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Transcatheter Arterial Embolization in Lower Gastrointestinal Bleeding: Ischemia Remains a Concern Even with a Superselective Approach

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

To evaluate the safety, efficacy, and feasibility of transcatheter arterial embolization (TAE) in the treatment of lower gastrointestinal bleeding (LGIB).

Methods

Study group comprised all patients receiving angiography for LGIB in the Helsinki University Hospital during the period of 2004–2016. Hospital medical records provided the study data. Rebleeding, complication, and mortality rates (≤ 30 days) were the primary outcomes. Secondary outcomes included need for blood transfusions, durations of intensive care unit and hospital admissions, incidence of delayed rebleeding, and long-term complications, as well as overall survival.

Results

During the study period, angiography for LGIB was necessary on 123 patients. Out of 123, 55 (45%) underwent embolization attempts. TAE was technically successful in 53 (96%). Rebleeding occurred in 14 (26%). The complication rate was 36%, minor complications occurring in 10 (19%) and major in nine (17%). Major complications resulted in bowel resection in seven (13%). Post embolization ischemia was the most common single complication seen in nine (17%). The mortality rate was 6%. Survival estimates of 1 and 5 years were 79 and 49%.

Discussion

LGIB is a severe physiological insult occurring in patients who are often elderly and moribund. Although major post embolization complications occur, transcatheter arterial embolization should be the first-line approach over surgery in profuse LGIB in patients with hemodynamic instability, when colonoscopy fails or is unavailable, or when computerized tomography angiography detects small intestinal bleeding.

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Acknowledgements

The authors would like to thank statistician Harri Mustonen for his valuable advice and comments.

Grant Support

Helsinki University Hospital Research Fund

Pehr Oscar Klingendahl’s Fund

Waldemar von Frenckell’s Foundation

Finnish-Norwegian Medical Foundation

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Authors and Affiliations

  1. Helsinki University Hospital, Abdominal Center and University of Helsinki, Department of Surgery, P.O. BOX 340, FI-00029, HUS, Helsinki, Finland

    Taina Nykänen, Leena Kylänpää & Marianne Udd

  2. Helsinki University Hospital, Helsinki Medical Imaging Center, Helsinki, Finland

    Erno Peltola

Authors
  1. Taina Nykänen
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  2. Erno Peltola
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  3. Leena Kylänpää
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  4. Marianne Udd
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Contributions

Taina Nykänen (TN), Marianne Udd (MU) and Leena Kylänpää (LK) designed the study. Erno Peltola (EP) identified patients from the hospital registry. TN performed data collection and analysis. TN and EP drafted the manuscript while MU and LK provided supervision. All authors have critically commented the manuscript and approved the final version.

Corresponding author

Correspondence to Taina Nykänen.

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Nykänen, T., Peltola, E., Kylänpää, L. et al. Transcatheter Arterial Embolization in Lower Gastrointestinal Bleeding: Ischemia Remains a Concern Even with a Superselective Approach. J Gastrointest Surg 22, 1394–1403 (2018). https://doi.org/10.1007/s11605-018-3728-7

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  • DOI: https://doi.org/10.1007/s11605-018-3728-7

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