Bandi R, Shetty P C, Sharma R P, Burke T H, Burke M W, Kastan D
Department of Diagnostic Radiology, Henry Ford Hospital, Detroit 48202, USA.
J Vasc Interv Radiol. 2001 Dec;12(12):1399-405. doi: 10.1016/s1051-0443(07)61697-2.
To evaluate the technical feasibility, efficacy of hemostasis, recurrent bleeding, and ischemia resulting from superselective embolization of acute lower gastrointestinal (GI) hemorrhage.
Fifty-two superselective mesenteric artery catheterization procedures were undertaken in 48 patients with angiographic evidence of lower GI bleeding. Embolization was performed only if the arterial recta leading to the bleed could be successfully catheterized (n = 39). The lesions treated were located in the colon (n = 33) and jejunum (n = 6). In 28 of 39 procedures, embolization was achieved by delivering polyvinyl alcohol (PVA) particles (150-500 microm) through a microcatheter. Microcoils were used as the sole embolic agent in four procedures and a combination of microcoils and PVA particles were used in another four. Gelfoam particles were used in three of our earliest procedures. Of the 35 patients who underwent embolization, 25 were evaluated for objective evidence of ischemia by endoscopy (n = 16) and/or histologic evaluation of the surgical specimen (n = 9); the remaining 10 patients were followed clinically.
Embolization was successful in 39 procedures involving 35 patients. Immediate hemostasis was achieved after embolization in all but two patients. Recurrent bleeding occurred in 12 other patients, eight patients underwent surgery, three were managed medically, and one underwent successful repeat embolization. Of the 25 patients evaluated for ischemia, mucosal ischemia was demonstrated in six (24%), but they remained asymptomatic and developed no sequelae as a result of ischemic changes on long-term follow-up. There was no incidence of clinically significant intestinal ischemia. Embolization alone was the definitive treatment in 44% patients (21 of 48). Reasons for unsuccessful superselective catheterization (27%) were small vessel spasm, cessation of bleeding, and vessel tortuosity.
Superselective embolization is a feasible, safe, and effective technique for treating acute lower GI hemorrhage.
评估超选择性栓塞急性下消化道（GI）出血的技术可行性、止血效果、再出血情况及缺血情况。
对48例有下消化道出血血管造影证据的患者进行了52次超选择性肠系膜动脉插管操作。仅当导致出血的直肠动脉能够成功插管时才进行栓塞（n = 39）。治疗的病变位于结肠（n = 33）和空肠（n = 6）。在39例操作中的28例中，通过微导管输送聚乙烯醇（PVA）颗粒（150 - 500微米）实现栓塞。4例操作中仅使用微线圈作为栓塞剂，另外4例操作中使用微线圈和PVA颗粒联合使用。在我们最早的3例操作中使用了明胶海绵颗粒。在接受栓塞的35例患者中，25例通过内镜检查（n = 16）和/或手术标本的组织学评估（n = 9）评估是否有缺血的客观证据；其余10例患者进行临床随访。
39例涉及35例患者的栓塞操作成功。除2例患者外，所有患者栓塞后立即止血。另外12例患者发生再出血，8例患者接受手术，3例接受内科治疗，1例成功进行了重复栓塞。在评估缺血的25例患者中，6例（24%）出现黏膜缺血，但他们无症状，长期随访中未因缺血改变出现后遗症。无临床显著肠缺血的发生。仅栓塞是44%患者（48例中的21例）的确定性治疗方法。超选择性插管失败的原因（27%）是小血管痉挛、出血停止和血管迂曲。
超选择性栓塞是治疗急性下消化道出血的一种可行、安全且有效的技术。
