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Empiric embolization of lower gastrointestinal hemorrhage using nuclear medicine bleeding scan localization
S12
’
Sunday
Scientific Session
Hct Change Over 24 hr Prior
60% 50%
0 to –20%
12%
Any increase
19%
JVIR
Conclusions: Colonic hemorrhage is a common life threatening problem. Often the bleeding scan is positive while the angiogram is negative in up to 50% of patients. We present a simple inexpensive technique to allow accurate localization of a bleeding site even when the angiogram is negative. We feel that this is a viable alternative to emergency surgery.
Active Extravasation
to Angiography –40% to –60% –20% to –40%
’
SUNDAY: Scientific Sessions
References
4:03 PM
Abstract No. 18
Empiric embolization of lower gastrointestinal hemorrhage using nuclear medicine bleeding scan localization
1. Syed MI, Shaikh A. Accurate localization of life threatening colonic hemorrhage during nuclear medicine bleeding scan as an aid to selective angiography. World J Emerg Surg. 2009 May 27;4:20. 2. Gillespie CJ, Sutherland AD, Mossop PJ, Woods RJ, Keck JO, Heriot AG. Mesenteric embolization for lower gastrointestinal bleeding. Dis Colon Rectum.2010 Sep;53(9):1258-64. Sunday
Scientific Session 3
T. Akhter1, T. Akhter1, M. Syed2, H. Chaudhry3, S. Patel4, A. Shaikh4; 1Temple University Hospital, Philadelphia, PA; 2Dayton Interventional Radiology, Springfield, OH; 3 CMH Lahore Medical College, Beavercreek, OH; 4Dayton Interventional Radiology, Dayton, OH. Purpose: To propose an efficient therapy to treat lower gastric hemorrhage via empiric superselective embolization using nuclear medicine scan as an aid to localization. Materials: A marker was utilized during the nuclear medicine GI bleeding scan to localize the bleeding site. During angiography, if no active bleed was seen, empiric embolization was performed using up to .4 vials of 500-700 micron embolic particles using a microcatheter, sub-selection of the arterial branch as close as possible to the marker. Embolization was not performed to stasis. IRB approval was obtained. Results: See table. All 10 patients had cessation of bleeding. One patient developed ischemic colitis which responded to conservative management. No patients required surgical colonic resection.
IVC Filters I Sunday, April 3, 2016 3:00 PM – 4:30 PM Room: 116/117 3:00 PM
Abstract No. 19
Electrification of IVC filters with radiofrequency ablation to facilitate removal: ex vivo phantom study R. Seifabadi1, L. Jiang2, V. Krishnasamy3, A. Negussie4, F. Banovac5, B. Wood6; 1National Institute of Health,
Table
Nuclear Medicine Source of Bleed Hepatic flexure Hepatic flexure Splenic flexure Splenic flexure
Angiographically Positive Yes
Hemostasis after Embolization Yes
Etiology of Bleed by Colonoscopy Diverticulosis
No
Yes
Diverticulosis
No
Yes
Unknown
No
Yes
Submucosal vascular ectasia Rectal ulcer due to rectal tube Colorectal carcinoma Diverticulosis Diverticulosis
Age/Sex 70/M
Hb Level on Presentation (g/dL) 11.4
2
84/F
5.4
3
65/F
7
4
55/F
7.9
5
68/M
11
Rectum
Yes
Yes
6
93/M
4
No
Yes
7 8
92/F 81/F
9 10.4
Yes No
Yes Yes
9
80/M
9
Splenic flexure Cecum Sigmoid colon Sigmoid colon
No
Yes
10
85/F
10
No
Yes
Patient # 1
Sigmoid colon
Suspected diverticulosis Diverticulosis
’
Sunday
Scientific Session
Hct Change Over 24 hr Prior
60% 50%
0 to –20%
12%
Any increase
19%
JVIR
Conclusions: Colonic hemorrhage is a common life threatening problem. Often the bleeding scan is positive while the angiogram is negative in up to 50% of patients. We present a simple inexpensive technique to allow accurate localization of a bleeding site even when the angiogram is negative. We feel that this is a viable alternative to emergency surgery.
Active Extravasation
to Angiography –40% to –60% –20% to –40%
’
SUNDAY: Scientific Sessions
References
4:03 PM
Abstract No. 18
Empiric embolization of lower gastrointestinal hemorrhage using nuclear medicine bleeding scan localization
1. Syed MI, Shaikh A. Accurate localization of life threatening colonic hemorrhage during nuclear medicine bleeding scan as an aid to selective angiography. World J Emerg Surg. 2009 May 27;4:20. 2. Gillespie CJ, Sutherland AD, Mossop PJ, Woods RJ, Keck JO, Heriot AG. Mesenteric embolization for lower gastrointestinal bleeding. Dis Colon Rectum.2010 Sep;53(9):1258-64. Sunday
Scientific Session 3
T. Akhter1, T. Akhter1, M. Syed2, H. Chaudhry3, S. Patel4, A. Shaikh4; 1Temple University Hospital, Philadelphia, PA; 2Dayton Interventional Radiology, Springfield, OH; 3 CMH Lahore Medical College, Beavercreek, OH; 4Dayton Interventional Radiology, Dayton, OH. Purpose: To propose an efficient therapy to treat lower gastric hemorrhage via empiric superselective embolization using nuclear medicine scan as an aid to localization. Materials: A marker was utilized during the nuclear medicine GI bleeding scan to localize the bleeding site. During angiography, if no active bleed was seen, empiric embolization was performed using up to .4 vials of 500-700 micron embolic particles using a microcatheter, sub-selection of the arterial branch as close as possible to the marker. Embolization was not performed to stasis. IRB approval was obtained. Results: See table. All 10 patients had cessation of bleeding. One patient developed ischemic colitis which responded to conservative management. No patients required surgical colonic resection.
IVC Filters I Sunday, April 3, 2016 3:00 PM – 4:30 PM Room: 116/117 3:00 PM
Abstract No. 19
Electrification of IVC filters with radiofrequency ablation to facilitate removal: ex vivo phantom study R. Seifabadi1, L. Jiang2, V. Krishnasamy3, A. Negussie4, F. Banovac5, B. Wood6; 1National Institute of Health,
Table
Nuclear Medicine Source of Bleed Hepatic flexure Hepatic flexure Splenic flexure Splenic flexure
Angiographically Positive Yes
Hemostasis after Embolization Yes
Etiology of Bleed by Colonoscopy Diverticulosis
No
Yes
Diverticulosis
No
Yes
Unknown
No
Yes
Submucosal vascular ectasia Rectal ulcer due to rectal tube Colorectal carcinoma Diverticulosis Diverticulosis
Age/Sex 70/M
Hb Level on Presentation (g/dL) 11.4
2
84/F
5.4
3
65/F
7
4
55/F
7.9
5
68/M
11
Rectum
Yes
Yes
6
93/M
4
No
Yes
7 8
92/F 81/F
9 10.4
Yes No
Yes Yes
9
80/M
9
Splenic flexure Cecum Sigmoid colon Sigmoid colon
No
Yes
10
85/F
10
No
Yes
Patient # 1
Sigmoid colon
Suspected diverticulosis Diverticulosis