PMID- 29537132
OWN - NLM
STAT- MEDLINE
DCOM- 20190624
LR  - 20190624
IS  - 1445-2197 (Electronic)
IS  - 1445-1433 (Linking)
VI  - 88
IP  - 9
DP  - 2018 Sep
TI  - Role of super-selective embolization in lower gastrointestinal bleeding.
PG  - E644-E648
LID - 10.1111/ans.14441 [doi]
AB  - BACKGROUND: Lower gastrointestinal bleeding (LGIB) is a common acute general 
      surgical condition that is typically self-limiting; however in refractory cases 
      it can necessitate life-saving intervention. When bleeding is refractory, 
      super-selective embolization (SSE) becomes an important management strategy. This 
      study aims to evaluate outcomes of this procedure at our institution and identify 
      predictors of clinical success. METHODS: A retrospective analysis of patients 
      with positive computed tomography angiograms for LGIB at a tertiary centre 
      between December 2007 and May 2017. RESULTS: Of 87 600 acute general surgical 
      admissions, 2700 were for LGIB. Computed tomography angiography demonstrated 
      active bleeding in 104 patients who then had mesenteric angiograms. SSE was 
      performed in 77 patients of whom 66 (86%) demonstrated active bleeding. Technical 
      success was achieved in 75 patients (97%). Clinical success was achieved in 63 
      patients (81%). Re-bleeding occurred in 14 patients (19%), with four requiring 
      surgery. One patient went forward for re-embolization. Bowel ischaemia occurred 
      in four patients (5.2%), with two requiring bowel resection. A 30-day mortality 
      following SSE was 6.5%, with one death attributable to bowel ischaemia and four 
      deaths from medical comorbidity. Median age (years) of those who had clinical 
      success was 78 (interquartile range (IQR) 16.4) and those who did not was 65 (IQR 
      20.2) (P = 0.031). Clinical success was more common in those who had diverticular 
      related bleeding (61.9%) compared to other pathologies (38.1%) (P = 0.036). 
      CONCLUSION: SSE was successful in a high proportion of patients in this series 
      with low complication rates. Clinical success was higher in those who were older 
      or with diverticular related bleeding.
CI  - (c) 2018 Royal Australasian College of Surgeons.
FAU - Senadeera, Sajith C
AU  - Senadeera SC
AUID- ORCID: 0000-0002-8054-6374
AD  - Department of General Surgery, Christchurch Public Hospital, Canterbury, New 
      Zealand.
AD  - Department of Radiology, Christchurch Public Hospital, Canterbury, New Zealand.
FAU - Vun, Simon V
AU  - Vun SV
AD  - Department of General Surgery, Christchurch Public Hospital, Canterbury, New 
      Zealand.
FAU - Butterfield, Nicholas
AU  - Butterfield N
AD  - Department of Radiology, Christchurch Public Hospital, Canterbury, New Zealand.
FAU - Eglinton, Tim W
AU  - Eglinton TW
AD  - Department of General Surgery, Christchurch Public Hospital, Canterbury, New 
      Zealand.
FAU - Frizelle, Frank A
AU  - Frizelle FA
AD  - Department of General Surgery, Christchurch Public Hospital, Canterbury, New 
      Zealand.
LA  - eng
PT  - Journal Article
DEP - 20180314
PL  - Australia
TA  - ANZ J Surg
JT  - ANZ journal of surgery
JID - 101086634
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Aged, 80 and over
MH  - Angiography
MH  - Comorbidity
MH  - Computed Tomography Angiography/*methods
MH  - Embolization, Therapeutic/*methods
MH  - Female
MH  - Gastrointestinal Hemorrhage/diagnostic imaging/epidemiology/mortality/*therapy
MH  - Humans
MH  - Male
MH  - Mesentery/*blood supply/diagnostic imaging
MH  - Middle Aged
MH  - Postoperative Complications/epidemiology
MH  - Predictive Value of Tests
MH  - Recurrence
MH  - Retreatment
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - interventional radiology
OT  - lower gastrointestinal bleeding
OT  - mesenteric embolization
EDAT- 2018/03/15 06:00
MHDA- 2019/06/25 06:00
CRDT- 2018/03/15 06:00
PHST- 2017/09/10 00:00 [received]
PHST- 2018/01/12 00:00 [revised]
PHST- 2018/01/23 00:00 [accepted]
PHST- 2018/03/15 06:00 [pubmed]
PHST- 2019/06/25 06:00 [medline]
PHST- 2018/03/15 06:00 [entrez]
AID - 10.1111/ans.14441 [doi]
PST - ppublish
SO  - ANZ J Surg. 2018 Sep;88(9):E644-E648. doi: 10.1111/ans.14441. Epub 2018 Mar 14.