Endovascular Arterial Embolization for Management of Acute Gastrointestinal Hemorrhage: A Retrospective Cross-Sectional Study

Abstract

Introduction: Role of interventional radiology is now becoming fundamental in management of acute gastrointestinal hemorrhage. Overall improvements in hardware ranging from microcatheters, microwires and newer embolic agents have resulted in high success rates worldwide. This study aims to assess and reflect the outcomes of endovascular arterial embolization for managing acute gastrointestinal hemorrhage.
Methods: This was a single center retrospective cross-sectional descriptive study carried out at Nepal Mediciti Hospital. Patients who underwent endovascular arterial embolization for management of non-variceal acute gastrointestinal hemorrhage from January 2019 to July 2024 were included in study. Demographic details of patients, source of arterial bleeding, vascular pathology, embolic agent utilized were recorded. Technical and clinical success rates of the procedure and related complications were documented. Data entry was done in Epi-Info version 7.2.2.6 and analysis was done in EZR version 1.36.
Results: Arterial pseudoaneurysm (44.4%) was the most common etiology of gastrointestinal bleeding, and the most common culprit artery was gastroduodenal artery. Gelfoam was the most commonly used embolic agent, used in 18 cases (50%); followed by n-butyl cyanoacrylate (NBCA) glue in 17 cases (47%), microcoil in 15 cases (41.6%) and 99% ethanol in a single case (2.7%). Combination of couple of these agents was required in 15 out of 36 settings. Technical success rate was 94.4%, while clinical success rate was 91.6%. Re-bleeding after embolization was observed in 8.3% and 30-day mortality was 3%.
Conclusions: Endovascular arterial embolization is a minimally invasive, safe and effective measure for management of acute gastrointestinal hemorrhage.