Department of Surgery, Auckland City Hospital, Auckland, New Zealand.
Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
ANZ J Surg. 2021 Oct;91(10):2097-2105. doi: 10.1111/ans.16879. Epub 2021 Apr 23.
To develop a model of clinical factors that may predict: (1) technically and clinically successful embolization of a bleeding vessel at digital subtraction angiography (DSA) for lower gastrointestinal bleed (LGIB); (2) a negative DSA in the presence of positive CT-mesenteric angiography (CTMA) for LGIB.
A retrospective cohort study of all DSAs conducted with intent for embolization for acute LGIB over a 10-year period was undertaken. Pre-procedural and intra-procedural clinical variables were evaluated using uni- and multi-variate analysis.
One hundred and twenty-three DSAs were evaluated. Technical success was 81% and clinical success 78% where DSA was positive. Technical success was associated with super-selective approach, contrast extravasation on CT, haemoglobin drop, anatomical source and time from CT to DSA on univariate analysis. On multivariate analysis, time from CT to DSA was significant with a higher success probability within 120 min with different factors being salient depending on degree of delay. Clinical success was only associated with activated partial thromboplastin time (<27.5 s). A negative DSA was associated with anatomical source, haemodynamic stability, platelet count and time from CT to DSA on univariate analysis. The latter three remained so on multivariate analysis.
A triaging approach to utilizing emergency DSA may be helpful. If prolonged delay between CT and DSA is anticipated, with haemodynamic stability and a near-normal platelet count, the DSA may not be fruitful. Technical success may be more likely if DSA occurs within 120 min. Clinical success may be more likely if activated partial thromboplastin time is within normal range.
开发一种临床因素模型，以预测：（1）在数字减影血管造影（DSA）下对下消化道出血（LGIB）的出血血管进行技术和临床上成功的栓塞；（2）在 CT 肠系膜血管造影（CTMA）阳性但 DSA 阴性的情况下。
对 10 年来所有意图用于急性 LGIB 栓塞的 DSA 进行回顾性队列研究。使用单变量和多变量分析评估术前和术中的临床变量。
共评估了 123 例 DSA。阳性 DSA 的技术成功率为 81%，临床成功率为 78%。技术成功与超选择性入路、CT 上的造影剂外渗、血红蛋白下降、解剖学来源和 CT 至 DSA 的时间有关，在单变量分析中。在多变量分析中，从 CT 到 DSA 的时间是显著的，在 120 分钟内成功率更高，不同的因素取决于延迟的程度。临床成功仅与活化部分凝血活酶时间（<27.5 s）有关。阴性 DSA 与解剖学来源、血流动力学稳定性、血小板计数和 CT 至 DSA 的时间有关，在单变量分析中。后三个因素在多变量分析中仍然如此。
对紧急 DSA 进行分诊可能会有所帮助。如果预计 CT 和 DSA 之间的延迟时间延长，同时血流动力学稳定且血小板计数接近正常，那么 DSA 可能不会有结果。如果 DSA 在 120 分钟内进行，技术成功率可能更高。如果活化部分凝血活酶时间在正常范围内，临床成功率可能更高。
