Revisiting the past: Intra-arterial vasopressin for severe gastrointestinal bleeding in Crohn's disease
Revisiting the past: Intra-arterial vasopressin for severe gastrointestinal bleeding in Crohn's disease
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DOI：
10.1016/j.crohns.2010.02.011
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发表时间：
2010-10-01
影响因子：
8
通讯作者：
Yellapu, Radha Krishna
中科院分区：
文献类型：
--
作者：
Alla, Venkata M. B.;Ojili, Vijayanadh;Yellapu, Radha Krishna
过去几十年的技术进步使栓塞的安全性和有效性得到了极大的改善，使其成为血管造影阳性下消化道出血的首选治疗干预。加压素因此被遗忘了，它几乎从来没有使用的当代干预。然而，弹簧圈栓塞在技术上具有挑战性，需要更多的专业知识。超选择性导管插入困难和缺乏足够的侧支也会妨碍弹簧圈的成功输送。在这篇文章中，我们提出了成功地使用动脉血管加压素的病人与克罗恩氏病严重下消化道出血。尽管不是首选，但加压素可以安全有效地用于不适合栓塞治疗的选定患者。本文的目的是讨论血管加压素维斯栓塞的相对优点和缺点，并确定血管加压素在当今超选择性栓塞时代的作用。动脉内加压素输注成功控制下消化道大出血以前仅在克罗恩病中报告过一次。我们建议，这种技术可以用来试图避免这些患者的手术。(C)2010年欧洲克罗恩病和结肠炎组织。Elsevier B.V.出版，保留所有权利。
Technological advances in the last couple of decades have led to a tremendous improvement in the safety and efficacy of embolization making it the therapeutic intervention of choice in angiogram positive lower gastrointestinal bleeding. Vasopressin has thus been forgotten and it is hardly ever used by the current generation of interventionists. However, coil embolization is technically challenging and requires greater expertise. Difficulty in super-selective catheterization and lack of adequate collateralization can also prevent successful delivery of coils. In this article we present the successful use of intra-arterial vasopressin in a patient with Crohn's disease with severe lower gastrointestinal bleeding. Despite not being the first choice, vasopressin can be safely and effectively used in selected patients who are not candidates for embolotherapy. The purpose of this article is to discuss the relative merits and demerits of vasopressin vis-a-vis embolization and to identify the role of vasopressin in the current era of super-selective embolization. Successful control of massive lower gastrointestinal bleeding by intra-arterial vasopressin infusion has previously been reported only once before in Crohn's disease. We suggest that this technique may be used in an attempt to avoid surgery in these patients. (C) 2010 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.