Retrospective Study
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World J Radiol. May 28, 2014; 6(5): 218-222
Published online May 28, 2014. doi: 10.4329/wjr.v6.i5.218
Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed
Pasteur Rasuli, Joseph Doumit, Majdi Boulos, Caroline Rizk, Gaby Doumit
Pasteur Rasuli, Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada
Joseph Doumit, Gaby Doumit, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, United States
Majdi Boulos, Caroline Rizk, Department of Internal Medicine, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada
Author contributions: Rasuli P designed research and revised manuscript; Doumit J designed research and performed data acquisition; Boulos M and Rizk C drafted and reviewed the manuscript; Doumit G designed research and performed statistical analysis; all authors reviewed and approved final version to be published.
Correspondence to: Pasteur Rasuli, MD, Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. prasuli@rogers.com
Telephone: +1-613-7492431 Fax: +1-613-7491990
Received: December 26, 2013
Revised: January 22, 2014
Accepted: April 17, 2014
Published online: May 28, 2014
Processing time: 152 Days and 21.4 Hours
Abstract

AIM: To assess if certain triaging rules could be established to optimize the yield of mesenteric angiography.

METHODS: Medical records of 101 patients were retrospectively reviewed and parameters relating to age, gender, pulse rate, blood pressure, serum hemoglobin, intensive care unit (ICU) admission, and the number of packed red blood cells (PRBC) transfused in the 12 and 24 h prior to the angiography were tabulated in two groups with positive and negative angiography results.

RESULTS: We found no correlation between gender, pulse rate, blood pressure or serum hemoglobin and positivity of the mesenteric angiogram. But patients with positive angiogram were found to be on average 7 years older (73.2 years vs 65.9 years old) (P = 0.02). Angiogram was positive in 39.3 % (11/28) of patients admitted in ICU vs 23.2% (17/73) who were admitted elsewhere in the hospital (P = 0.03). In the 12 and 24 h prior to angiography, patients with a positive angiogram received a mean of 2.7 ± 2.3 and 3.3 ± 2.6 units of PRBC s respectively, while patients with a negative angiogram had a mean of 1.6 ± 1.9 (P = 0.02) and 2.1 ± 2.6 units (P = 0.04) received respectively in the same period.

CONCLUSION: Older age, ICU admission, having received at least 4 units PRBC over 12 h or 5 units over 24 h prior to angiogram are leading indicators for a positive study.

Keywords: Angiography; Diagnostic use; Colon; Blood supply; Radiograph; Gastrointestinal hemorrhage; Emergencies; Mesenteric arteries

Core tip: Mesenteric angiography is associated with a low yield of about 30%. We evaluated several factors in 101 patients undergoing mesenteric angiography in a tertiary care institution to see if any could be used for predicting a positive angiogram. We found that vital signs are poor discriminators but older age, intensive care unit admission, having received at least 4 units PRBC over 12 h or 5 units over 24 h prior to angiogram are leading indicators for a positive study. We postulate that the reason is that patients are given enough blood units to compensate for blood loss and stabilize vital signs and therefore the number of blood units given indirectly correlate with severity of active bleeding.