Article

Transcatheter vasopressin infusion therapy in the management of acute gastrointestinal bleeding

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Abstract

Development of modern angiographic techniques and the infusion of vasopressin (Pitressin) into selected mesenteric arteries have aided the radiologist in the identification of acute gastrointestinal hemorrhage and subsequent treatment of the patient. The efficacy of selective infusion of vasopressin for control of acute arterial and variceal bleeding is substantiated in recent publications. This study summarizes the experience of the Cleveland Clinic from 1971 to 1974.

Results

This is a retrospective study of 201 patients who underwent arteriography from January 1, 1971, to October 31, 1974, because of a history of either acute or chronic gastrointestinal bleeding. Patients were considered to have acute bleeding if the blood was bright red by nasogastric tube or by rectum, if falling hematocrit necessitated transfusion, or if there was some other evidence of an acute bleed at the time of hospital admission prior to angiography. There were 118 acutely bleeding patients, and 82 were considered to have a chronic bleed. One study was considered technically unsatisfactory. The site of hemorrhage was correctly identified in 61 of the 118 with acute bleeding (52%). In 38 of the 57 patients in whom the site of hemorrhage was not identified, angiography was done at least 48 hours after admission, or there was some clinical indication that hemorrhage had stopped by the time of the angiogram.

Forty-three patients had active arterial bleeding demonstrated by angiography, and 18 patients had evidence of portal hypertension and variceal bleeding. Twenty-three of the 43 with arterial bleeding were given infusions of vasopressin; only . . .


 

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