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home - Miscellaneous - Bleeding - Angiography Written by Dr Sebastian Zeki

Angiography

American College of Radiology appropriateness criteria —Surgery and angiography therapeutic endoscopyIf high risk for surgery.TAI is the best technique for treatment of bleeding into the biliary tree or pancreatic duct. Intraarterial vasopressin:Indications:-Those with endoscopically documented hemorrhagic gastritis-Those in whom the bowel has a poor collateral blood supply (a contraindication to embolization), such as following bowel surgery-Those with bleeding from anastomotic ulcers or endoscopic biopsy sitesOutcome:Initially controls 75 % of cases of gastric arterial hemorrhage.Bleeding recurs in 18 %36 % of these had recontrol of bleeding either by a repeat infusion of vasopressin or by embolization.Dont use straight after embolization as can cause infarctionSide effects: arrhythmias, especially bradycardia, and water retention leading to hyponatremia. Angiography for GI Bleeding EMBOLIZATION —Indications —-Failed vasopressin infusion (or contraindication to the use of vasopressin). -Active bleeding occurring at >0.5 mL/minute, visible angiographically and amena-ble to percutaneous access-Pyloroduodenal bleeding-Hemobilia-Bleeding into pancreatic pseudocysts or from visceral artery aneurysms-Underlying coagulopathy-Bleeding from attempted endoscopic coagulation of gastric ulcers Temporary-Autologous blood clot lyses too rapidly (stabilise with epsilon aminocaproic acid but still short half)-Biodegradable long-acting gelatin sponge- causes hemostasis on contact when injected into vessel. PermananentPolyvinyl alcohol (Ivalon), as small microspheres or sheets.Occlusion is achieved through mechanical impaction.Used when bleeding occurs from lesion unlikely to heal spontaneously eg tumor, aneurysm, or AVM.Mechanical blocking agents such as steel coils, platinum microcoils, balloons, and silk thread can also be used when permanent occlusion of an artery is required.Indicated for bleeding varices, a large visceral artery, or the gastroduodenal artery (rich dual blood supply).Coils placed both proximal and distal to sites of bleeding in order to prevent backbleeding when collat-eral vessels are present.Detachable balloons are seldom used for GI bleeding; however, nondetachable balloons can be used as a temporary measure prior to surgery.Sometimes use combination Materials used for emboliza-tion are either temporary or perma-nent: Complications —Those associated with arteriography itself (eg, hemato-mas, arterial thrombosis, dissection, embolism, and pseudoaneurysm formation ), and bowel infarction. Written by Dr Sebastian Zeki

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