J Trauma Acute Care Surg. 2013 Sep;75(3):398-403. doi: 10.1097/TA.0b013e31829a8b7a.
Therapeutic angioembolization is a relatively new "rescue treatment" modality for gastrointestinal hemorrhage (GIH) for unstable patients who fail primary treatment approaches; however, the effectiveness of this treatment and the incidence of ischemic necrosis following embolization for acute GIH are poorly described. The purpose of this study was to evaluate the effectiveness and safety of "rescue" transcatheter superselective angioembolization (SSAE) for the treatment of hemodynamically unstable patients with GIH.
A 10-year retrospective review of all hemodynamically unstable patients (systolic blood pressure < 90 mm Hg and ongoing transfusion requirement) who underwent "rescue" SSAE for GIH after failed endoscopic management was performed. All patients with evidence of active contrast extravasation were included. Data were collected on demographics, comorbidities, clinical presentation, and type of intravascular angioembolic agent used. Outcomes included technical success (cessation of extravasation), clinical success (no rebleeding requiring intervention within 30 days), and incidence of ischemic complications.
Ninety-eight patients underwent SSAE for GIH during the study period; 47 were excluded owing to lack of active contrast extravasation. Of the remaining 51 patients, 22 (43%) presented with a lower GIH and 29 (57%) with upper GIH. The majority underwent embolization with a permanent agent (71%), while the remaining patients received either a temporary agent (16%) or a combination (14%). The overall technical and clinical success rates were 98% and 71%, respectively. Of the 14 patients with technical success but clinical failure (rebleeding within 30 days) and the 1 patient with technical failure, 4 were managed successfully with reembolization, while 2 underwent successful endoscopic therapy, and 9 had surgical resections. Only one patient had an ischemic complication (small bowel necrosis) requiring resection.
SSAE, with reembolization if necessary, is an effective rescue treatment modality for hemodynamically unstable patients with active GIH. Of the patients, 20% will fail SSAE and require additional intervention. Ischemic complications are extremely rare.
Therapeutic study, level IV.
治疗性血管栓塞术是一种相对较新的“挽救治疗”方式，适用于未能通过主要治疗方法得到控制的不稳定型胃肠道出血（GIH）患者；然而，这种治疗的有效性以及栓塞治疗急性 GIH 后发生缺血性坏死的发生率描述甚少。本研究旨在评估经导管超选择性血管栓塞术（SSAE）作为不稳定型 GIH 患者的“挽救治疗”的有效性和安全性。
对所有因内镜治疗失败而行“挽救”SSAE 治疗的血流动力学不稳定（收缩压＜90mmHg 且持续需要输血）的 GIH 患者进行了一项回顾性研究，回顾时间为 10 年。所有有明显造影剂外渗证据的患者均纳入研究。收集的数据包括人口统计学、合并症、临床表现和使用的血管内栓塞剂类型。研究的结果包括技术成功（造影剂外渗停止）、临床成功（30 天内无再次出血需要介入治疗）和缺血性并发症的发生率。
研究期间共有 98 例患者因 GIH 而行 SSAE，其中 47 例因无明显造影剂外渗而被排除。在其余 51 例患者中，22 例（43%）为下消化道出血，29 例（57%）为上消化道出血。大多数患者采用永久性栓塞剂（71%）进行栓塞，而其余患者分别采用临时性栓塞剂（16%）或联合使用（14%）。总的技术成功率和临床成功率分别为 98%和 71%。在 14 例技术成功但临床失败（30 天内再出血）的患者和 1 例技术失败的患者中，有 4 例通过再次栓塞成功治疗，2 例通过内镜治疗成功，9 例通过手术切除成功治疗。只有 1 例发生缺血性并发症（小肠坏死），需要切除。
对于有活动性 GIH 的血流动力学不稳定患者，SSAE 是一种有效的挽救治疗方式，如有必要可进行再次栓塞。其中 20%的患者会对 SSAE 治疗失败，需要额外的介入治疗。缺血性并发症非常罕见。
治疗研究，IV 级。
