Selective arterial embolization for control of massive upper gastrointestinal bleeding.

Massive upper gastrointestinal bleeding was controlled in 11 of 15 patients by the use of selective injected arterial emboli. Embolization is most successful in the treatment of patients with demonstrated arterial bleeding sites at angiography. This group of patients generally has ulcers and it is this group in whom vasopressin infusion has the lowest success rate. At the same time we were successful in controlling only 1 of 4 patients who were bleeding from diffuse hemorrhagic gastritis, those patients in whom vasopressin infusion is very successfu, We, therefore, now embolize only patients in whom arterial bleeding sites are demonstrated at angiography or in whom vasopressin infusion has failed to control the bleeding from hemorrhagic gastritis. Our experience also indicates that short acting occlusive agents, such as autogenous blood clot mixed with aminocaproic acid, are as successful in controlling bleeding as the more permanent types of embolic material.