Radiology, Vol 151, 365-370, Copyright © 1984 by Radiological Society of North America
Gelfoam powder embolization of the left gastric artery in treatment of massive small-vessel gastric bleeding
J Rosch, FS Keller, B Kozak, N Niles and CT Dotter
Gelfoam (gelatin foam) powder was used for embolization therapy of massive
gastric bleeding from small vessels in 14 patients with severe underlying
medical problems. Bleeding was controlled in 10 patients with lesions
localized in areas supplied by the embolized left gastric artery. In four
patients with concurrent lesions in other portions of the stomach, bleeding
decreased only (3 patients) or did not respond to embolization (1 patient).
Complications developed in 2 patients with compromised vascular supply of
the stomach: superficial ischemic ulcers that healed, and a large ulcer
that perforated and required surgery. Microscopic studies demonstrated
Gelfoam powder penetration mostly into vessels 100 to 200 microns in
diameter and only occasionally into smaller vessels 50 to 60 microns, with
occlusion of approximately 10 to 15% of the vasculature. It is concluded
that Gelfoam fragments are the primary embolic material to be used for
occlusion of the left gastric artery. Use of Gelfoam powder should be
limited to occasional patients who have only little chance of responding to
Gelfoam fragment embolization. Potential candidates for Gelfoam powder
embolization include patients with major coagulopathies and/or uremia who
massively hemorrhage from small-vessel lesions localized in upper portions
of the stomach, exhibit significant mucosal hypervascularity, and do not
respond to selective vasopressin treatment. An uncompromised vascular
supply of the stomach is a precondition of a safe left gastric artery
embolization.
