Southern Association For Vascular Surgery

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Embolization of a Bleeding Gastroepiploic artery
Alan B Lumsden
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX

OBJECTIVES: Demonstrate how use of advanced endovascular techniques can be employed to reduce anastamotic bleeding following sophagectomy METHODS: Using step by step demonstration of this procedure, we will increase familiarity and comfort level in undertaking the following procedure. As vascular surgeons have greatly expanded their endovascular skill set, we are occasionally confronted with challenges, which are unique and unusual. However, with good foundational training, many of these challenges can be met with the simple application of knowledge of the underlying pathology, vascular anatomy and advanced catheter and wire skills. In this report, we demonstrate the procedure for identification and embolization of a bleeding esophagogastric anastomosis. RESULTS: 76 yo male 2 weeks s/p esophagectomy and esophago-gastric anastomosis. The stomach was pedicled on right gastric and right gastroepiploic artery. 24 hrs prior to consultation he developed an upper GI bleed requiring 7 units of blood. Upper GI Endoscopy showed the esophagus and stomach to be full of blood clot and fresh blood. a bleeding source could not be identified. A CT scan showed a huge amount go blood clot and fresh blood. Vascular Surgery was notified and the endovascular approach demonstrated in the video. CONCLUSIONS: This minimally invasive approach precluded a redo thoracotomy in this unstable elderly male. The methods and techniques demonstrated well within the armamentarium of well trained vascular surgeons.


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