Angiographic diagnosis and transcatheter treatment of duodenal hemorrhage. A: Celiac digital subtraction angiography (DSA) arteriogram obtained in a patient with copious bleeding seen endoscopically in the duodenum shows focal contrast extravasation (black arrow) arising from the gastroduodenal artery (GDA); B: An image slightly later in the arterial phase of the DSA shows increasing extravasation (black arrow); C: The GDA was successfully coil embolized using microcoils (black arrowheads) through a microcatheter; D: An superior mesenteric artery DSA arteriogram was performed after the coil embolization in order to exclude any additional contribution to the duodenal hemorrhage from the pancreaticoduodenal arcade, as the duodenum has a rich collateral blood supply.  

Contexts in source publication

Context 1

... angiographic evaluation of a patient with acute gas- trointestinal hemorrhage should begin with the selective catheterization of the artery supplying the most likely site of bleeding, as determined by the available clinical, endoscopic and imaging data. Thus for suspected upper gastrointestinal hemorrhage, the celiac artery should first be evaluated ( Figure 3), followed by the superior mesen- teric artery (SMA), as the latter may contribute to a site of upper gastrointestinal hemorrhage through the pan- creaticoduodenal arcade. The lower gastrointestinal tract, however, is the primary territory within the distribution of the SMA. ...

Context 2

... must carefully choose appropriate sized microcoils how- ever, as a coil that is oversized relative to the target vessel may displace the microcatheter from its superselective position. This could lead to deployment of the microcoil in a non-target location ( Figure 13). Similarly, undersized coils may fail to adequately occlude the target vessel or may lodge distal to the lesion that is to be treated. ...

Context 3

... selective embolotherapy is now used preferentially over vasopressin infusion for treating gastrointestinal hemor- rhage because embolization poses fewer risks and can 1199 March 21, 2012|Volume 18|Issue 11| WJG|www.wjgnet.com Figure 13 Example of nontarget embolization during treatment of lower gastrointestinal bleeding. A: Superior mesenteric artery arteriogram obtained in a patient with lower gastrointestinal bleeding shows a focal contrast collection (black arrow) arising from a branch of the ileocolic artery; B: A microcatheter was introduced and was subselectively positioned with the tip (long black arrow) immediately proximal to the focal extravasation and a microcoil (black arrow) was placed; C: While attempting to place a second microcoil, the microcatheter tip was displaced proximally resulting in coil placement in a nontarget location (black arrowhead). ...