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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. [ABSTRACT FROM AUTHOR]

Objective: To investigate the safety and efficacy of transcatheter arterial embolisation (TAE) in the management of lower gastrointestinal bleeding (LGIB) and to identify predictors of clinical outcomes.Methods: Between December 2005 and April 2017, 274 patients underwent diagnostic angiography for signs and symptoms of LGIB; 134 patients with positive angiographic findings were retrospectively analysed. 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 analysed. Predictors for clinical outcomes were evaluated using univariate and multivariate logistic regression analyses.Results: A total of 134 patients (mean age, 59.7 years; range, 14-82 years) underwent TAE for LGIB. The bleeding foci were in the small bowel in 74 patients (55.2%), colon in 35 (26.1%), and rectum in 25 (18.7%). Technical success was achieved in 127 patients (94.8%). The clinical success rate was 63% (80/127). The rates of recurrent bleeding, major complications, and in-hospital mortality were 27.9% (31/111), 18.5% (23/124), and 23.6% (33/127), respectively. Superselective embolisation and the use of N-butyl cyanoacrylate (NBCA) were significant prognostic factors associated with reduced recurrent bleeding (OR, 0.258; p = 0.004 for superselective embolisation, OR, 0.313; p = 0.01 for NBCA) and fewer major complications (OR, 0.087; p ˂ 0.001 for superselective embolisation, OR, 0.272; p = 0.007 for NBCA).Conclusions: TAE is an effective treatment modality for LGIB. Superselective embolisation is essential to reduce recurrent bleeding and avoid major complications. NBCA appears to be a preferred embolic agent.Key Points: • Transcatheter arterial Embolisation (TAE) is a safe and effective treatment for lower gastrointestinal tract haemorrhage. • Superselective embolisation is essential to improve outcomes. • N-butyl cyanoacrylate (NBCA) appears to be a preferred embolic agent with better clinical outcomes. [ABSTRACT FROM AUTHOR]

Background Perigastric lymph nodes are dissected during gastrectomy, potentially resulting in life-threatening postoperative bleeding. Purpose To evaluate the safety and effectiveness of transarterial embolization (TAE) for bleeding from the splenic artery in patients who underwent gastrectomy. Material and Methods Between January 2004 and December 2016, 14,523 patients underwent gastrectomy at our institution, and ten patients (nine men; mean age = 64.7 years; age range = 51-80 years) underwent TAE for postoperative bleeding from the splenic artery. The location of bleeding was classified as either: (i) the main splenic artery (MSA) or (ii) the parenchymal splenic artery (PSA). The clinical outcomes of TAE were explored. Results Bleeding occurred at a median of 13.5 days (range = 4-34 days) after gastrectomy. The onset of bleeding was late in all patients and clinically manifested as abdominal bleeding in seven patients and luminal bleeding in three patients. Technical and clinical success rates were 100% and 70%, respectively. The three major complications occurred only in patients with MSA bleeding, resulting in two 30-day mortality cases and one splenic abscess with fistula formation to the jejunum. The causes of death were infarctions in the spleen and/or remnant stomach and sepsis. Conclusion TAE seems to be effective in stabilizing patients with bleeding from the splenic artery. Moreover, TAE with curative intent may be performed for bleeding from the PSA; however, further resection of the remnant stomach and/or spleen seems to be required to avoid sepsis and mortality in case of bleeding from the MSA. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of bariatric arterial embolization (BAE) with non-spherical polyvinyl alcohol (PVA) particles on systemic ghrelin levels, weight change, and gastric ulceration risk in a swine model.Materials and Methods: From March 2014 to February 2015, ten healthy swine were used in the study (mean weight 31.5 kg; range 24.0-41.5 kg). The animals were randomly assigned to two groups: the embolized group (n = 5) in which BAE was performed and the control group (n = 5). In the embolized group, BAE was performed by selectively infusing 150-250 or 50-150 μm PVA into the gastric arteries that supplied the fundus of the stomach. In the control group, a sham procedure was performed with saline infusion. Plasma ghrelin levels were prospectively obtained at baseline and every 2 weeks thereafter. Endoscopy was performed 3 weeks after BAE to see whether any gastric ulcer occurred. To determine the durability of the occluded arteries, repeated celiac trunk angiography was performed 8 weeks after BAE. Then, all the swine were killed and necropsies were performed.Results: The mean post-procedure ghrelin value decreased by 370.0 pg/mL in the embolized group at week 3 (mean 536.0 ± 334.3 pg/mL) and week 5 (mean 515.0 ± 150.0 pg/mL, p < 0.05) relative to baseline (880.0 ± 559.5 pg/mL), respectively, but ghrelin levels were not significantly decreased between the embolized and control groups. There was a significant body weight change as follows: 35.1 ± 9.5 to 46.6 ± 15.7 kg and 31.8 ± 5.8 to 41.2 ± 6.6 kg at baseline and endpoint in the control and embolized groups, respectively (p < 0.05). However, the difference between groups was not significant at endpoint. In the embolized group, ulcerations were identified in three animals (60%) and the recanalization of the embolized arteries was noted on follow-up angiography in three animals (60%), respectively.Conclusion: BAE with PVA particles can transiently suppress ghrelin levels in embolized animals, but levels are not significantly different compared to controls. Stomach ulcerations were identified in 60% of the embolized animals. [ABSTRACT FROM AUTHOR]

