Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2018 Vol. 26 No 2

GENERAL & SPECIAL SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2018.2.169   |  

YU.V. AVDOSYEV 1, 2, I.V. BELOZEROV 2, O.N. KUDREVICH 2

ENDOVASCULAR METHODS OF DIAGNOSIS AND TREATMENT OF ACUTE HEMORRHAGES IN THE GASTROINTESTINAL TRACT LUMEN

Institute of General and Emergency Surgery named after V. T. Zaitsev of National Academy of Medical Sciences of Ukraine 1,
Kharkiv National University named after V.N. Karazin 2,
Kharkiv, Ukraine

Objective. To assess the effectiveness of endovascular diagnosis and treatment methods of acute gastrointestinal hemorrhage.
Methods. The paper summarizes the experience of angiographic diagnosis and endovascular treatment of 342 patients who were admitted to the Institute of General and Emergency Surgery named after V. T. Zaitsev with a clinical picture of bleeding in the lumen of the gastrointestinal tract for the period from 1998 to 2016. There were 145 (42.4%) women and 197 (57.6%) men aged 16 to 77 years (mean age 59.311.1 years) among the patients.
Results. As the study has established the most informative method was superselective arteriography, which permitted to reveal both direct and indirect angiographic signs of gastrointestinal hemorrhage. Thus, in 63 (18.4%) patients the direct signs of continuing bleeding were diagnosed. In 272 (79.5%) examined patients, the indirect angiographic signs of stopped bleeding were revealed. A higher percentage of indirect signs of bleeding is associated with both the chronic course of the underlying disease and the characteristic angiographic pattern for a particular gastrointestinal disease complicated by bleeding and with stopping of active bleeding by the time of angiography.
Based on the clinical examination and angiographic data, a direct source of gastrointestinal hemorrhage was diagnosed in 215 (62.8%) patients.
Conclusions. The conducted study has confirmed that selective angiography of the branches of the abdominal aorta and iliac arteries is a highly informative diagnostic method and in 62.8% of observations it was possible to establish the source and localization of bleeding. In patients with ongoing gastrointestinal hemorrhage and questionably tolerance of surgical intervention, the endovascular hemostasis is often a choice of treatment of these patients. Differentiated using of both primary and repeated (in case of recurrent bleeding), the endovascular methods of hemostasis in patients with acute gastrointestinal hemorrhage allowed achieving final hemostasis in 90.4% of cases.

Keywords: gastrointestinal hemorrhage, diagnosis of bleeding, angiography, surgical treatment, X-ray endovascular hemostasis
p. 169-178 of the original issue
References
  1. Vertkin AL, Sveshnikov KA. Natsionalnoe rukovodstvo po skoroi pomoshchi. Moscow, RF: EKSMO; 2012. 816 p. (in Russ.)
  2. Fallah MA, Prakash C, Edmundowicz S. Acute gastrointestinal bleeding. Med Clin North Am. 2000 Sep;84(5):1183-208.
  3. Pantsyrev IuM, Mikhlev AI, Fedorov ED, Kuzeev EA. Lechenie iazvennykh gastroduodenalnykh krovotechenii. Khirurgiia Zhurn im NI Pirogova. 2000;(3):21-25. (in Russ.)
  4. Krylov NN. Krovotechenie iz verkhnikh otdelov pishchevaritelnogo trakta: prichiny, faktory riska diagnostika, lechenie. Ros Zhurn Gastroenterologii Gepatologii i Koloproktologii. 2001;11(2):76-87. (in Russ.)
  5. Nikishin LF, Altman IV, Kondratiuk VA, Vereshchagin SV. Lechenie ostrykh zheludochno-kishechnykh krovotechenii metodami rentgenoendovaskuliarnoi khirurgii. Rentgenokhrurgia nevdkladnikh stanv. Nove v nterventsini radolog: materialy dokl; 1997 Apr 24-26; Chernigov, Ukraina. p. 84-87. (in Russ.)
  6. Avdosev IuV, Boiko VV. Angiografiia i rentgenendovaskuliarnaia khirurgiia abdominalnykh krovotechenii: monogr. Kharkov, Ukraina: Izdatel Savchuk OO; 2011. 648 p. (in Russ.)
  7. Nanavati SM. What if endoscopic hemostasis fails? Alternative treatment strategies: interventional radiology. Gastroenterol Clin North Am. 2014 Dec;43(4):739-52. doi: 10.1016/j.gtc.2014.08.013.
  8. Dallal HJ, Palmer KR. ABC of the upper gastrointestinal tract: Upper gastrointestinal haemorrhage. BMJ. 2001 Nov 10;323(7321):1115-17.
  9. Annamalai G, Masson N, Robertson I. Acute gastrointestinal haemorrhage: investigation and treatment. Imaging. 2009;21(Is 2):142-51.
  10. Walker TG, Salazar GM, Waltman AC. Angiographic evaluation and management of acute gastrointestinal hemorrhage. World J Gastroenterol. 2012 Mar 21;18(11):1191-201. doi: 10.3748/wjg.v18.i11.1191.
  11. Teng HC, Liang HL, Lin YH, Huang JS, Chen CY, Lee SC, Pan HB. The Efficacy and long-term outcome of microcoil embolotherapy for acute lower gastrointestinal bleeding. Korean J Radiol. 2013 Mar-Apr; 14(2): 259-68. Published online 2013 Feb 22. doi: 10.3348/kjr.2013.14.2.259.
Address for correspondence:
61000, Ukraine,
Kharkiv, Svoboda Square, 6,
Kharkiv National University
named after V.N. Karazin,
Department of Surgical Diseases,
Operative Surgery and Topographic Anatomy,
Tel. +380 50 902-72-72,
e-mail: b0risfen@ukr.net,
Kudrevich Olexandr N.
Information about the authors:
Avdosyev Yuriy V., MD, Head of the X-ray Surgery Unit, Institute of General and Emergency Surgery named after V. T. Zaitsev of National Academy of Medical Sciences of Ukraine, Professor of the Department of Surgical Diseases, Operative Surgery and Topographic Anatomy of the Medical Faculty, Kharkiv National University named after V.N. Karazin, Kharkiv, Ukraine.
http://orcid.org/0000-0002-2677-4464.
Belozerov Igor V., MD, Dean of the Medical Faculty, Kharkiv National University named after V.N. Karazin, Kharkiv, Ukraine.
http://orcid.org/0000-0002-7567-6449.
Kudrevich Olexandr N., PhD, Head of the Department of Surgical Diseases, Operative Surgery and Topographic Anatomy of the Medical Faculty, Kharkiv National University named after V.N. Karazin, Kharkiv, Ukraine.
http://orcid.org/0000-0002-2086-8822.
Contacts | ©Vitebsk State Medical University, 2007