Efficacy of angioembolization in lower gastrointestinal bleeds and analysis of associated complications: A retrospective study at an Australian Tertiary Hospital

Purpose: The management of lower gastrointestinal bleeding (LGIB) varies between institutions. Mesenteric embolization, first introduced in 1965, is less invasive than surgery, has more significant bleeding localization than colonoscopy, and thus has become a standard mode of minimally invasive treatment for patients with LGIB. Early catheter design and initial embolic materials, including autologous clot and gelatin sponge, were limited by high rates of bowel ischemia. Still, the development of microcatheter technology and super-selective embolization has reduced the incidence of bowel infarction and bleeding from adjacent collaterals. This study explores the data from a single center, aiming to prove that angioembolisation is efficacious as first-line management in the setting of LGIB. 

Methods: 95 patients who underwent angioembolisation for LGIB were retrospectively analyzed amongst a cohort of 526 patients with a positive CT angiogram. Qualitative and quantitative data were collected. Summative data analysis was performed, including frequencies of binary variables and mean, median, range, and standard deviation of continuous variables. A comparison of quantitative variables was performed using the paired t-test. Potential predictive factors for embolization from patients with a positive CTA were initially assessed using univariable analysis, and then p-values less than 0.1 were included as part of multivariable analysis. 

Results: Of the total 95 embolizations, 93 were technically successful, resulting in cessation of bleeding. The most used material for embolization was microcoils alone and a combination of microcoils and gelfoam. 19 patients rebled within 72 hours of embolization, of whom 16 were managed conservatively or with medical management. There were a total of 6 minor complications and 9 significant complications, of which a total of 3 required surgery, and 2 died. Multivariate logistic regression was performed to assess predictors of embolization amongst patients who underwent CTA for LGIB. Patients with a history of previous LGIB are more likely to undergo embolization compared to patients without a history of previous LGIB.  

Conclusion: Transcatheter arterial embolization is an effective first-line means of managing LGIB, with a technical success rate and complication rate comparable to therapeutic colonoscopy. However, further randomized data are needed to compare various therapeutic methods