Purpose

To identify and characterize the Multidetector CT and CT angiography findings of various mesenteric vascular lesions.

Role of CT angiography in guiding interventional radiology procedures

Material and methods

A prospective study was done with a study population of 258 cases for a period of 5 years. the study was carried out in our radiology department on 160 slice CT scanner. Various lesions of mesenteric vasculature were studied.

Results

Among the total 258 patients most common findings in CTA included bowel wall thickening, mural enhancement, arterial thrombosis, arterial bleed , arterial aneurysm, venous thrombosis. Other findings were arterial stenosis, arterial dissection with associated secondary findings like bowel lumen dilatation, mesenteric stranding, pneumatosis intestinalis, solid organ infarction and ascites.

Conclusion

We concluded the MDCT with CTA is fast, accurate, non-invasive diagnostic tool for detection of mesenteric vascular lesions which can aid significantly in timely management, thereby reducing the morbidity and mortality associated with this condition. MDCTA findings help to characterise these lesions which helps to delineate the management plan. In our study we had found the use of neutral oral contrast (Mannitol) helped in better visualisation of bowel wall characteristics in mesenteric vascular lesions by adequate bowel lumen distention.

Purpose

To elucidate the role of super-selective endovascular interventions in the setting of acute non-variceal gastrointestinal (GI) bleeding as life saving tool.

Material and methods

We prospectively evaluated 112 patients with endoscopic evidence of acute non-variceal GI bleeding, strong clinical suspicion of arterial bleeding due to significant hemodynamic instability and recurrent bleeding after conservative management. The technical and clinical endpoint for a successful procedural outcome was taken as super-selective catheterization (micro-catheter) of the bleeding vessel (as seen on CTA) and complete cessation of bleeding respectively. The mean procedural time and contrast dosage were calculated.

Results

8 All these 84 patients underwent therapeutic embolization using either permanent or temporary embolic agents. 28 patients did not show any CTA abnormality; 21 patients were managed conservatively and the remaining 7 patients underwent embolization as these patients had recent therapeutic endoscopic procedure related bleeding. Super-selective catheterization using micro-catheter was achieved in all the 91 patients who underwent endovascular embolization. Cessation of bleeding was seen in 86 patients after single sitting of embolization. 3 patients had recurrent bleeding; 2 patients underwent repeat embolization with successful outcome and one patient underwent surgery. 2 patients had bowel ischemia after embolization and they underwent surgical resection. The mean endovascular procedural time was 60 mins and mean contrast dosage was 50 ml in this study.

Conclusion

Super-selective endovascular intervention in acute GI bleeding is a life saving procedure with help of appropriate interventional hardware/embolic agent, which in turn minimizes procedural time and contrast dosage