Safety and efficacy of provocative angiography for localization and treatment of gastrointestinal hemorrhage

Abstract

Purpose

Mesenteric angiography and embolization is an effective treatment of gastrointestinal bleeding. In the setting of occult bleeding, provocative maneuvers with intra-arterial vasodilators and thrombolytics can increase the diagnostic yield of angiography. This study aimed to assess the clinical outcomes of provocative angiography and factors that increase the positivity rate for active bleeding at the time of provocation.

Methods

An institutional database was used to retrospectively identify patients that underwent provocative angiography for identification and treatment of gastrointestinal bleeding between 2015 and 2024. Patient demographic data, laboratory values, and clinical outcomes were recorded from the electronic medical record. Provocative angiography was performed using intra-arterial injection of heparin, nitroglycerin, and/or tPA.

Results

Provocative angiography identified active gastrointestinal bleeding in 35 % (14/40) of patients. There was no significant difference in age, hemoglobin level, transfusion requirement, ICU admission, or vasopressor requirement between patients that were positive versus negative for bleeding. 50 % (20/40) of patients had undergone prior mesenteric angiography that was negative for active hemorrhage. The mean doses of heparin, nitroglycerin, and tPA were 4973 +/− 2242 U, 507.3 +/− 317.2 μg, and 16.9 +/− 8.3 mg, respectively. Active bleeding was treated successfully in 100 % (14/14) patients. There were no bleeding complications related to provocative maneuvers.

Discussion

Provocative angiography is safe and effective for the identification of intermittent gastrointestinal bleeding during mesenteric angiography. There were no factors identified that increased the likelihood of identification of active bleeding during provocative angiography. There were no bleeding complications related to provocative mesenteric angiography in this study.