LE2I Laboratory, CNRS UMR 5158, Department of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 Bd Maréchal de Lattre de Tassigny, BP 77908, 21079 Dijon, France.
World J Gastrointest Surg. 2011 Jul 27;3(7):89-100. doi: 10.4240/wjgs.v3.i7.89.
Over the past two decades, transcatheter arterial embolization has become the first-line therapy for the management of upper gastrointestinal bleeding that is refractory to endoscopic hemostasis. Advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the management of hemorrhage for a variety of indications, such as peptic ulcer bleeding, malignant disease, hemorrhagic Dieulafoy lesions and iatrogenic or trauma bleeding. Transcatheter interventions include the following: selective embolization of the feeding artery, sandwich coil occlusion of the gastroduodenal artery, blind or empiric embolization of the supposed bleeding vessel based on endoscopic findings and coil pseudoaneurysm or aneurysm embolization by three-dimensional sac packing with preservation of the parent artery. Transcatheter embolization is a fast, safe and effective, minimally invasive alternative to surgery when endoscopic treatment fails to control bleeding from the upper gastrointestinal tract. This article reviews the various transcatheter endovascular techniques and devices that are used in a variety of clinical scenarios for the management of hemorrhagic gastrointestinal emergencies.
在过去的二十年中，经导管动脉栓塞术已成为治疗内镜止血无效的上消化道出血的一线治疗方法。基于导管的技术和新型栓塞剂的进步，以及对微创治疗选择有效性的认识，介入放射学在管理各种适应症的出血方面的作用得到了扩展，例如消化性溃疡出血、恶性疾病、出血性 Dieulafoy 病变以及医源性或创伤性出血。经导管介入包括以下内容：供血动脉的选择性栓塞、胃十二指肠动脉的三明治线圈闭塞、根据内镜发现对疑似出血血管进行盲法或经验性栓塞以及通过三维囊袋包装对线圈假性动脉瘤或动脉瘤进行栓塞，同时保留母动脉。当内镜治疗未能控制上消化道出血时，经导管栓塞术是一种快速、安全、有效的微创替代手术方法。本文综述了在各种临床情况下用于治疗胃肠道出血急症的各种经导管血管内技术和装置。
