the extent of col onic resection. Design: Retrospective chart review. Setting: Tertiary care hospital. Patients: Sixty-five patients undergoing 75 selective a ngiograms for evaluation of acute lower GI bleeding. Mean age was 71 y ears (range, 27-93 years), and 37 (57%) were women. Main Outcome Measu res: Demographic data were collected that included any associated medi cal problems, potential factors contributing to an increased risk for bleeding, and the diagnostic methods used in evaluating the source of lower GI bleeding. The details of angiography procedures were recorded with special attention to the impact of the procedure on clinical man agement and any associated complications. Results: Twenty-three patien ts (35%) had positive angiography findings, and 14 of thorn (61%) requ ired operations. Forty-two patients (65%) had negative angiography fin dings, and 8 of them (19%) required operations. Surgery for the 22 pat ients included hemicolectomy in 11 patients, subtotal colectomy in 10 patients, and small-bowel tumor resection in 1 patient. In 9 patients, a hemicolectomy was performed on the basis of angiography findings. T hree patients (2 with negative angiography findings) experienced reble eding after a hemicolectomy and required a subsequent subtotal colecto my. Overall, only 8 (12%) of the 65 patients underwent a segmental col on resection that was based on angiography findings and did not bleed after their operation. Complications from angiography occurred in 7 pa tients (11%). Conclusion: Selective angiography appears to add little clinically useful information in patients with acute lower GI bleeding and carries a relatively high complication risk.