非外傷性動脈性消化管出血に対するIVR

DOI
  • 矢田 晋作
    鳥取大学医学部　病態解析医学講座　画像診断治療学分野

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  • IVR for Non-traumatic Arterial Bleeding of Gastrointestinal Tract

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Non-traumatic arterial bleeding of gastrointestinal (GI) tract is associated with potential morbidity and mortality. When it fails to achieve hemostasis by an endoscopic measure, transcatheter arterial embolization (TAE) is a good treatment option with a high rate of hemostasis and a low rate of ischemic complication. Various kinds of embolic materials including gelatin sponge particles, metallic coils, and N-butyl-2-cyanoacrylate (NBCA) may be used. Each embolic agent has its own characteristics, benefits and drawbacks that interventionalists need to be familiar with. The choice of embolic agent depends on a combination of the bleeding location, vascular anatomy, achievable catheter position, and the operator’s preference. Evaluation of the angiographic findings is also important. Not only direct signs of GI bleeding like extravasation of contrast medium, but also indirect signs including pseudoaneurysm, vessel spasm or cutoff, and increased vascularity must not to be missed. Provocative angiography or empiric embolization may be useful when the bleeding site cannot be identified angiographically. Compared with TAE, intraarterial vasopressin infusion therapy has disadvantages of a high recurrent bleeding rate and a long-term placement of catheter, but is still probably preferable for diffuse lesions.

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