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World Journal of Surgery
Published in: World Journal of Surgery 9/2014

01-09-2014

Relevance of Surgery after Embolization of Gastrointestinal and Abdominal Hemorrhage

Authors: Gernot Köhler, Oliver Owen Koch, Stavros A. Antoniou, Franz Mayer, Michael Lechner, Leo Pallwein-Prettner, Klaus Emmanuel

Published in: World Journal of Surgery | Issue 9/2014

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Abstract

Background

Gastrointestinal and abdominal bleeding can lead to life-threatening situations. Embolization is considered a feasible and safe treatment option. The relevance of surgery has thus diminished in the past. The aim of the present study was to evaluate the role of surgery in the management of patients after embolization.

Methods

We performed a retrospective single-center analysis of outcomes after transarterial embolization of acute abdominal and gastrointestinal hemorrhage between January 2009 and December 2012 at the Sisters of Charity Hospital, Linz. Patients were divided into three groups, as follows: upper gastrointestinal bleeding (UGIB), lower gastrointestinal bleeding (LGIB), and abdominal hemorrhage.

Results

Fifty-four patients with 55 bleeding events were included. The bleeding source could be localized angiographically in 80 %, and the primary clinical success rate of embolization was 81.8 % (45/55 cases). Early recurrent bleeding (<30 days) occurred in 18.2 % (10/55) of the patients, and delayed recurrent hemorrhage (>30 days) developed in 3.6 % (2/55). The mean follow-up was 8.4 months, and data were available for 85.2 % (46/54) of the patients. Surgery after embolization was required in 20.4 % of these patients (11/54). Failure to localize the bleeding site was identified as predictive of recurrent bleeding (p = 0.009). More than one embolization effort increased the risk of complications (p = 0.02) and rebleeding (p = 0.07).

Conclusions

Surgery still has an important role after embolization in patients with gastrointestinal and abdominal hemorrhage. One of five patients required surgery in cases of early and delayed rebleeding or because of ischemic complications (2/55 both had ischemic damage of the gallbladder) and bleeding consequences.
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Metadata
Title
Relevance of Surgery after Embolization of Gastrointestinal and Abdominal Hemorrhage
Authors
Gernot Köhler
Oliver Owen Koch
Stavros A. Antoniou
Franz Mayer
Michael Lechner
Leo Pallwein-Prettner
Klaus Emmanuel
Publication date
01-09-2014
Publisher
Springer US
Published in
World Journal of Surgery / Issue 9/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-014-2570-7

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