Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
Diagn Interv Radiol. 2011 Dec;17(4):368-73. doi: 10.4261/1305-3825.DIR.3963-10.1. Epub 2011 Jan 4.
This retrospective study was designed to investigate the transcatheter mesenteric angiography of patients with gastrointestinal (GI) bleeding and to determine the most important variables that should be monitored in patients with GI bleeding prior to transcatheter arteriography.
In this study, we evaluated the transcatheter mesenteric angiography results of patients with massive GI bleeding (defined as hypotension, tachycardia, and a greater than 4-unit blood transfusion requirement in 24 h) seen between 2005 and 2009. Detailed clinical follow-up and accessible hospital data from 45 procedures were examined from 42 patients (two procedures were performed in three patients) between 24 and 85 years old (mean age, 57.6 years). The present study included 33 males and 9 females. Angiography was performed for lower GI bleeding in 22 patients, upper GI bleeding in 15 patients, and upper/lower (multiple origins) GI bleeding in five patients. Imaging work-ups, including endoscopic interventions, and follow-ups with patients after the procedure were evaluated in detail. Several variables recorded prior to the procedure, including the clinical status, etiological cause of the bleeding, bleeding parameters (e.g., international normalized ratio, platelets), imaging workup, gender, season, and angiography time, were examined.
Embolization was performed in 24 (53%) of the 45 procedures. Overall, the technical success rate of the diagnostic arteriograms was 100%, and no major complications occurred. For the embolizations, coils were used in 17 patients (70%), polyvinyl alcohol particles were used in six patients (25%), and n-butyl cyano-acrylate was used in one patient (4%). The detection rate of mesenteric arteriographies to examine GI bleeding performed outside of normal working hours was significantly greater than the detection rate of the arteriographies performed during normal working hours (P = 0.050). Low platelet levels or a prolonged prothrombin time were not associated with the mesenteric arteriography results (P = 1.00). Interestingly, the intermittent nature of GI bleeding was the most challenging part of detection, which made management of the bleeding difficult. Blind embolization of the left gastric artery was only helpful in preventing massive bleeding in three out of eight patients with upper GI bleeding.
Endoscopy for upper gastrointestinal bleeding and scintigraphy for lower gastrointestinal bleeding are important steps in the management and outcome of transcatheter angiography. Computerized tomography angiography is a promising tool for the treatment of both upper and lower GI bleeding, and this procedure has become part of the imaging toolset. In addition, angiography performed outside of working hours had a higher rate of clinical success than the angiographies performed in working hours, most likely secondary to much appropriate timing of arteriogram in terms of critical bleeding intervals.
本回顾性研究旨在探讨胃肠道（GI）出血患者的经导管肠系膜血管造影术，并确定在进行经导管血管造影术之前应监测 GI 出血患者的最重要变量。
在这项研究中，我们评估了 2005 年至 2009 年间接受大量胃肠道出血（定义为低血压、心动过速和 24 小时内需要输注 4 个单位以上的血液）治疗的患者的经导管肠系膜血管造影术结果。对 42 名患者的 45 次程序中的详细临床随访和可获得的医院数据进行了检查（三名患者进行了两次程序），年龄为 24 至 85 岁（平均年龄为 57.6 岁）。本研究包括 33 名男性和 9 名女性。22 例患者进行了下胃肠道出血血管造影，15 例患者进行了上胃肠道出血血管造影，5 例患者进行了上/下（多个来源）胃肠道出血血管造影。详细评估了包括内镜干预在内的成像检查以及术后对患者的随访。检查了术前记录的几个变量，包括临床状态、出血病因、出血参数（例如国际标准化比值、血小板）、成像检查、性别、季节和血管造影时间。
在 45 次操作中，有 24 次（53%）进行了栓塞。总体而言，诊断性动脉造影的技术成功率为 100%，未发生重大并发症。栓塞中，17 例患者使用了线圈（70%），6 例患者使用了聚乙烯醇颗粒（25%），1 例患者使用了正丁基氰基丙烯酸酯（4%）。在非工作时间进行的肠系膜血管造影术检查胃肠道出血的检出率明显高于在工作时间进行的血管造影术检查的检出率（P = 0.050）。血小板水平低或凝血酶原时间延长与肠系膜血管造影术结果无关（P = 1.00）。有趣的是，胃肠道出血的间歇性是检测的最大挑战，这使得出血的管理变得困难。对 8 例上胃肠道出血患者中的 3 例进行盲目胃左动脉栓塞仅有助于预防大出血。
上胃肠道出血的内镜检查和下胃肠道出血的闪烁扫描是经导管血管造影术治疗和预后的重要步骤。计算机断层血管造影术是治疗上、下胃肠道出血的一种很有前途的工具，并且已经成为成像工具集的一部分。此外，非工作时间进行的血管造影术比工作时间进行的血管造影术具有更高的临床成功率，这很可能是由于在关键出血间隔时间方面更恰当地安排了血管造影术。
