Department of Radiology, Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
J Vasc Interv Radiol. 2010 Apr;21(4):477-83. doi: 10.1016/j.jvir.2009.11.021. Epub 2010 Feb 19.
To determine the diagnostic capability, complication rate, and potential predictors of success for provocative mesenteric angiography in patients with obscure and recurrent lower gastrointestinal (GI) hemorrhage.
Thirty-four patients (age, 7-92 years; 22 men) underwent 36 provocative mesenteric angiograms between January 2002 and December 2008. Provocative mesenteric angiography consisted of systemic anticoagulation with heparin followed by selective transcatheter injection of vasodilator and tissue plasminogen activator into the arterial distribution of highest suspicion. Medications were administered incrementally until active extravasation was visualized or until the operator deemed the outcome negative. The pertinent clinical, radiologic, surgical, laboratory, and pathologic notes were retrospectively reviewed.
Among 36 provocative mesenteric angiograms, 11 resulted in angiographically visible extravasation (31%) and an additional procedure resulted in angiographic visualization of an undiagnosed hypervascular mass, resulting in the identification of a source of a hemorrhage in 33% overall. In 10 of the 11 cases with visualized extravasation, transcatheter embolization successfully controlled recurrent hemorrhage, while the hypervascular mass without extravasation was successfully resected. Therefore, a total of 11 of 36 studies (31%) resulted in successful definitive treatment of recurrent hemorrhage. One embolization-related complication occurred, resulting in surgical resection of perforated ischemic bowel. No hemorrhagic complications were identified. Patients with melena and patients admitted for reasons other than acute lower GI hemorrhage were significantly less likely to benefit from provocative mesenteric angiography.
In this series, provocative mesenteric angiography was safe and effective for eliciting the source of occult lower GI hemorrhage, leading to definitive therapy in about one third of patients.
确定在原因不明和复发性下胃肠道（GI）出血的患者中，激发性肠系膜血管造影的诊断能力、并发症发生率和成功的潜在预测因素。
2002 年 1 月至 2008 年 12 月期间，34 例患者（年龄 7-92 岁；22 名男性）接受了 36 次激发性肠系膜血管造影。激发性肠系膜血管造影包括肝素全身抗凝，然后选择性地将血管扩张剂和组织纤溶酶原激活物注入动脉分布中最高怀疑的部位。药物逐渐增加，直到出现活动性外渗或操作者认为结果为阴性。回顾性地审查了相关的临床、放射学、手术、实验室和病理记录。
在 36 次激发性肠系膜血管造影中，11 次造影显示有外渗（31%），另外一次手术显示有未诊断的高血管肿块，导致总体上有 33%的出血源得到明确。在 11 例有可见外渗的病例中，经导管栓塞成功地控制了复发性出血，而无外渗的高血管肿块则成功地切除。因此，总共 36 项研究中有 11 项（31%）成功地对复发性出血进行了明确的治疗。发生了 1 例与栓塞相关的并发症，导致穿孔性缺血性肠切除。没有发现出血性并发症。有黑便的患者和因急性下胃肠道出血以外的原因入院的患者，从激发性肠系膜血管造影中获益的可能性明显降低。
在本系列中，激发性肠系膜血管造影是安全有效的，可以引出隐匿性下胃肠道出血的源头，使大约三分之一的患者得到明确的治疗。
