Abstract No. 252 - Single center interventional radiology experience in the management of gastrointestinal bleeding in patients with ventricular assist devices

Abstract

Purpose Gastrointestinal (GI) bleeding is a well-recognized complication in patients with ventricular assist devices (VADs). Possible mechanisms include use of anticoagulation and development of GI angiodysplasia. Treatment of GI bleeding in this patient population is not well-defined. We aim to study VAD patients with GI bleeding, including an in depth analysis of those patients referred to interventional radiology (IR) for further management. Materials and Methods A single center retrospective review of VAD patients between 2005 and 2011 was conducted. Patients who subsequently developed GI bleeding were identified. Covariates such as gender, age, days on support prior to first episode of bleed, and management of GI bleeding was analyzed. Patients referred to IR were analyzed in detail and the outcomes associated with intervention recorded. Results GI bleeding was common, seen in 23/154 (15%) of VAD patients. Of these, none required surgery for the treatment of recurrent bleeding, and all episodes were managed with supportive, endoscopic or endovascular management. Bleeding was more common with continuous versus pulsatile VADs (21% vs. 4%, p Conclusion GI bleeding is common in VAD patients. When the bleed is localized to the duodenum or stomach, empiric embolization of the GDA or left gastric artery may be of benefit in obtaining hemostasis. If the bleed is localized with angiography, targeted embolization can be performed. In this fragile population, appropriate management is critical to minimize interventions and prevent further recurrence. A management algorithm involving IR could be of great benefit to these patients.