Transcatheter embolization in management of hemorrhage from duodenal ulcer: long-term results and complications.

Effectiveness of transcatheter embolization for treatment of bleeding duodenal ulcers was evaluated in 57 patients followed up for at least 5 years. Terminal muscular branch vessel embolization was effective for initial control of bleeding in 27 of 28 cases, and gastroduodenal artery embolization was effective in 25 of 29 (P = .371). Terminal vessel embolization was more effective in attaining long-term control of bleeding (15 of 28 patients) than was gastroduodenal artery embolization (eight of 29) (P = .084). Occlusion of terminal vessels with 6-cyanoacrylate resulted in long-term control of bleeding in nine of 10 patients. With selective embolization of terminal vessels, late complications of duodenal stenosis occurred in seven of 28 patients; when occlusion was at the level of the gastroduodenal artery (P = .131), this developed in only two of 29. Occlusion of the proximal gastroduodenal artery by means of epsilon-aminocaproic acid-induced autologous clot was the most innocuous technique. Retrograde perfusion via the superior mesenteric and inferior pancreaticoduodenal artery (though at a reduced flow rate and pressure gradient) and reconstitution of flow after clot lysis are the theoretical advantages of this technique.