What IR (Interventional Radiology) embolization procedure is indicated for a CT (Computed Tomography) abdomen pelvis showing focal active extravasation in the midportion of the ascending colon?

From the Guidelines

For a CT abdomen pelvis showing focal active extravasation in the midportion of the ascending colon, the indicated interventional radiology procedure is a selective mesenteric angiography with embolization of the right colic artery or its branches, as this approach allows for targeted treatment of the bleeding vessel while preserving surrounding tissue perfusion as much as possible 1.

Procedure Details

The procedure involves accessing the arterial system through the femoral artery, navigating a catheter to the superior mesenteric artery, and then selectively catheterizing the right colic artery or the specific branch supplying the bleeding site.

• Key steps include:
  • Accessing the arterial system through the femoral artery or left radial artery
  • Navigating a catheter to the superior mesenteric artery
  • Selectively catheterizing the right colic artery or the specific branch supplying the bleeding site
  • Deploying embolization materials such as microcoils or glue (N-butyl 2-cyanoacrylate) to occlude the vessel and stop the hemorrhage

Rationale

This approach is supported by recent studies, including the 2024 consensus recommendations on the role of imaging for GI bleeding, which suggest that CA with embolization can be used as the primary treatment modality in unstable patients with active extravasation at CTA 1.

• The goal of embolization is to decrease the blood flow to the bleeding site to achieve hemostasis while maintaining collateral perfusion to prevent ischemia of the bowel 1.
• The use of a microcatheter allows for distal access and superselective embolization of single vasa recta at the site of bleeding, reducing the risk of ischemic complications 1.

From the Research

IR Embolization Procedure Indications

The IR embolization procedure indicated for a CT abdomen pelvis showing focal active extravasation in the midportion of the ascending colon is:

• Transcatheter arterial embolization (TAE) 2

Active Extravasation Detection

Active extravasation can be detected using:

• Contrast-enhanced CT scans, which can show the anatomic location of bleeding and indicate the probable vascular origin 3, 4, 5
• Contrast-enhanced sonography, which can detect contrast leakage and is useful in the assessment and management of abdominal emergencies 6

Clinical Implications

The finding of active extravasation in blunt or penetrating trauma patients has significant clinical and management implications, including:

• The need for immediate surgical or interventional treatment 3, 4, 5
• The use of TAE as a safe and effective procedure to control mesenteric bleeding 2

Location and Outcome

The location of active extravasation is predictive of the type of subsequent clinical management, with:

• Solid organ, gastrointestinal/mesenteric, and pelvic sources of bleeding showing a higher likelihood of requiring subsequent intervention or dying 5
• Colon as the site of bleeding being a significant risk factor for bowel necrosis 2