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How to Increase the Probability of Visualizing Angiographic Extravasation in Patients with Acute Hemorrhage from the Gastrointestinal Tract?

Authors
Journal
Korean Journal of Radiology
1229-6929
Publisher
The Korean Society of Radiology (KAMJE)
Publication Date
Volume
10
Issue
6
Identifiers
DOI: 10.3348/kjr.2009.10.6.649
Keywords
  • Letter To The Editor
Disciplines
  • Medicine

Abstract

Korean J Radiol 10(6), Nov/Dec 2009 649 DOI:10.3348/kjr.2009.10.6.649 How to Increase the Probability of Visualizing Angiographic Extravasation in Patients with Acute Hemorrhage from the Gastrointestinal Tract? Romaric Loffroy, MD, Basem Abualsaud, MD, Jean-Pierre Cercueil, MD, Denis Krause、, MD Division of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Mare、chal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex, France We read with great interest the recent article by Kim et al. (1) reporting the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal bleeding. We have several comments and questions. First, transcatheter embolization is now accepted as the salvage treatment of choice for acute hemorrhage from the upper or lower gastrointestinal tract despite endoscopic treatment. Many published studies confirm the feasibility of this approach and the high technical and clinical success rates, which range from 69% to 100% and from 63% to 97%, respec- tively, in all case-series including more than 20 patients over the last decade (2-4). The main challenge in such situations is to detect and localize the bleeding source in order to enable safe catheter-directed therapy. We agree with the authors that most patients with persistent lower gastrointestinal bleeding, despite endoscopic therapy, may fail to benefit from a transcatheter embolization. This is because the angiography may fail to visualize the bleeding point. Indeed, only 68 (48%) of the 143 patients studied by Kim et al. (1) had signs of active bleeding at angiogra- phy (i.e., extravasation of contrast medium). However, in our experience, the extravasation rate can be much higher (3, 4). Three factors may contribute to explain this discrep- ancy: first, selective catheterization of the inferior hemorrhoidal artery must be performed routinely to increase the probability of visualizing active b

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