Low-dose particulate polyvinylalcohol embolization in massive small artery intestinal hemorrhage. Experimental and clinical results.

The branches of the superior mesenteric artery were embolized with polyvinylalcohol (PVA) particles 149 to 250 mu (small), 420 to 590 mu (medium), and 590 to 1000 mu (large), respectively, in three groups of dogs. In the small PVA particle group, all three dogs died. In the medium and the large PVA particle groups, nine of the 11 dogs showed no significant ischemic change and the remaining two (one dog in the medium PVA group and one in the large PVA group) had a superficial ulcer. This study suggests that PVA embolization can be performed safely if particles of 420 mu or larger are used. In clinical studies, large PVA particles were used in embolization therapy for massive intestinal hemorrhage from small arteries in five patients. All had the hemorrhage from ulcer disease in the small bowel (four patients) and the ascending colon (one patient). Three patients were completely controlled with no recurrence of hemorrhage. The remaining two experienced rebleeding after embolization. No major complication was found in this series. It is concluded that low-dose large PVA particles are suitable as an embolic material for transcatheter occlusion of small-artery intestinal hemorrhage.