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Titolo:
Nonlocalized lower gastrointestinal bleeding: Provocative bleeding studieswith intraarterial tPA, heparin, and tolazoline
Autore:
Ryan, JM; Key, SM; Dumbleton, SA; Smith, TP;
Indirizzi:
Duke Univ, Med Ctr, Div Vasc & Intervent Radiol, Durham, NC 27710 USA DukeUniv Durham NC USA 27710 sc & Intervent Radiol, Durham, NC 27710 USA
Titolo Testata:
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY
fascicolo: 11, volume: 12, anno: 2001,
pagine: 1273 - 1277
SICI:
1051-0443(200111)12:11<1273:NLGBPB>2.0.ZU;2-H
Fonte:
ISI
Lingua:
ENG
Soggetto:
OBSCURE ORIGIN; HEMORRHAGE; ANGIOGRAPHY; EXPERIENCE; EMBOLIZATION; ARTERIOGRAPHY; SCINTIGRAPHY; DIAGNOSIS; CT;
Keywords:
angiography, mesenteric; gastrointestinal tract, hemorrhage;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
27
Recensione:
Indirizzi per estratti:
Indirizzo: Ryan, JM Duke Univ, Med Ctr, Div Vasc & Intervent Radiol, Box 3808,Erwin Rd, Durham, NC 27710 USA Duke Univ Box 3808,Erwin Rd Durham NC USA 27710 ham, NC 27710 USA
Citazione:
J.M. Ryan et al., "Nonlocalized lower gastrointestinal bleeding: Provocative bleeding studieswith intraarterial tPA, heparin, and tolazoline", J VAS INT R, 12(11), 2001, pp. 1273-1277

Abstract

PURPOSE: The purpose of this study was to assess the efficacy and safety of provocative mesenteric angiography with tissue plasminogen activator (tPA), heparin, and tolazoline in patients with nonlocalized lower gastrointestinal (LGI) bleeding. Results were examined to assess the clinical impact ofthe study on patients who had positive or negative results from elective provocative bleeding studies. MATERIALS AND METHODS: Seventeen provocative bleeding studies for occult LGI bleeding were performed in 16 patients, nine of whom were women, aged 44-79 years. All patients had negative results from previous endoscopic and angiographic studies. Patients' requirements for blood transfusion ranged from 6 to 69 units. Studies were performed electively. Blood group matching and cross-matching were performed for all patients. To provoke bleeding, a combination of intravenous heparin, intraarterial tolazoline, and intraarterial tPA was used. Doses used included 3,000-10,000 U heparin, 25-100 mg intraarterial tolazoline, and 10-50 mg intraarterial tPA (mean, 20.3 mg). Duration of follow-up was 3-34 months. RESULTS: Seventeen elective provocative studies were performed in 16 patients with occult LGI bleeding, leading to provoked bleeding in six patients (37.5%). In addition, two previously undiagnosed vascular abnormalities were diagnosed, which did not bleed during provocation. Therefore, an abnormality was identified in eight of 16 patients (50%) overall. There were no procedural complications encountered during or after any of the 17 procedures. In six patients in whom bleeding was successfully provoked, four bleeding episodes occurred in the large bowel and two occurred in the small bowel. Five of the positively provoked patients had a previously positive tagged red cell scintigraphic study. Three patients had superselective embolization at the time of provoked bleeding. Two were treated with estrogen therapy, and one patient was treated palliatively. Five of these six patients required no further therapy for LGI bleeding. Ten patients (including two with vascular abnormalities) did not bleed during the provoked study with tPA. Follow-up of the group of eight patients with completely normal study results ranged from 3 to 34 months in duration, and during the follow-up period, five patients experienced repeated bleeding and one had no further bleeding. One patient was diagnosed with an ileal vascular lesion during subsequent intraoperative enteroscopy and underwent surgical resection. One patient was lost to follow-up. CONCLUSION: Intraarterial provocative mesenteric angiography with heparin,vasodilator, and tPA identified the site of bleeding in 37.5% of patients in our study group and contributed to treatment in 50%. This small study indicates that the procedure appears to be safe, with no complications encountered in this series. Larger prospective studies are needed to fully assessthe safety and efficacy of the technique and to optimize the pharmacologicprotocol and patient selection.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 09/04/20 alle ore 13:00:42