Superselective coil embolization in acute gastrointestinal hemorrhage: personal experience in 10 patients and review of the literature

Abstract

Purpose: To evaluate the safety and efficiency of microcoil embolization in upper and lower gastrointestinal hemorrhage.

Patients and methods: Superselective microcoil embolization was performed in 10 patients (upper gastrointestinal bleeding, n = 3; lower gastrointestinal bleeding, n = 7) who had acute gastrointestinal hemorrhage. Embolization was performed as peripherally as possible with use of coaxial catheter systems. Embolization materials included microcoils (2-4 mm) alone (n = 5), microcoils and polyvinyl alcohol particles (355-500 microm) (n = 4), and microcoils and gelatin sponge particles (n = 1).

Results: Immediate hemostasis was achieved in eight patients. In two patients with dual blood supply of the bleeding site, significant reduction of hemorrhage resulted. In these two patients, it was technically impossible to place the coaxial catheter distally enough to allow safe embolization of both feeding vessels. No clinical signs of ischemia or infarction were observed after intervention.

Conclusion: Microcoil embolization is a safe and efficient procedure for controlling acute lower gastrointestinal bleeding if performed in a superselective catheter position. In upper gastrointestinal bleeding, microcoil embolization is an established treatment and can be performed more proximally.