Relationship between angiography timing and angiographic visualization of extravasation in patients with acute non-varic
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RESEARCH ARTICLE
Open Access
Relationship between angiography timing and angiographic visualization of extravasation in patients with acute non‑variceal gastrointestinal bleeding Chungjo Choi1, Hyun Lim1* , Min‑Jeong Kim2, Bo Young Lee1, Sung‑Yeun Kim1, Jae Seung Soh1, Ho Suk Kang1, Sung Hoon Moon1 and Jong Hyeok Kim1
Abstract Background: Angiographic embolization is now considered the first-line therapy for acute gastrointestinal (GI) bleeding refractory to endoscopic therapy. The success of angiographic embolization depends on the detection of the bleeding site. This study aimed to identify the clinical and procedural predictors for the angiographic visualization of extravasation, including angiography timing, as well as analyze the outcomes of angiographic embolization accord‑ ing to the angiographic visualization of extravasation. Methods: The clinical and procedural data of 138 consecutive patients (mean age, 66.5 years; 65.9% men) who underwent angiography with or without embolization for acute non-variceal GI bleeding between February 2008 and July 2018 were retrospectively analyzed. Results: Of the 138 patients, 58 (42%) had active extravasation on initial angiography and 113 (81.9%) underwent embolization. The angiographic visualization of extravasation was significantly higher in patients with diabetes (p = 0.036), a low platelet count (p = 0.048), high maximum heart rate (p = 0.002) and AIMS65 score (p = 0.026), upper GI bleeding (p = 0.025), and short time-to-angiography (p = 0.031). The angiographic embolization was successful in all angiograms, with angiographic visualization of extravasation (100%). The clinical success of patients without angiographic visualization of extravasation (83.9%) was significantly higher than that of patients with angiographic visualization of extravasation (65.5%) (p = 0.004). In multivariate analysis, the time-to-angiography (odds ratio 0.373 [95% CI 0.154–0.903], p = 0.029) was the only significant predictor associated with the angiographic visualization of extravasation. The cutoff value of time-to-angiography was 5.0 h, with a sensitivity and specificity of 79.3% and 47.5%, respectively (p = 0.012). Conclusions: Angiography timing is an important factor that is associated with the angiographic visualization of extravasation in patients with acute GI bleeding. Angiography should be performed early in the course of bleeding in critically ill patients. Keywords: Angiography, Endovascular, Gastrointestinal bleeding, Trans-arterial embolization
*Correspondence: [email protected] 1 Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong‑ro 170‑gil, Dongan‑gu, Anyang 431‑796, Republic of Korea Full list of author information is available at the end of the article
Background Acute gastrointestinal (GI) bleeding is a medical emergency with a mortality rate ranging from 8 to 14% [1–3]. After initial assessment and hemodynamic resuscitation, urgent endoscopy is the treatment of choice for patie
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