Provocative mesenteric angiography for lower gastrointestinal hemorrhage: results from a single-institution study.

Published

Journal Article

PURPOSE: To determine the diagnostic capability, complication rate, and potential predictors of success for provocative mesenteric angiography in patients with obscure and recurrent lower gastrointestinal (GI) hemorrhage. MATERIALS AND METHODS: Thirty-four patients (age, 7-92 years; 22 men) underwent 36 provocative mesenteric angiograms between January 2002 and December 2008. Provocative mesenteric angiography consisted of systemic anticoagulation with heparin followed by selective transcatheter injection of vasodilator and tissue plasminogen activator into the arterial distribution of highest suspicion. Medications were administered incrementally until active extravasation was visualized or until the operator deemed the outcome negative. The pertinent clinical, radiologic, surgical, laboratory, and pathologic notes were retrospectively reviewed. RESULTS: Among 36 provocative mesenteric angiograms, 11 resulted in angiographically visible extravasation (31%) and an additional procedure resulted in angiographic visualization of an undiagnosed hypervascular mass, resulting in the identification of a source of a hemorrhage in 33% overall. In 10 of the 11 cases with visualized extravasation, transcatheter embolization successfully controlled recurrent hemorrhage, while the hypervascular mass without extravasation was successfully resected. Therefore, a total of 11 of 36 studies (31%) resulted in successful definitive treatment of recurrent hemorrhage. One embolization-related complication occurred, resulting in surgical resection of perforated ischemic bowel. No hemorrhagic complications were identified. Patients with melena and patients admitted for reasons other than acute lower GI hemorrhage were significantly less likely to benefit from provocative mesenteric angiography. CONCLUSIONS: In this series, provocative mesenteric angiography was safe and effective for eliciting the source of occult lower GI hemorrhage, leading to definitive therapy in about one third of patients.

Full Text

Duke Authors

Cited Authors

  • Kim, CY; Suhocki, PV; Miller, MJ; Khan, M; Janus, G; Smith, TP

Published Date

  • April 2010

Published In

Volume / Issue

  • 21 / 4

Start / End Page

  • 477 - 483

PubMed ID

  • 20171902

Pubmed Central ID

  • 20171902

Electronic International Standard Serial Number (EISSN)

  • 1535-7732

Digital Object Identifier (DOI)

  • 10.1016/j.jvir.2009.11.021

Language

  • eng

Conference Location

  • United States