Gastrointestinal bleeding caused by angiodysplasia; one stop angiographic diagnosis and endovascular treatment by super selective embolization with polyvinyl alcohol particles

AbstractBackground and aimsAngiodysplasia is the most common vascular abnormality of the gastrointestinal tract GIT. Angiography, like colonoscopy, serves as both a diagnostic and a therapeutic modality for gastrointestinal bleeding. Since the development of microcatheters and new embolic materials, the role of embolization has grown as primary therapy for gastrointestinal bleeding with fewer complications reported. Microcatheters allow more selective catheterization, often enabling embolization of the offending artery at the bowel wall.The current study aims to assess the role of trans arterial embolization in treatment of GIT bleeding secondary to angiodysplasia of the gastrointestinal tract using super selective embolization with polyvinyl alcohol particles.MethodsThis study was carried out at the Radiology Department, Assiut University Hospitals, in the period from July 2007 to November 2009. The study included 12 consecutive patients (1 patient with upper and 11 patients with lower GI bleeding); referred from Surgical Department Assiut University and Tropical Medicine Department, Minia University, in whom active hemorrhage caused by angiodysplasia of gastrointestinal tract as shown on arteriograms underwent superselective transcatheter arterial embolization by polyvinyl alcohol particles 250–350μm in diameter.ResultsThe study included 12 consecutive patients (3 females and 9 males); (1 patient with upper and 11 patients with lower GI bleeding); in whom active hemorrhage due to angiodysplasia of gastrointestinal tract as shown on arteriograms underwent superselective transcatheter arterial embolization by polyvinyl alcohol particles 250–350μm particles to stop the hemorrhage. Bleeding was found in the distribution of the right gastroepiploic artery in one patient, in the distribution of the superior mesenteric artery, jejunal branch in three patients, in the distribution of the inferior mesenteric artery in eight patients, sigmoidal branch (n=2), ileocolic/anterior cecal branch (n=3), and superior rectal branch (n=3). One patient had a lesion in the greater curvature of the stomach. Three patients have lesions in the small intestine; all at the jejunum, eight patients had large-bowel lesions in the following distribution: cecum and proximal part of ascending colon (n=3), sigmoid colon (n=2), and rectum (n=3). The cause for bleeding was angiodysplasia in all cases. Three patients had recurrent lower GI bleeding 1–24days (mean 9days) after initial embolization. Two of these patients had surgery, while one had a successful second embolization.ConclusionSuperselective embolization using 250–350μm polyvinyl alcohol particles is effectively used as the transcatheter therapy for treatment of both upper and lower gastrointestinal tract bleeding