Widlus David M, Salis Ari I
Department of Radiology, Northwest Hospital Center, 5401 Old Court Road, Randallstown, MD 21133, USA.
J Clin Gastroenterol. 2007 Oct;41(9):830-3. doi: 10.1097/01.mcg.0000225640.83275.23.
To present the results of a new protocol for provocative visceral arteriography.
Acute lower gastrointestinal hemorrhage (LGIB) usually stops spontaneously. In the absence of an identifiable source, if bleeding is recurrent, provocative visceral arteriography has been advocated for diagnosis. Prior studies using Streptokinase, Urokinase, or tissue plasminogen activator have reported a 33% to 37.5% rate of identifying the site of hemorrhage.
We report a retrospective analysis of 9 patients in whom provocative visceral arteriography was performed using a new protocol with Reteplase as the fibrinolytic agent. All patients had recurrent, massive LGIB without definable source. Initial arteriography did not elicit a site of bleeding. Five units of Reteplase were administered over 1 minute into the inferior mesenteric artery, the superior mesenteric artery or both vessels sequentially. Arteriography was repeated after 5 to 10 minutes.
Colonic hemorrhage was induced in 89% of patients. There were no procedure-related complications.
Reteplase may prove safe and effective as a provocative agent, stimulating bleeding to allow localization, in patients with occult, recurrent, massive LGIB.
介绍一种新的刺激性内脏血管造影术方案的结果。
急性下消化道出血（LGIB）通常会自行停止。在没有可识别的出血源的情况下，如果出血复发，有人主张采用刺激性内脏血管造影术进行诊断。先前使用链激酶、尿激酶或组织纤溶酶原激活剂的研究报告称，确定出血部位的比率为33%至37.5%。
我们报告了一项对9例患者的回顾性分析，这些患者采用了以瑞替普酶作为溶栓剂的新方案进行刺激性内脏血管造影术。所有患者均有复发性大量LGIB且无明确出血源。初始血管造影未引出出血部位。在1分钟内将5单位瑞替普酶依次注入肠系膜下动脉、肠系膜上动脉或这两支血管。5至10分钟后重复血管造影。
89%的患者诱发了结肠出血。没有与操作相关的并发症。
对于隐匿性、复发性、大量LGIB患者，瑞替普酶作为一种刺激性药物，可能被证明是安全有效的，可促使出血以便定位。
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