Ierardi Anna Maria, Urbano Josè, De Marchi Giuseppe, Micieli Camilla, Duka Ejona, Iacobellis Francesca, Fontana Federico, Carrafiello Gianpaolo
1 Interventional Radiology Unit, Radiology Department, Uninsubria, Varese, Italy.
2 Vascular and Interventional Radiology Department, Jiménez Díaz Foundation University Hospital, Madrid, Spain.
Br J Radiol. 2016;89(1061):20150934. doi: 10.1259/bjr.20150934. Epub 2016 Feb 4.
Lower gastrointestinal bleeding (LGIB) is associated with high morbidity and mortality. Embolization is currently proposed as the first step in the treatment of acute, life-threatening LGIB, when endoscopic approach is not possible or is unsuccessful. Like most procedures performed in emergency setting, time represents a significant factor influencing outcome. Modern tools permit identifying and reaching the bleeding site faster than two-dimensional angiography. Non-selective cone-beam CT arteriography can identify a damaged vessel. Moreover, sophisticated software able to detect the vessel may facilitate direct placement of a microcatheter into the culprit vessel without the need for sequential angiography. A further important aspect is the use of an appropriate technique of embolization and a safe and effective embolic agent. Current evidence shows the use of detachable coils (with or without a triaxial system) and liquid embolics has proven advantages compared with other embolic agents. The present article analyses these modern tools, making embolization of acute LGIB safer and more effective.
下消化道出血（LGIB）与高发病率和死亡率相关。当无法进行内镜治疗或内镜治疗失败时，目前建议将栓塞作为治疗急性、危及生命的LGIB的第一步。与大多数在急诊环境中进行的操作一样，时间是影响治疗结果的重要因素。现代工具能够比二维血管造影更快地识别并到达出血部位。非选择性锥形束CT血管造影可以识别受损血管。此外，能够检测血管的先进软件可能有助于将微导管直接放置到肇事血管中，而无需进行序贯血管造影。另一个重要方面是使用合适的栓塞技术和安全有效的栓塞剂。目前的证据表明，与其他栓塞剂相比，使用可脱卸线圈（有或没有三轴系统）和液体栓塞剂已被证明具有优势。本文分析了这些现代工具，使急性LGIB的栓塞治疗更安全、更有效。
