Celiac artery-superior mesenteric artery (SMA) watershed zone
Near ligament of Treitz
Some hemorrhages can be supplied by both celiac artery and SMA
Specifically, 2nd and 3rd portions of duodenum
Upper and midesophagus are supplied by short aortic branches
Lower esophagus is supplied by left gastric artery; branch of celiac artery
Epidemiology
~ 375,000 patients receive treatment for arterial GI hemorrhage in USA annually
> 80% have UGI source
Prior to introduction of endoscopic/endovascular treatments, mortality was 25%; it is now ~ 5%
Causes of UGI hemorrhage
~ 70% of UGI hemorrhage are due to gastric or duodenal ulcer disease of erosive gastritis/duodenitis
Secondary causes of UGI hemorrhage
Mallory-Weiss tear: ~ 6%
Cancer: ~ 4%
Other: ~ 20%
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Expected Outcome
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Expected Outcome
Selected References
Dariushnia SR et al: Society of Interventional Radiology quality improvement standards for percutaneous transcatheter embolization. J Vasc Interv Radiol. 32(3):476.e1-33, 2021
Mujtaba S et al: Diagnosis and management of non-variceal gastrointestinal hemorrhage: a review of current guidelines and future perspectives. J Clin Med. 9(2), 2020
Vora P et al: Thirty-year incidence and mortality trends in upper and lower gastrointestinal bleeding in Finland. JAMA Netw Open. 3(10):e2020172, 2020
Warhadapande S et al: Clinical approach to and work-up of bleeding patients. Semin Intervent Radiol. 37(1):24-30, 2020
Foltz G et al: Embolization of nonvariceal upper gastrointestinal hemorrhage complicated by bowel ischemia. Semin Intervent Radiol. 36(2):76-83, 2019
Aquarius M et al: Prospective multicenter validation of the Glasgow Blatchford bleeding score in the management of patients with upper gastrointestinal hemorrhage presenting at an emergency department. Eur J Gastroenterol Hepatol. 27(9):1011-6, 2015
Loffroy R et al: Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes. Diagn Interv Imaging. 96(7-8):731-44, 2015
Soto JA et al: Gastrointestinal hemorrhage: evaluation with MDCT. Abdom Imaging. 40(5):993-1009, 2015
Dariushnia SR et al: Quality improvement guidelines for diagnostic arteriography. J Vasc Interv Radiol. 25(12):1873-81, 2014
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
TERMINOLOGY
Definitions
Upper gastrointestinal (UGI) hemorrhage
Hemorrhage in territory supplied by celiac artery
Boundary between UGI and lower GI hemorrhage
Celiac artery-superior mesenteric artery (SMA) watershed zone
Near ligament of Treitz
Some hemorrhages can be supplied by both celiac artery and SMA
Specifically, 2nd and 3rd portions of duodenum
Upper and midesophagus are supplied by short aortic branches
Lower esophagus is supplied by left gastric artery; branch of celiac artery
Epidemiology
~ 375,000 patients receive treatment for arterial GI hemorrhage in USA annually
> 80% have UGI source
Prior to introduction of endoscopic/endovascular treatments, mortality was 25%; it is now ~ 5%
Causes of UGI hemorrhage
~ 70% of UGI hemorrhage are due to gastric or duodenal ulcer disease of erosive gastritis/duodenitis
Secondary causes of UGI hemorrhage
Mallory-Weiss tear: ~ 6%
Cancer: ~ 4%
Other: ~ 20%
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Expected Outcome
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Expected Outcome
Selected References
Dariushnia SR et al: Society of Interventional Radiology quality improvement standards for percutaneous transcatheter embolization. J Vasc Interv Radiol. 32(3):476.e1-33, 2021
Mujtaba S et al: Diagnosis and management of non-variceal gastrointestinal hemorrhage: a review of current guidelines and future perspectives. J Clin Med. 9(2), 2020
Vora P et al: Thirty-year incidence and mortality trends in upper and lower gastrointestinal bleeding in Finland. JAMA Netw Open. 3(10):e2020172, 2020
Warhadapande S et al: Clinical approach to and work-up of bleeding patients. Semin Intervent Radiol. 37(1):24-30, 2020
Foltz G et al: Embolization of nonvariceal upper gastrointestinal hemorrhage complicated by bowel ischemia. Semin Intervent Radiol. 36(2):76-83, 2019
Aquarius M et al: Prospective multicenter validation of the Glasgow Blatchford bleeding score in the management of patients with upper gastrointestinal hemorrhage presenting at an emergency department. Eur J Gastroenterol Hepatol. 27(9):1011-6, 2015
Loffroy R et al: Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes. Diagn Interv Imaging. 96(7-8):731-44, 2015
Soto JA et al: Gastrointestinal hemorrhage: evaluation with MDCT. Abdom Imaging. 40(5):993-1009, 2015
Dariushnia SR et al: Quality improvement guidelines for diagnostic arteriography. J Vasc Interv Radiol. 25(12):1873-81, 2014
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