An abdominal CT scan with contrast and/or a CT angiography (CTA) scan was then obtained. If signs of active bleeding (contrast pooling and/or extravasation) or pseudoaneurysm were observed on the CT scan, angiography was suggested. If there was no active bleeding sign but clinical suspicion remained high, with or without unstable vital signs, angiography was also indicated. The right or left common femoral artery was accessed using a puncture needle, which was then exchanged for a size 5 French sheath via the Seldinger technique. An angiogram of the celiac trunk, the superior mesenteric artery, and/or the common hepatic artery was obtained with an angiographic catheter for evaluation of the bleeding site. Positive angiography findings were defined as contrast extravasation/pooling or pseudoaneurysm. After evaluation of the GDA stump, with or without pseudoaneurysm, conservative treatment or TAE was performed. The patients were retrospectively split into three groups, according to their treatment: conservative treatment without embolization (group A), hepatic artery sacrifice/embolization (group B), and GDA stump embolization (group C).
In group A, conservative treatment without TAE was performed under close observation in the intensive care units. This group was divided into two subgroups: subgroup A1, for those who had negative angiography findings, and subgroup A2, for those who had hemodynamically stable vital signs, with positive contrast extravasation and/or pseudoaneurysm.
Two embolization techniques were performed: hepatic artery sacrifice/embolization (group B) and GDA stump embolization (group C). In group B, a microcatheter was advanced through the hepatic artery, distal to the GDA stump. Then, micro-coils were deployed to achieve the embolization of the proper/common hepatic artery, proximal to the GDA stump. After embolization, a complete celiac angiogram was performed to confirm the effects of TAE, such as sacrifice/complete (subgroup B1) or incomplete (subgroup B2) occlusion/embolization of the hepatic artery. The sacrifice of the hepatic artery involves embolism opacification in the hepatic artery, without patent blood flow; incomplete embolization involves embolism opacification in the hepatic artery, with residual partial hepatic artery flow. In group C, selective embolization of the GDA stump and/or pseudoaneurysm was carried out to preserve the hepatic arterial flow. Micro-coils were deployed to achieve the complete occlusion of the GDA stump.
In group A, conservative treatment without TAE was performed under close observation in the intensive care units. This group was divided into two subgroups: subgroup A1, for those who had negative angiography findings, and subgroup A2, for those who had hemodynamically stable vital signs, with positive contrast extravasation and/or pseudoaneurysm.
Two embolization techniques were performed: hepatic artery sacrifice/embolization (group B) and GDA stump embolization (group C). In group B, a microcatheter was advanced through the hepatic artery, distal to the GDA stump. Then, micro-coils were deployed to achieve the embolization of the proper/common hepatic artery, proximal to the GDA stump. After embolization, a complete celiac angiogram was performed to confirm the effects of TAE, such as sacrifice/complete (subgroup B1) or incomplete (subgroup B2) occlusion/embolization of the hepatic artery. The sacrifice of the hepatic artery involves embolism opacification in the hepatic artery, without patent blood flow; incomplete embolization involves embolism opacification in the hepatic artery, with residual partial hepatic artery flow. In group C, selective embolization of the GDA stump and/or pseudoaneurysm was carried out to preserve the hepatic arterial flow. Micro-coils were deployed to achieve the complete occlusion of the GDA stump.
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