SIR 2024
Arterial Interventions and Peripheral Arterial Disease (PAD)
Tommy Pan, MD (he/him/his)
Interventional Radiology Research Intern
New York University Langone Health
Financial relationships: Full list of relationships is listed on the CME information page.
Wenqiao Wang, BS
MS4
Dell Medical School - University of Texas at Austin
Disclosure information not submitted.
Bedros Taslakian, MD, FCIRSE (he/him/his)
Director of VIR Research Program; Director of Clinical Research Integration
NYU Langone Health
Disclosure information not submitted.
Conventional angiography is an accepted management option for patients with acute lower gastrointestinal bleeding (LGIB). Despite careful patient selection, a substantial proportion of angiograms are negative for arterial injury and no embolization is performed {1}. The purpose of this study is to identify factors predicting the presence of active extravasation on conventional angiography in patients with acute LGIB.
Materials and Methods:
The charts of 31 adults who presented with LGIB and underwent CTA followed by conventional angiography were reviewed retrospectively. Medical records were reviewed for patient demographics, pre-angiography shock or syncope, pre-angiography vital signs, change in hematocrit and hemoglobin, units of packed red blood cells (pRBCs) and fresh frozen plasma (FFP) given, volume of intravenous fluid (IVF) transfused, location of extravasation on CTA, and time to angiography.
Results:
Of the 31 patients, 16 (51.6%) had evidence of active extravasation on angiography and underwent embolization. Multiple logistic regression showed that performing angiography within 180 minutes of the CTA was the only independent predictor of contrast extravasation (p=0.047, OR=7.26). Patients with positive angiography underwent angiography from CTA in 223 ± 168 minutes on average, compared to 307 ± 140 minutes for patients with negative angiography. Patient demographics, pre-angiography shock or syncope, difference in the highest and lowest recorded pre-angiography vitals, change in hematocrit and hemoglobin, units of pRBC and FFP given, volume of IVF transfused, and CTA findings were not predictive of active extravasation (Table 1).
Conclusion: A shorter time interval between CTA and conventional angiography predicts active extravasation in patients with acute LGIB and positive CTA. Patients with a positive CTA should be triaged for rapid angiography to increase the likelihood of detecting an abnormal vascular focus. A larger sample size may be needed to detect additional predictors of active extravasation.