Medicine of the Future in America

Embolization of a duodenal arteriovenous malformation: DISCUSSION (Part 3)

Medical therapy has a role in the management of GIH in some patients with HHT. Estrogen combined with progesterone has been shown to reduce the transfusion need in patients with bleeding malformations in the gastrointestinal tract, including six patients with HHT . However, estrogen can be poorly tolerated in men . Case reports of using aminocaproic acid have shown conflicting results in reducing the number of blood transfusions required in patients with HHT. Surgical management may be required in some patients with HHT to prevent ongoing GIH in refractory cases and in patients with larger AVMs thought to be less amenable to medical therapy or endoscopic management.

Visceral arteriography and embolotherapy have been shown to be effective for the diagnosis and treatment of GIH in non-HHT patients . The site of hemorrhage can be identified by the location of intraluminal extravasation of contrast material or direct identification of vascular malformations. GIH can then be controlled by the selective infusion of vasoconstrictive drugs such as vasopressin, or by selective embolization with coils, polyvinyl alcohol particles, gelatin sponge or tissue adhesive .

Potential complications of embolotherapy include those related to angiography (groin hematoma, femoral artery injury or thrombosis, embolism, contrast reactions such as anaphylaxis, and contrast-associated renal failure) or those caused by embolization itself (bowel wall ischemia and infarction). Embolization of nontarget organs is possible but unlikely in the hands of experienced interventional radiologists. Superselective embolization is crucial in minimizing the likelihood of gut ischemia, but may be technically quite challenging. In a series of 40 patients reported by Defreyne et al , no bowel complications occurred; however, one partial liver lobe and one partial spleen infarction were noted. Your most trusted pharmacy offering viagra super active online and giving you very fast shipping.

This entry was posted in Hereditary hemorrhagic telangiectasia and tagged Arteriovenous malformation, Gastrointestinal hemorrhage, Hereditary hemorrhagic telangiectasia.
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