The European journal of surgery = Acta chirurgica · 2002
Arterial embolisation in management of massive bleeding from gastric and duodenal ulcers.
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Ljungdahl Mikael, Eriksson Lars-Gunnar, Nyman Rickard, Gustavsson Sven
Аннотация
OBJECTIVE: We have tried angiography and selective arterial embolisation as a complement or another option in patients with massive bleeding from peptic ulcers who were considered poor candidates for surgery.
DESIGN: Prospective, descriptive study.
SETTING: University hospital, Sweden.
PATIENTS: Since 1998, 18 patients (11 women) with a median age of 78 years (range 53-94) had selective arterial embolisation for uncontrollable bleeding from peptic ulcers.
INTERVENTION: Superselective angiographic catheterisation and embolisation of the arterial branch that was supplying the ulcer.
MAIN OUTCOME MEASURES: The success rate of haemostasis and the overall outcome.
RESULTS: 13 patients were treated after failed endoscopic treatment to stop bleeding or to control recurrent bleeding after initial arrest, while 5 patients were treated for recurrent bleeding after emergency operations for bleeding ulcers. Most of the ulcers were in the duodenum. The patients were haemodynamically unstable and had a median haemoglobin concentration of 72 g/L (50-98). Embolisation of the arterial branch that was supplying the ulcer was feasible in all patients. Permanent haemostasis was achieved in all but one patient, although two patients needed a second embolisation for recurrent bleeding. One patient had the bleeding controlled at an emergency operation, but eventually died of respiratory complications. There were no serious complications of embolisation.
CONCLUSION: Angiographic embolisation may be an effective way to stop massive bleeding from gastroduodenal ulcers. Emergency operations in poor surgical candidates can therefore be avoided.
DESIGN: Prospective, descriptive study.
SETTING: University hospital, Sweden.
PATIENTS: Since 1998, 18 patients (11 women) with a median age of 78 years (range 53-94) had selective arterial embolisation for uncontrollable bleeding from peptic ulcers.
INTERVENTION: Superselective angiographic catheterisation and embolisation of the arterial branch that was supplying the ulcer.
MAIN OUTCOME MEASURES: The success rate of haemostasis and the overall outcome.
RESULTS: 13 patients were treated after failed endoscopic treatment to stop bleeding or to control recurrent bleeding after initial arrest, while 5 patients were treated for recurrent bleeding after emergency operations for bleeding ulcers. Most of the ulcers were in the duodenum. The patients were haemodynamically unstable and had a median haemoglobin concentration of 72 g/L (50-98). Embolisation of the arterial branch that was supplying the ulcer was feasible in all patients. Permanent haemostasis was achieved in all but one patient, although two patients needed a second embolisation for recurrent bleeding. One patient had the bleeding controlled at an emergency operation, but eventually died of respiratory complications. There were no serious complications of embolisation.
CONCLUSION: Angiographic embolisation may be an effective way to stop massive bleeding from gastroduodenal ulcers. Emergency operations in poor surgical candidates can therefore be avoided.