SELECTIVE ARTERIAL EMBOLIZATION FOR THE CONTROL OF LOWER GASTROINTESTINAL-BLEEDING

BACKGROUND: Transcatheter embolization is accepted as a safe method fo r treating acute bleeding from the upper gastrointestinal (GI) tract. Hesitancy persists using this technique below the ligament of Treitz, based on the belief that the risk of intestinal infarction is unaccept ably high, despite mounting clinical evidence to the contrary. METHODS : A series of 17 consecutive patients with angiographically demonstrat ed small intestinal or colonic bleeding was retrospectively reviewed. The success and complication rate of subselective embolization was ass essed. RESULTS: Bleeding was stopped in 13 of 14 patients (93%) in who m embolization was possible, and in 13 of 17 patients (76%) where ther e was an intention to treat. Sufficiently selective catheterization to permit embolization could not be achieved in 3 patients. No clinicall y apparent bowel infarctions were caused. CONCLUSION: Subselective emb olization is a safe treatment option for lower GI bleeding, suitable f or many patients and effective in most. Careful technique and a readin ess to abandon embolization when a suitable catheter position cannot b e achieved are important. (C) 1997 by Excerpta Medica, Inc.