Aina R, Oliva V L, Therasse E, Perreault P, Bui B T, Dufresne M P, Soulez G
Department of Radiology, CHUM--Notre-Dame Hospital, Montreal, Quebec, Canada.
J Vasc Interv Radiol. 2001 Feb;12(2):195-200. doi: 10.1016/s1051-0443(07)61825-9.
To identify predictors of clinical outcome after arterial embolotherapy for upper gastrointestinal (UGI) hemorrhage.
Seventy-five consecutive patients (mean age, 62.5 y) underwent arterial embolization for acute UGI hemorrhage. Bleeding was detected at endoscopy and angiography in 22 patients, at endoscopy alone in 29 patients, and at angiography alone in 24 patients. As such, embolization was directed by angiography in 46 patients (61.3%) and by endoscopy (referred to as "blind" embolization) in 29 patients (38.7%). The embolic agents used were metallic coils, polyvinyl alcohol particles (size range, 355-710 microm), gelatin sponge, and tissue adhesive. Predictors of bleeding recurrence and mortality were analyzed with logistic regression and Cox models, respectively.
The technical success rate of embolization was 98.7%. Primary clinical success was achieved in 57 patients (76%). Secondary clinical success occurred in five additional patients (82.5%) after repeat embolization. There were four (5.3%) complications: two cases of self-resolving duodenal ischemia, one hepatic infarct, and one inguinal hematoma. The periprocedural mortality rate was 34.6% (26 of 75), mostly related to underlying illness. Early recurrence of bleeding (within 30 days of embolization) was associated with coagulation disorders (international normalized ratio >1.5, partial thromboplastin time >45 seconds, or platelet count <80,000/microL; odds ratio, 19.46; P = .001) and with the use of coils as the only embolic agent (odds ratio, 7.73; P = .01). Cirrhosis and cancer shortened the overall survival of patients after embolic therapy. The mean patient follow-up time was 34.5 months.
Arterial embolotherapy for UGI hemorrhage is safe, effective, and durable. Coagulopathy and the use of coils as the only embolic agent were associated with a higher risk of early bleeding recurrence.
确定上消化道（UGI）出血动脉栓塞治疗后临床结局的预测因素。
连续75例患者（平均年龄62.5岁）接受了急性UGI出血的动脉栓塞治疗。22例患者在内镜检查和血管造影中均检测到出血，29例患者仅在内镜检查中检测到出血，24例患者仅在血管造影中检测到出血。因此，46例患者（61.3%）通过血管造影引导进行栓塞，29例患者（38.7%）通过内镜检查（称为“盲目”栓塞）进行栓塞。使用的栓塞剂有金属线圈、聚乙烯醇颗粒（尺寸范围355 - 710微米）、明胶海绵和组织粘合剂。分别采用逻辑回归和Cox模型分析出血复发和死亡率的预测因素。
栓塞的技术成功率为98.7%。57例患者（76%）取得了初次临床成功。重复栓塞后，另外5例患者（82.5%）取得了二次临床成功。有4例（5.3%）并发症：2例十二指肠缺血自行缓解，1例肝梗死，1例腹股沟血肿。围手术期死亡率为34.6%（75例中有26例），主要与基础疾病有关。出血早期复发（栓塞后30天内）与凝血障碍（国际标准化比值>1.5、活化部分凝血活酶时间>45秒或血小板计数<80,000/微升；比值比，19.46；P = 0.001）以及仅使用线圈作为栓塞剂（比值比，7.73；P = 0.01）有关。肝硬化和癌症缩短了栓塞治疗后患者的总生存期。患者的平均随访时间为34.5个月。
UGI出血的动脉栓塞治疗安全、有效且持久。凝血障碍和仅使用线圈作为栓塞剂与早期出血复发风险较高有关。
