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- Title
Superselective transcatheter arterial embolization for acute small bowel bleeding: clinical outcomes and prognostic factors for ischemic complications.
- Authors
Kim, Yong Seek; Kwon, Joon Ho; Han, Kichang; Kim, Man-Deuk; Lee, Junhyung; Kim, Gyoung Min; Won, Jong Yun
- Abstract
<bold>Background: </bold>Small bowel bleeding (SBB) accounts for 5%-10% of all cases of acute gastrointestinal bleeding. Transcatheter arterial embolization (TAE) plays an important role in the treatment of SBB.<bold>Purpose: </bold>To evaluate the safety and efficacy of superselective TAE exclusively for SBB and to assess factors associated with clinical outcomes.<bold>Material and Methods: </bold>From January 2006 to April 2017, 919 patients were admitted with signs and symptoms of gastrointestinal bleeding; 74 patients (mean age = 57.5 years; age range = 14-82 years) with positive angiographic findings for SBB were retrospectively analyzed. The technical success of TAE and clinical outcomes, including recurrent bleeding, major complications, and in-hospital mortality were evaluated. The associations of various clinical and technical factors with clinical outcomes were analyzed.<bold>Results: </bold>The bleeding foci were in the ileum in 48 (65%) patients and the jejunum in 26 (35%). Technical success was achieved in 72 (97%) patients. The rates of recurrent bleeding, major complications, and in-hospital mortality were 12% (7/57), 21% (15/71), and 25% (18/72), respectively. Superselective embolization was a significant prognostic factor associated with fewer major complications (OR = 0.069; P = 0.003). The increased number of embolized vasa recta was significantly associated with a higher probability of major complications (OR = 2.64; P < 0.001). The use of N-butyl cyanoacrylate was associated with lower rates of major complication (OR = 0.257; P = 0.027).<bold>Conclusion: </bold>TAE is a safe and effective treatment modality for SBB. In addition, whenever possible, TAE should be performed in a superselective manner to minimize ischemic complications.
- Subjects
SMALL intestine; PROGNOSIS; THERAPEUTIC embolization; TREATMENT effectiveness; GASTROINTESTINAL hemorrhage; ARTERIAL catheters; HEMORRHAGE; HOSPITAL mortality
- Publication
Acta Radiologica, 2021, Vol 62, Issue 5, p574
- ISSN
0284-1851
- Publication type
journal article
- DOI
10.1177/0284185120936258