Medicine of the Future in America

Embolization of a duodenal arteriovenous malformation: DISCUSSION (Part 4)

small bowel AVMs treated by embolizationThere are no reports of small bowel AVMs treated by embolization in patients with HHT; however, there have been reports in non-HHT patients. In patients undergoing embolization for acute nonvariceal GIH, the bleeding lesion was devascularized by embolization in 39 of 40 patients . The most common source of bleeding in these patients were ulcers. In one non-HHT patient, a jejunal AVM was the source of bleeding and showed intermittent contrast medium extravasation during angiography . The jejunal artery was embolized with polyvinyl alcohol and the patient was asymptomatic for four months. However, when melena recurred, angiography was used to demonstrate revascularization of the previously embolized lesion. The microcatheter was then used for methylene blue marking to direct laproscopic resection of the involved jejunum and the patient was free of symptoms at 18 months.

Poon and Poon described a duodenal AVM in a patient who did not have HHT. This lesion was embolized using Gelfoam absorbable gelatin sponge (Pharmacia & Upjohn, USA); however, the lesion continued to bleed and the patient underwent laparotomy and ligation of the gastroduodenal artery. In a review of patients who underwent transcatheter embolic occlusion of the gastroduodenal artery for treatment of duodenal bleeding, Granmayeh et al described one patient who had a vascular abnormality as the cause of GIH. Occlusion with wire coils successfully controlled bleeding in this patient for one year. The patient later re-bled and was successfully treated with occlusion of collaterals. Furthermore, Palmaz et al described two patients with small bowel AVMs who were successfully treated with selective embolization of jejunal and ileal arteries. Cheapest drugs online – buy viagra super active online for you to spend less money every time.

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