Provocative mesenteric angiography for localizing ambiguous gastrointestinal hemorrhage

Objectives: Five percent of patients with recurrent gastrointestinal (GI) hemorrhage have indeterminate origin by radiological and endoscopic examinations. To improve diagnostic accuracy therapeutic embolization, the technique provocative mesenteric angiography (PMA) has been developed. It involves addition pharmacologic agents to standard angiographic protocols induce bleeding. Material Methods: This is an institutional review board-approved, retrospective study 20 who underwent PMA between 2014 2019. All had clinical evidence GI without a definite source. consisted anticoagulation 5000 units heparin selective transcatheter injection up 600 μg nitroglycerine, followed slow infusion 24 mg tissue plasminogen activator into arterial distribution highest suspicion artery. Results: Among PMA, 11/20 (55%) resulted in angiographically visible extravasation. Of these 11 patients, nine successful embolization coil or glue were discharged upon achieving hemodynamic stability. Two spontaneously stopped In our series, treatment 9/20 (45%) hemorrhage. No procedure-associated complications reported during procedure their course hospitalization. Conclusion: experience, effective safe approach localizing treating source bleeding about half otherwise unidentifiable