4:10 PM Abstract No. 228 - Intra-arterial CT angiography: the new gold standard for mesenteric embolisation in acute gastrointestinal bleeding

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Purpose There is limited evidence describing the role of Intra-Arterial CT Angiography (IACTA) in the investigation of acute bleeding of the gastrointestinal tract (BGIT). We aim to compare the sensitivity of IACTA with respect to conventional mesenteric digital subtraction angiography (DSA), in identifying the bleeding vessel (BV) and region of bleed (RB). We also aim to determine the complications and outcomes of IACTA, and positive predictors of IACTA. Materials and Methods The hospital data of patients who underwent both DSA and IACTA for BGIT in our institution from September 2008 to February 2012 was reviewed. 34 procedures in 31 patients (16 males, 15 females), mean age 61.9 years (range 25 to 88 years), were included in the study. The comorbidities of the patients were compiled and graded using Charlson Comorbidity Index (CCI) (1). The DSA and IACTA images were compared to determine the BV and RB. Univariate analysis was performed to determine any relationship between the pre-procedural clinical parameter and the positive predictors for bleeding on DSA and IACTA. In 4 procedures, the bleeding spontaneously stopped on table prior to the patient undergoing IACTA and these were excluded from the analyses. There were 23 lower BGIT cases and 11 upper BGIT cases. Results Out of 30 IACTAs, 19 identified the RB compared with 13 for DSA (p=0.03), and 11 identified the BV compared with 8 for DSA (p=0.25). Embolisation was performed in 11 (32.4%) procedures. Overall complication rate was 14.7% (n=5) with all being minor. In the cohort, 11 patients made a full recovery, 10 required surgical intervention, 5 endoscopy and another 5 repeat mesenteric angiogram. 30 day mortality was 8.8% (n=3). Higher CCI score, prolonged PT and lower systolic BP were associated with a positive DSA and IACTA (p Conclusion IACTA has a superior sensitivity in detecting BGIT compared to DSA. A negative IACTA can reduce the amount of time and radiation expended in detecting BGIT. IACTA is a promising modality and prospective multicentre studies are needed to further establish its role in the management of BGIT.