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. 2020 Dec 14;20(1):426.
doi: 10.1186/s12876-020-01570-y.

Relationship between angiography timing and angiographic visualization of extravasation in patients with acute non-variceal gastrointestinal bleeding

Chungjo Choi  1 , Hyun Lim  2 , Min-Jeong Kim  3 , Bo Young Lee  1 , Sung-Yeun Kim  1 , Jae Seung Soh  1 , Ho Suk Kang  1 , Sung Hoon Moon  1 , Jong Hyeok Kim  1
Affiliations

Relationship between angiography timing and angiographic visualization of extravasation in patients with acute non-variceal gastrointestinal bleeding

Chungjo Choi et al. BMC Gastroenterol. .

Abstract

Background: Angiographic embolization is now considered the first-line therapy for acute gastrointestinal (GI) bleeding refractory to endoscopic therapy. The success of angiographic embolization depends on the detection of the bleeding site. This study aimed to identify the clinical and procedural predictors for the angiographic visualization of extravasation, including angiography timing, as well as analyze the outcomes of angiographic embolization according to the angiographic visualization of extravasation.

Methods: The clinical and procedural data of 138 consecutive patients (mean age, 66.5 years; 65.9% men) who underwent angiography with or without embolization for acute non-variceal GI bleeding between February 2008 and July 2018 were retrospectively analyzed.

Results: Of the 138 patients, 58 (42%) had active extravasation on initial angiography and 113 (81.9%) underwent embolization. The angiographic visualization of extravasation was significantly higher in patients with diabetes (p = 0.036), a low platelet count (p = 0.048), high maximum heart rate (p = 0.002) and AIMS65 score (p = 0.026), upper GI bleeding (p = 0.025), and short time-to-angiography (p = 0.031). The angiographic embolization was successful in all angiograms, with angiographic visualization of extravasation (100%). The clinical success of patients without angiographic visualization of extravasation (83.9%) was significantly higher than that of patients with angiographic visualization of extravasation (65.5%) (p = 0.004). In multivariate analysis, the time-to-angiography (odds ratio 0.373 [95% CI 0.154-0.903], p = 0.029) was the only significant predictor associated with the angiographic visualization of extravasation. The cutoff value of time-to-angiography was 5.0 h, with a sensitivity and specificity of 79.3% and 47.5%, respectively (p = 0.012).

Conclusions: Angiography timing is an important factor that is associated with the angiographic visualization of extravasation in patients with acute GI bleeding. Angiography should be performed early in the course of bleeding in critically ill patients.

Keywords: Angiography; Endovascular; Gastrointestinal bleeding; Trans-arterial embolization.

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Conflict of interest statement

We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted.

Figures

Fig. 1
Fig. 1
Transcatheter arterial embolization for acute gastrointestinal bleeding. a, b Contrast extravasation guided embolization. Selective angiography shows contrast medium extravasation from the jejunal branches of the superior mesenteric artery (black arrow) (a). After microcatheterization guided by contrast extravasation, bleeding was controlled by embolization using microcoils and gelfoam (b). c, d Blind embolization. Angiography before embolization shows no evidence of contrast medium extravasation (c). After microcatheterization guided by clip position (black arrow), the left gastric artery terminating at clip was selectively embolized using microcoils and gelfoam (d)
Fig. 2
Fig. 2
Clinical outcomes according to the angiographic visualization of extravasation
Fig. 3
Fig. 3
ROC curve determining the cutoff value of time-to-angiography that predicts angiographic visualization of extravasation
See this image and copyright information in PMC

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