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GASTROINTESTINAL BLEEDING:
Interventional Radiology Procedures
and Indications for Operation
Amanda A. Muoz, MD
PGY-1
Trauma Conference
December 18, 2006
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This picture
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a.) Amanda
b.) Cindy
c.) Bea
d.) Stephanie
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GIB: IR Rx Options
Intra-arterial vasopressin
Arteriolar constriction and bowel wall contraction
Long half-life
Success rates 60-100% LGIB, complications 1020%, rebleed 50%
Only controls 15-30% of pyloroduodenal sources
Transcatheter embolization
- Gelatin sponge, microcoils, polyvinyl alcohol, balloon
- 73 -100% success rate, particularly in the UGI tract
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UGIB: IR Rx
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LGIB: IR Rx
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a.) Amanda
b.) Cindy
c.) Bea
d.) Stephanie
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GIB: IR Rx
Vasopressin Infusion
Limited by atherosclerotic disease
Coagulopathy
Catheter must be maintained in proper position for
the length of the infusion
2% rate of catheter dislodgement causing
recurrent bleeding (Darcy, J Vasc Intervent Radiol,
2003)
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GIB: IR Rx
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IR Complications
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b.) Cindy
c.) Bea
d.) Stephanie
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Perforation
Obstruction
Need to rule out malignancy
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Mallory-Weiss tears
Acute hemorrhagic gastritis
Dieulafoy lesion
Delayed repair if stable:
Paraesophageal or esophageal hiatal
hernia
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This picture
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b.) Cindy
c.) Bea
d.) Stephanie
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References
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