Refractory bleeding from gastroduodenal ulcers: arterial embolization in high-operative-risk patients

GOALS AND BACKGROUND: We evaluated the efficacy and medium-term outcomes of transcatheter embolization to control massive bleeding from gastroduodenal ulcers after failed endoscopic treatment in high-operative-risk patients. STUDY: Retrospective study of 35 consecutive emergency embolization procedures in hemodynamically unstable patients (24 men, 11 women, mean age 71+/-11.6 y) referred from 1999 to 2006 for selective angiography after failed endoscopic treatment. Mean follow-up was 27 months. RESULTS: Endovascular treatment was feasible in 33 patients and consistently stopped the bleeding. "Sandwich" coiling of the gastroduodenal artery was performed in 11 patients and superselective occlusion of the terminal feeding artery with glue, coils, or gelatine particles in 22 patients. Early rebleeding occurred in 6 patients and was managed successfully using endoscopy (n=2), reembolization (n=1), or surgery (n=3). No major complications related to catheterization occurred. Seven patients died within 30 days of embolization and 3 died later during the follow-up, but none of the deaths were due to rebleeding. No late bleeding recurrences were reported. CONCLUSIONS: Selective angiographic embolization is safe and effective for controlling life-threatening bleeding from gastroduodenal ulcers, usually obviating the need for emergency surgery in critically ill patients, whose immediate survival depends on their underlying conditions.