Evaluation of transarterial embolization for lower gastrointestinal bleeding

INTRODUCTION. Transcatheter arterial embolization hits been used as a thera peutic maneuver for lower gastrointestinal bleeding. The availability of hi ghly selective arteriography has made this procedure safer and warrants ree valuation. METHODS: A retrospective chart review was done of all patients u ndergoing arteriography for presumed lower gastrointestinal bleeding at two acute-care community hospitals. Causes of bleeding, clinical outcome, and complications caused by transcatheter arterial embolization were recorded. RESULTS: There were 26 arteriographically identified bleeding sites in the colon and small bowel. The most frequent cause of bleeding was diverticulos is (12 patients), with the diagnosis being arteriovenous malformation in tw o, and one unknown colonic source. Transcatheter arterial embolization was attempted fur 17 separate bleeding episodes in IG patients. Transfusion req uirements were an average (+/- standard deviation) of 7 +/- 1.43 units per patient. Transcatheter arterial embolization was successful in stopping ble eding in 14 cases (82 percent). Two patients had surgery lifter transcathet er arterial embolization: one for colonic necrosis and one for persisting b leeding. There were two more unsuccessful procedures; one had a successful repeated transcatheter arterial embolization, and one stopped spontaneously . One patient rebled during the same hospitalization and was controlled wit h intra-arterial vasopressin. There were two deaths, both secondary to seps is unrelated to die transcatheter arterial embolization or the gastrointest inal tract. CONCLUSIONS: Transcatheter arterial embolization is a relativel y safe and successful procedure in patients with massive lower gastrointest inal hemorrhage. It is an excellent choice of therapy for patients that are poor candidates fur surgery, but its role in other patients remains to be defined.