Reteplase provocative visceral arteriography.

Abstract

GOALS:

To present the results of a new protocol for provocative visceral arteriography.

BACKGROUND:

Acute lower gastrointestinal hemorrhage (LGIB) usually stops spontaneously. In the absence of an identifiable source, if bleeding is recurrent, provocative visceral arteriography has been advocated for diagnosis. Prior studies using Streptokinase, Urokinase, or tissue plasminogen activator have reported a 33% to 37.5% rate of identifying the site of hemorrhage.

STUDY:

We report a retrospective analysis of 9 patients in whom provocative visceral arteriography was performed using a new protocol with Reteplase as the fibrinolytic agent. All patients had recurrent, massive LGIB without definable source. Initial arteriography did not elicit a site of bleeding. Five units of Reteplase were administered over 1 minute into the inferior mesenteric artery, the superior mesenteric artery or both vessels sequentially. Arteriography was repeated after 5 to 10 minutes.

RESULTS:

Colonic hemorrhage was induced in 89% of patients. There were no procedure-related complications.

CONCLUSIONS:

Reteplase may prove safe and effective as a provocative agent, stimulating bleeding to allow localization, in patients with occult, recurrent, massive LGIB.

• Authors: David M Widlus, Ari I Salis
• Journal: Journal of clinical gastroenterology (J Clin Gastroenterol) Vol. 41 Issue 9 Pg. 830-3 (Oct 2007) ISSN: 0192-0790 [Print] United States
• PMID: 17881929 (Publication Type: Journal Article)

Chemical References

• Fibrinolytic Agents
• Recombinant Proteins
• reteplase
• Tissue Plasminogen Activator

Topics

• Adult
• Aged
• Aged, 80 and over
• Angiography (methods)
• Colon (pathology)
• Female
• Fibrinolytic Agents (adverse effects)
• Gastrointestinal Hemorrhage (diagnosis)
• Humans
• Infusions, Intra-Arterial
• Lower Gastrointestinal Tract (pathology)
• Male
• Mesenteric Artery, Inferior
• Mesenteric Artery, Superior
• Middle Aged
• Recombinant Proteins (adverse effects)
• Retrospective Studies
• Tissue Plasminogen Activator (adverse effects)
• Viscera (blood supply)