What is the role of superselective embolization in the treatment of lower gastrointestinal (GI) bleeding (LGIB)?

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Answer

An alternative to vasopressin infusion is embolization with agents such as gelatin sponges, coil springs, polyvinyl alcohol, and oxidized cellulose. Embolization involves superselective catheterization of the bleeding vessel to minimize necrosis, the most feared complication of ischemic colitis. This therapeutic modality is useful in patients in whom vasopressin is unsuccessful or contraindicated.

Early experience with embolization suggested that complications of intestinal infarction were as high as 20%. With the advent of superselective catheterization and embolization of the vasa recta, successful embolization has been performed without intestinal infarction. [61, 62] A 3 French (F) microcatheter is placed coaxially through a diagnostic 5F catheter, and the therapeutic catheter is advanced as far as the vasa recta over a 0.018-inch guidewire to reduce the risk of infarction.

Once the bleeding vessel is identified, microcoils are used to occlude the bleeding vessel and to achieve hemostasis. Although microcoils are most commonly used, polyvinyl alcohol and Gelfoam are also used alone or in conjunction with microcoils. [8, 63, 64] However, if terminal mural branches of the bleeding vessel cannot be catheterized, abort the procedure and immediately perform surgery.


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