1. Glubran 2 Transcatheter Embolization of Active Gastrointestinal
Hemorrhage
Marcello R. ^ Marcello G. *
^ ACO San Filippo Neri – Rome * Campus BioMedico – Rome
All Authors have no financial disclosures
Purpose: The aim of our study was to demonstrate the safety and effectiveness of percutaneous transcatheter glue embolization of active gastrointestinal (GI) hemorrhage. Materials and Methods: From February to December 2012, 6 patients referred to the emergency unit of our institution complained of melena and associated symptoms of active lower GI bleeding. All patients received contrast-enhanced multidetector computed tomography (ce-MDCT) of the upper and lower abdomen in order to detect the acute bleeding site. In 5 patients, a localized vascular lesion of the bowel wall was detected. One patient previously treated elsewhere with superior mesenteric artery (SMA) stenting was diagnosed with multiple arteriovenous malformations of the bowels. Common femoral artery access was obtained and all patients received selective visceral angiography. A microcatheter (Progreat 2.7F; Terumo, Tokyo, Japan) was then advanced to the target lesion through the diagnostic catheter. Glue embolization with different dilutions of butyl-cyanoacrylate (Glubran 2 GEM Srl, Viareggio, Italy) and Lipiodol was carried out. Patients were closely observed for 48 hours after the procedure. Results: Cessation of active hemorrhage was achieved in all patients. No further intervention was necessary, and no immediate or late complications were observed.
No complaints of abdominal pain or disfunction were recorded. All patients were discharged from hospital within 2 to 8 days following the procedure. Conclusion: Our experience with a limited number of patients suffering from GI hemorrhage treated by percutaneous transcatheter glue embolization showed the safety and the effectiveness of such a procedure. However, further evaluation of glue embolization of active GI bleeding on a larger number of patients is needed.
A 60Y old man suffering from abdominal pain related to meals. SMA stricture was detected and stenting was performed in another Institution. One month later abdominal pain and melena occurred. Multiple small bowel AVM were detected.
A 64Y old man experienced recent surgery for malignancy of rectum and bowel perforation. Ten days later he complained with abdominal pain and hemorrhage.
Pre stenting A B B
Post stenting C DD D
Diagnostic angiography: AVM of ileocolic artery branch.
B,C) Glue embolization of AVM (ratio 1:3 with Lipiodol).
D) Final angiogram at the end of the procedure.
Angiography of IMA detected a bleeding vascular lesion arising from a recto-sigmoid branch. Embolization was done with Glubran2+Lipiodol(1:2 ratio).
CE MDCT of abdomen with VR reformatted images of SMA stenosis.
Authors s: –