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SIR 2025

Arterial Interventions

Scientific Session

Session: Embolization

Prognostic Factors and Outcomes of Provocative Mesenteric Angiography for Acute Lower Gastrointestinal Diverticular Bleed: A Multi-Site 5-Year Experience

Tuesday, April 1, 2025
3:45 PM – 3:54 PM CT
Location: Music City Center, 201 AB
Purpose: To evaluate the safety and efficacy of provocative mesenteric angiography for acute lower gastrointestinal bleed (LGIB) due to diverticulosis.

Materials and Methods: In this multi-site retrospective review, we analyzed clinical data and imaging for patients receiving provocative mesenteric angiography (PMA) with tPA for LGIB due to presumed or imaging-confirmed diverticulosis between January 2018 to December 2022. Pre-procedural data and procedural details were collected, including demographic information, vitals, labs, and time interval between CTA and angiography. Post-procedural outcomes including technical/clinical success, inpatient complications, and 30-day morbidity and mortality were assessed.

Results:

Of 26 patients who received PMA for LGIB, 14 showed active extravasation after administration of tPA, with 100% technical success of subsequent coil and/or Gelfoam embolization (p< 0.001). 1 patient with no bleed after tPA was empirically embolized, with pathology from subsequent right hemicolectomy for worsening abdominal pain demonstrating focal ischemia at the embolization site. 



Clinical success was achieved in 8 of 11 patients (73%) with negative PMA who were not embolized, as compared to 8 of 14 (57%) who were embolized for positive PMA (p=0.68). Of 6 patients who rebled following PMA, 3 had been embolized for active bleed and 3 were not embolized (p=1.0).  



5 of 14 patients embolized after positive PMA had endoscopy or pathology-proven bowel ischemia (p=0.046), with 3 requiring bowel resection. However, 27% of patients (n=3) with negative PMA who were not embolized also underwent bowel resection, though for refractory LGIB (p=0.072). 3 of 4 patients readmitted for LGIB-related reasons within 30 days of discharge had been embolized following PMA (p=0.60), with 1 additional patient per group readmitted for reasons unrelated to LGIB.  



There were 2 deaths following PMA with embolization, and no deaths among the non-embolized group (p=0.49). One patient died due to presumed hemorrhagic shock and the other died within 30 days of discharge following resection of necrotic embolized bowel. 



Conclusion: While provocative angiography can increase the likelihood of localizing intermittent diverticular LGIB – particularly when endoscopy or conventional angiography have failed – the procedure carries significant risk of bowel ischemia, rebleeding, and death. Though limited by small sample size, our review demonstrates mixed clinical efficacy of embolization following positive PMA and no statistically significant prognostic factors for predicting clinical success.