The efficacy and durability of super-selective embolization in the treatment of lower gastrointestinal bleeding

Purpose: This study was designed to identify the short-term safety and efficacy of super-selective embolization for lower gastrointestinal bleeding and to examine the long-term durability. Methods: Outcomes of patients who underwent super-selective embolization for lower gastrointestinal bleeding from January 1999 to September 2005 were identified retrospectively at a single institution. Results: Seventy-five hospitalizations (71 patients) were identified. Mean age was 73 years. Short-term outcomes: this technique was successful in achieving immediate hemostasis in 73 of 75 cases identified (97 percent). Twelve patients (16 percent) rebled, eight required surgery, and four were successfully reembolized. Five patients (7 percent) developed postembolization ischemia: four required operations, and one was followed clinically. Long-term outcomes: 52 patients were followed for a mean of 32 months. Eight patients were readmitted for recurrent bleeding: four required surgeries, one was successfully reembolized, and the remaining three patients were followed clinically. Conclusions: This large series reaffirms the high success rate (97 percent) and relatively low acute ischemia risk (7 percent) of super-selective embolization for lower gastrointestinal bleeding. Furthermore, only 15 percent of patients ultimately required readmission for recurrent bleeding. It is our recommendation that super-selective embolization be used as the primary therapeutic modality in the treatment of angiogram positive lower gastrointestinal bleeding.