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Clinical Predictors of Arterial Extravasation, Rebleedingand Mortality Following Angiographic Interventions in Gastrointestinal Bleeding

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Prasoon Mohan1, John Manov2, Alexander Diaz-Bode3, Sree Venkat1, Michael Langston4, Akash Naidu2, Rayna Howse1, Govindarajan Narayanan1

1) Department of Interventional Radiology, University of Miami,
2) Department of Radiology, University of Miami,
3) University of Miami School of Medicine,
4) Department of Medicine, University of Florida, Miami, FL, USA

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.273.daz


Background & Aims: The aim of this study was to identify clinical and imaging predictors of arterial extravasation, post embolization rebleeding and 30-day mortality in gastrointestinal (GI) bleeding.

Method: This retrospective study included 114 patients who underwent angiography for upper or lower GI bleeding. Multivariate logistic regression was used to identify clinical and imaging predictors.

Results: Angiography demonstrated arterial extravasation in 22 patients (19%) and embolization was performed in 48 (42%) patients including prophylactic embolization in 26 (56%). Fall in hemoglobin level from baseline was an independent predictor of arterial extravasation with 65% increased odds for every unit drop (OR 1.65, 95%CI 1.13-2.40, p=0.01). Age <60 years was a negative predictor of rebleed within 30-days (OR 0.94, 95%CI 0.89-1.00, p=0.04). Patients with a history of malignancy were more likely to rebleed (OR 4.4, 95%CI 1.06-18.36, p=0.04). Hemodynamic instability prior to angiography (OR 13.22, 95%CI 1.65-106.07, p=0.02), history of malignancy (OR 1.36, 95%CI 1.49-10.49, p=0.01), number of units of platelets transfused (OR 1.42, 95%CI 1.02-1.97, p=0.04) and rebleed after angiography (OR 46.8, 95%CI 4.80-456.14, p<0.01) were predictors of 30-day mortality. Prophylactic embolization was not a predictor of rebleed or 30-day mortality.

Conclusions: This paper identified important clinical predictors of arterial extravasation, rebleed and 30-day mortality in GI bleedings, which will assist in patient selection and help to improve the overall angiographic management of GI bleeding.

Key words: Embolization − upper gastrointestinal bleeding − lower gastrointestinal bleeding − mesenteric angiography.

Abbreviations: CT: computed tomography; CTA: computed tomography angiography; FFP: fresh frozen plasma; GI: gastrointestinal; INR: International Normalized Ratio; IRB: institutional review board; PACS: Picture Archiving and Communication System; pRBC: packed red blood cells; PT: prothrombin time; TAE: transcatheter angiographic embolization.