Outcomes following "rescue" superselective angioembolization for gastrointestinal hemorrhage in hemodynamically unstable patients.

Ali Y. Mejaddam, Catrina M. Cropano, Sanjeeva Kalva, T. Gregory Walker, Ayesha M. Imam, George C. Velmahos, Marc A. de Moya, David R. King

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Therapeutic angioembolization is a relatively new "rescue treatment" modality for gastrointestinal hemorrhage (GIH) for unstable patients who fail primary treatment approaches; however, the effectiveness of this treatment and the incidence of ischemic necrosis following embolization for acute GIH are poorly described. The purpose of this study was to evaluate the effectiveness and safety of "rescue" transcatheter superselective angioembolization (SSAE) for the treatment of hemodynamically unstable patients with GIH. A 10-year retrospective review of all hemodynamically unstable patients (systolic blood pressure < 90 mm Hg and ongoing transfusion requirement) who underwent "rescue" SSAE for GIH after failed endoscopic management was performed. All patients with evidence of active contrast extravasation were included. Data were collected on demographics, comorbidities, clinical presentation, and type of intravascular angioembolic agent used. Outcomes included technical success (cessation of extravasation), clinical success (no rebleeding requiring intervention within 30 days), and incidence of ischemic complications. Ninety-eight patients underwent SSAE for GIH during the study period; 47 were excluded owing to lack of active contrast extravasation. Of the remaining 51 patients, 22 (43%) presented with a lower GIH and 29 (57%) with upper GIH. The majority underwent embolization with a permanent agent (71%), while the remaining patients received either a temporary agent (16%) or a combination (14%). The overall technical and clinical success rates were 98% and 71%, respectively. Of the 14 patients with technical success but clinical failure (rebleeding within 30 days) and the 1 patient with technical failure, 4 were managed successfully with reembolization, while 2 underwent successful endoscopic therapy, and 9 had surgical resections. Only one patient had an ischemic complication (small bowel necrosis) requiring resection. SSAE, with reembolization if necessary, is an effective rescue treatment modality for hemodynamically unstable patients with active GIH. Of the patients, 20% will fail SSAE and require additional intervention. Ischemic complications are extremely rare. Therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)398-403
Number of pages6
JournalThe journal of trauma and acute care surgery
Volume75
Issue number3
StatePublished - Sep 2013

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Gastrointestinal Hemorrhage
Therapeutics
Necrosis
Blood Pressure
Incidence
Comorbidity
Demography

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Outcomes following "rescue" superselective angioembolization for gastrointestinal hemorrhage in hemodynamically unstable patients. / Mejaddam, Ali Y.; Cropano, Catrina M.; Kalva, Sanjeeva; Walker, T. Gregory; Imam, Ayesha M.; Velmahos, George C.; de Moya, Marc A.; King, David R.

In: The journal of trauma and acute care surgery, Vol. 75, No. 3, 09.2013, p. 398-403.

Research output: Contribution to journalArticle

Mejaddam, AY, Cropano, CM, Kalva, S, Walker, TG, Imam, AM, Velmahos, GC, de Moya, MA & King, DR 2013, 'Outcomes following "rescue" superselective angioembolization for gastrointestinal hemorrhage in hemodynamically unstable patients.', The journal of trauma and acute care surgery, vol. 75, no. 3, pp. 398-403.
Mejaddam, Ali Y. ; Cropano, Catrina M. ; Kalva, Sanjeeva ; Walker, T. Gregory ; Imam, Ayesha M. ; Velmahos, George C. ; de Moya, Marc A. ; King, David R. / Outcomes following "rescue" superselective angioembolization for gastrointestinal hemorrhage in hemodynamically unstable patients. In: The journal of trauma and acute care surgery. 2013 ; Vol. 75, No. 3. pp. 398-403.
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