SUCCESSFUL EMERGENCY ARTERIAL EMBOLIZATION FOR MASSIVE GASTRODUODENAL BLEEDING IN HIGH-RISK PATIENT. CASE REPORT.

Abstract

Massive upper gastrointestinal bleeding still remains a challenge, which can cause serious clinical problems especially in high-risk patients. We present a rare case of patient with complex pathology successfully managed by endovascular treatment. A 78-year-old man with a medical history of chronic bronchitis, several minor strokes, type II diabetes, a 30-year history of smoking, and a family history of cardiovascular disease, presented with severe pain on the left side of his chest radiating to his left arm. Urgent coronary angiography (CAG) revealed subtotal occlusive thrombosis of the proximal right coronary artery (RCA). An immediate percutaneous coronary intervention (PCI) was conducted and after thrombus aspiration, a 4.0 mm × 30 mm drug-eluting stent (JW Medical Systems) was implanted in the proximal RCA. 12 hours after surgical intervention the patient experienced a sudden syncopal episode. Emergency fibrogastroscopy revealed active gastroduodenal bleeding from a chronic anterior duodenal ulcer measuring 2.0 mm × 1.5 mm. Endoscopic hemostasis failed and due to patient's unfavorable risk factors (hemorrhagic shock, hemodynamic instability, coagulopathy and etc.,) open surgery was considered as a very high-risk procedure according to the Rockall score. As a last and alternative method, the embolization of the gastroduodenal artery was performed via a radial approach, using a hemostatic sponge and embolization coils (Cook Incorporated, USA). The rapid hemostasis was achieved, patient's condition stabilized post-intervention, and he was discharged in satisfactory condition on the 10th day of hospitalization. Our case illustrates that transcatheter arterial embolization is a safe and feasible method of treatment and real alternative to surgery and failed endoscopic approaches especially in complex and high-risk patients.