What blood vessel is cauterized to stop bleeding in angiodysplasia causing a perirectal bleed, the ileocolic artery or the mesenteric artery?

From the Guidelines

For perirectal bleeding due to angiodysplasia, the correct vessel to cauterize to stop the bleeding is the ileocolic artery. This is because angiodysplasia lesions are vascular malformations characterized by dilated, tortuous submucosal vessels that can rupture and cause gastrointestinal bleeding, and when these lesions occur in the right colon, they are supplied by the ileocolic artery, a branch of the superior mesenteric artery 1. During angiography, selective catheterization and embolization of the ileocolic artery can effectively stop bleeding from angiodysplastic lesions in this region. Some key points to consider when managing angiodysplasia include:

• Technical success rates in cases of lower GIB generally range from 73% to 100% 1
• Embolization using coils has demonstrated lower rates of recurrent bleeding than embolization with other agents 1
• N-Butyl cyanoacrylate (NBCA) has also been shown to demonstrate very high technical and clinical success rates with a low complication rate in patients with lower GIB 1 The term "mesenteric artery" is too general, as it could refer to either the superior or inferior mesenteric artery, which supply different portions of the intestine. In the context of angiodysplasia, targeted embolization of the specific feeding vessel (in this case, the ileocolic artery) is the preferred approach for interventional management, as it allows for effective control of bleeding while minimizing the risk of complications 1.

From the Research

Blood Vessel Cauterization for Angiodysplasia

To stop bleeding in angiodysplasia causing a perirectal bleed, the specific blood vessel to be cauterized is not explicitly stated in the provided studies as being either the ileocolic artery or the mesenteric artery for this particular condition. However, we can look at the information provided:

• The study 2 mentions that three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, indicating that the ileocolic artery can be involved in treating angiodysplasia-related bleeding.
• The study 3 discusses a case where infarction resulted from therapeutic embolization of the ileocolic artery in a patient with angiodysplasia, suggesting caution with this approach due to the risk of devascularization of the cecum and appendix.
• The study 4 talks about embolization of branches of the superior and inferior mesenteric arteries for treating colonic hemorrhage, including cases of angiodysplasia, but does not specify the use of these arteries for perirectal bleeds.
• The study 5 describes a case of managing a middle rectal artery pseudoaneurysm with coil embolization for massive lower gastrointestinal bleeding, which is a different condition but shows the use of embolization techniques for bleeding control in the rectal area.

Key Points

• The ileocolic artery has been embolized in cases of cecal angiodysplasia 2.
• Embolization of the ileocolic artery carries a risk of bowel infarction due to its arterial anatomy 3.
• Mesenteric arteries (superior and inferior) have been used for embolization in cases of colonic hemorrhage, including angiodysplasia 4.
• Specific treatment for perirectal bleed due to angiodysplasia is not detailed in the provided studies, but embolization techniques are used for various types of gastrointestinal bleeding.