Background Extrahepatic portal hypertension after surgery involving the duodenum or jejunum might result in massive ectopic variceal bleeding. Purpose To report the results of portal vein stent placement with the addition of variceal embolization. Material and Methods Between January 2000 and June 2015, portal vein stent placement was attempted in 477 patients. Of these, 22 patients (age, 63 ± 10 years) with jejunal variceal bleeding caused by portal vein obstruction after surgery were included in this study. Computed tomography (CT) findings before and after treatment and the rates of technical and clinical success, complications, and clinical outcomes were retrospectively evaluated. Results Stent placement was successful in 19 of 22 patients. Additional variceal embolization was performed in five cases. Clinical success, defined as the cessation of bleeding without recurrence within 1 month, was achieved in 18 of 19 patients with technical success. One patient developed recurrent bleeding 4 days after stent placement and was successfully treated with additional variceal embolization. There were no procedure-related complications. A regression of the jejunal varices was noted in 14 of 19 patients on follow-up CT scans. During the follow-up period (258 days; range, 7-1196 days), stent occlusion and recurrent bleeding occurred in six and four patients, respectively, of the 19 patients who achieved technical success. Statistical analyses revealed no significant differences regarding stent patency between benign and malignant strictures. Conclusion Percutaneous, transhepatic, portal vein stent placement with or without jejunal variceal embolization appears to be a safe and effective treatment for jejunal variceal bleeding after surgery. [ABSTRACT FROM AUTHOR]

Background: To investigate the use of uterine artery embolization (UAE) to manage ectopic pregnancies that are refractory to systemic methotrexate (MTX) therapy and plagued by persistently high serum β-human chorionic gonadotrophin (hCG) levels and vaginal bleeding. The safety and efficacy of UAE were addressed.Materials and Methods: A retrospective review was conducted for thirteen patients (mean age 35.2 years; range 28-41 years), who were treated between December 2006 and June 2016. Each was subjected to UAE due to persistently high serum β-hCG levels and vaginal bleeding after systemic MTX therapy for ectopic pregnancy. Embolic agents used were non-spherical polyvinyl alcohol or gelatin sponge particles. Post-treatment follow-up was performed by monitoring for clinical signs of vaginal bleeding, serum β-hCG testing, and transvaginal US. Outcomes were technical success, clinical success, and complications.Results: Median follow-up period was 172.5 days (range 30-600 days). Technical success was achieved in all 13 patients (100%). In 10 patients, vaginal bleeding resolved after one UAE attempt (clinical success 76.0%). Rebleeding in other three (23.1%) was controlled through repeat UAE. Seven patients (53.8%) had additional dilatation and curettage to remove gestational sac remnants. All ectopic pregnancies were successfully treated by UAE, with normalization of serum β-hCG levels during follow-up monitoring (P = 0.01). Uterine preservation was achieved in all 13 patients, without major procedural complications.Conclusion: UAE appears safe and effective as treatment of ectopic pregnancies marked by persistently high serum β-hCG levels and vaginal bleeding after systemic MTX treatment. [ABSTRACT FROM AUTHOR]