Angiography in poor-risk patients with massive nonvariceal upper gastrointestinal bleeding

Article Abstract:

The mortality of patients with massive upper gastrointestinal (GI) bleeding who undergo surgery is about 20 percent. Angiography (X-ray of blood vessels using a radiopaque contrast agent) is helpful in the diagnosis and treatment of this condition in certain populations. This study evaluated the use of angiography in poor-risk patients. These patients (64) had acute, massive upper GI bleeding that required daily transfusions of four or more units of blood. The bleeding was not due to varices or bulging blood vessels. Prior to angiography, endoscopy (viewing the area through a tube with an optical system) was performed in all patients. The endoscopic diagnosis was compared with the diagnosis at angiography. On angiogram, vessels of 39 percent of the patients (25 of 64) showed leakage of the contrast medium, indicating the presence and location of GI bleeding. In over half of these patients, endoscopy either did not reveal bleeding or incorrectly indicated an absence of bleeding. The 25 patients were treated with localized attempts at bleeding control; in 52 percent (13 of 25 patients) these measures were successful and surgery was avoided. Angiography and localized treatment resulted in a 50 percent reduction in mortality. Attempts to control vessels suspected of bleeding without prior angiography were not successful. Most patients who do not have leakage of contrast on angiogram will stop bleeding without surgery. Angiography is a safe and effective procedure that can be used in poor-risk patients to diagnose and treat severe GI hemorrhage that is not due to varices. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Hemorrhage, Angiography, Endoscopy

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Partial portal decompression for variceal hemorrhage

Article Abstract:

To test the hypothesis that partial relief of pressure at one end of a variceal hemorrhage of the portal vein (dilated, and leaking blood vessel) will diminish subsequent encephalopathy (loss of brain function), 50 patients were studied after surgical creation of a tube connecting the largest vein in the body, the vena cava, (which returns systemic blood to the heart) with the large portal vein. The portal vein that collects blood from the gastrointestinal system and passes through the liver. The purpose of this small stoma portacaval shunt was to achieve a pressure difference between the two veins of ten millimeters of mercury. During a follow-up period averaging 26 months, six patients died. Four patients suffered rebleeding, but only one from a variceal hemorrhage. The portacaval shunts remained free of blockage in all patients. Despite reversal or stagnation of the flow of blood in the portal vein in all patients, encephalopathy by direct observation or psychological tests occurred in only three patients. This procedure can be performed with reliably low rates of rebleeding and encephalopathy. That encephalopathy was rare despite a decline in blood flow through the liver via the portal vein suggests that other factors besides a decline in blood flow through the portal vein are the cause of liver failures after this procedure.

Complications and side effects, Surgery, Varicose veins, Vena cava, Venae cavae, Portacaval anastomosis, Portal vein bypass

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A twelve-year survey of cervicothoracic vascular injuries

Article Abstract:

Statistics for a large group of victims of injury to the large blood vessels of the neck or upper chest confirm how lethal these injuries are, since more than half of the victims died. The best treatment for patients who may have damage to these blood vessels includes skilled resuscitation before reaching the hospital, rapid transport to a trauma center, a high suspicion of potential problems, blood-vessel x-rays if there is even a slight indication of vessel trauma, careful surveillance for associated injuries to nerves, breathing passageways, and the digestive tract, and timely surgical repair of injuries, including cutting into the chest to assure control of blood flow.

Case studies, Injuries, Blood vessels, Neck, Chest, Neck injuries, Emergency medicine, Thoracic injuries

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