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Superselective transcatheter arterial embolization for acute small bowel bleeding: clinical outcomes and prognostic factors for ischemic complications

 Yong Seek Kim  ;  Joon Ho Kwon  ;  Kichang Han  ;  Man-Deuk Kim  ;  Junhyung Lee  ;  Gyoung Min Kim  ;  Jong Yun Won 
 ACTA RADIOLOGICA, Vol.62(5) : 574-583, 2021-05 
Journal Title
Issue Date
Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Arteries ; Catheterization, Peripheral* ; Embolization, Therapeutic / adverse effects* ; Embolization, Therapeutic / methods* ; Female ; Gastrointestinal Hemorrhage / mortality ; Gastrointestinal Hemorrhage / therapy* ; Hospital Mortality ; Humans ; Intestine, Small* ; Ischemia / epidemiology ; Ischemia / etiology* ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Treatment Outcome ; Young Adult
Gastrointestinal hemorrhage ; postoperative complications ; small intestine ; therapeutic embolization ; treatment outcome
Background: Small bowel bleeding (SBB) accounts for 5%-10% of all cases of acute gastrointestinal bleeding. Transcatheter arterial embolization (TAE) plays an important role in the treatment of SBB.

Purpose: To evaluate the safety and efficacy of superselective TAE exclusively for SBB and to assess factors associated with clinical outcomes.

Material and methods: From January 2006 to April 2017, 919 patients were admitted with signs and symptoms of gastrointestinal bleeding; 74 patients (mean age = 57.5 years; age range = 14-82 years) with positive angiographic findings for SBB were retrospectively analyzed. The technical success of TAE and clinical outcomes, including recurrent bleeding, major complications, and in-hospital mortality were evaluated. The associations of various clinical and technical factors with clinical outcomes were analyzed.

Results: The bleeding foci were in the ileum in 48 (65%) patients and the jejunum in 26 (35%). Technical success was achieved in 72 (97%) patients. The rates of recurrent bleeding, major complications, and in-hospital mortality were 12% (7/57), 21% (15/71), and 25% (18/72), respectively. Superselective embolization was a significant prognostic factor associated with fewer major complications (OR = 0.069; P = 0.003). The increased number of embolized vasa recta was significantly associated with a higher probability of major complications (OR = 2.64; P < 0.001). The use of N-butyl cyanoacrylate was associated with lower rates of major complication (OR = 0.257; P = 0.027).

Conclusion: TAE is a safe and effective treatment modality for SBB. In addition, whenever possible, TAE should be performed in a superselective manner to minimize ischemic complications.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Joon Ho(권준호) ORCID logo https://orcid.org/0000-0002-6178-7252
Kim, Gyoung Min(김경민) ORCID logo https://orcid.org/0000-0001-6768-4396
Kim, Man Deuk(김만득) ORCID logo https://orcid.org/0000-0002-3575-5847
Won, Jong Yun(원종윤) ORCID logo https://orcid.org/0000-0002-8237-5628
Lee, Junhyung(이준형) ORCID logo https://orcid.org/0000-0002-1942-5485
Han, Ki Chang(한기창) ORCID logo https://orcid.org/0000-0002-9701-9757
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