Embolization

FIRST THERAPEUTIC ARTERIAL GI EMBOLIZATION
Performed November 1, 1970

A 43 year old female with cirrhosis, gastric ulcer and recurrent GI bleeding. Following an episode of severe hematemesis, she was admitted to the hospital in moderate shock, with icterus, ascites and impaired liver function with significant coagulation defect. Emergency visceral arteriography demonstrated active bleeding in gastric antrum from the right gastroepiploic artery, presumably from an ulcer.

	A) selective gastroduodenal angiogram B) after blood clot injection

A 60 minute infusion of epinephrine into common hepatic artery at a rate of 20 micrograms per minute resulted in extensive vasoconstriction. Bleeding was controlled and bloody gastric lavage cleared.

Bleeding, however, recurred after epinephrine infusion. Consulting surgeons agreed with our suggestion of selective arterial occlusion because patient was a poor surgical candidate.

Right gastroduodenal artery was selectively catheterized and its angiogram revealed again extravasation. After a 20 minute infusion of epinephrine to constrict the right gastroepiploic artery a 2 cc of autogenous blood clot was injected through the catheter.

	14 hour follow-up

Follow-up angiography disclosed marked vasoconstriction and clot in the gastroduodenal artery. Clinically bleeding stopped, gastric lavage cleared and hematocrit stabilized, no further transfusions were needed. Follow-up angiography 14 hours after embolization showed a localized occlusion of the gastroepiploic artery and no bleeding.

Although no further bleeding occurred, the patient's liver failure continued to deteriorate, hepatorenal syndrome developed and she died 13 days after embolization. Autopsy showed advanced Laennec cirrhosis, renal tubular necrosis and bilateral pneumonia. Stomach contained large ulcer at the greater curvature. The central part of the right gastroepiploic artery was occluded for 4 cm by a fixed partially organized thrombus.