Synchronous embolization of the gastroduodenal artery and the inferior pancreaticoduodenal artery in patients with massive duodenal hemorrhage.

PURPOSE

To assess the efficacy and safety of synchronous embolization of the gastroduodenal artery (GDA) and inferior pancreaticoduodenal artery (IPDA) in patients with massive duodenal hemorrhage.

PATIENTS AND METHODS

All cases of synchronous embolization of the GDA and IPDA at the authors' hospital between 1980 and 1989 were retrospectively reviewed.

RESULTS

Bleeding was successfully controlled acutely in all six patients who underwent synchronous embolization. Clinical evidence of recurrent hemorrhage was found in two patients, but repeat angiography showed no extravasation of contrast material. Three patients died within 30 days of embolotherapy. In one patient who also received an infusion of vasopressin, postmortem evidence of pancreatic necrosis was found.

CONCLUSION

Synchronous embolization of the GDA and IPDA can be an effective treatment for continuing duodenal hemorrhage after failed endoscopic therapy in patients considered a poor surgical risk. The procedure should be undertaken only as a lifesaving measure due to the risk of pancreatic and duodenal necrosis.