In Reply to: Case 497_07 -- Attempted GDA embolization for UGI bleeding posted by Editor on April 18, 1997 at 11:17:10:
GI bleeding is probably one of the most frustrating clinical situations we face in IR.
How to approach a patient who is known to have bled and is not currently bleeding?
There are numerous articles in the literature on different protocols to follow for these types of patients.
These types of patients will usually stop bleeding with conservative medical therapy.
However, if a rebleed occurs it can be catastrophic.
One thing to have considered in this patient is the placement of a Simmons shaped guiding catheter into the SMA.
Through the guide cath a tracker type catheter could be placed into the Inferior Pancreaticoduadenal artery and
maneuvered into the GDA. You could then place a spider coil into the GDA and coil back into the IPDA.
There are also neurointerventional catheters with balloons on the tip that can be placed into the GDA in the same fashion.
The balloon can be inflated to cut down on the blood to allow for accurate coil placement as well.
Another approach is to cannulate the GDA from above and place a balloon tipped catheter and then inject gelfoam pledgets
into the GDA via the IPDA access. I have done a variety of different embolization techniques on these types of patients with
good success at stopping the bleeding. You can get pretty creative given the anatomy in this area.