Endovascular Intervention

Arterial embolization may be used as an alternative to surgery if bleeding is not controlled by endoscopic therapy. The goal of arterial embolization is to decrease the blood pressure at the bleeding site thereby facilitating the formation of an effective clot (Hamlin et al, 1997) Superselective catheterization and the use of resorbable agents avoid tissue ischemia. There is a separate chapter on

GI bleeding (see Chapter 102, "Gastrointestinal Bleeding: Therapeutic Radiologic Approaches").

Gelatin (Gelfoam, Upjohn Corp) is a widely used resorbable agent. When large particles are used, vessel recanalization typically occurs 1 to 3 weeks following resorption. Gastric and bowel infarction is rare, but the risk is increased in patients with prior abdominal surgeries or those with variant vascular anatomy. Therefore, both the celiac and superior mesenteric arterial distributions must be completely visualized prior to embolization to avoid possible gastric and bowel infarctions (Hamlin et al, 1997).

Nonresorbable materials such as coils are used for large bleeding vessels, chronic ulcers, and neoplasms. These materials are necessary to prevent recanalization of the embolized vessel and recurrent bleeding. Coils placed in bleeding vessels may facilitate their identification at surgery (by palpation or under fluoroscopy) should this be necessary.

The left gastric artery supplies the fundus and gastroesophageal junction, whereas the gastroduodenal artery supplies the duodenum, pylorus, and greater curvature. In patients with gastric bleeding, the left gastric artery usually supplies the bleeding vessel and may be embolized safely. Gastric ischemia is rare due to its collateral blood supply and rich submucosal vascular network. In addition to bleeding ulcers, gastric Dieulafoy's lesions have been embolized successfully.

In patients with duodenal bleeding, the gastroduodenal artery or one of its branches is often responsible. The infe-riorpancreaticoduodenal arteries contribute to the dual vascular supply in the duodenum. Superselective catheterization and embolization of the gastroduodenal artery often reduces perfusion pressure sufficiently to initiate hemostasis.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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