Jennifer E. Gould, M.D.

DEPARTMENT OF Radiology
Keywords: arteriography, thrombosis, vena cava filters

Endovascular diagnosis and treatment of upper and lower gastrointestinal tract bleeding: Gastrointestinal bleeding is a common problem that can carry significant morbidity and mortality, particularly if severe. Treatment is often impaired by difficulty localizing the site of bleeding, complications of severe blood loss and hypotension, and the morbidity/mortality of surgical resection. When endoscopic methods are unsuccessful in diagnosis or treatment, endovascular methods are often utilized to detect and/or stop bleeding. Arteriography is useful for detection of active bleeding and diagnosis of abnormalities that may be the source of bleeding. When positive, arteriography can guide treatment with catheter-directed vasoconstrictor drug infusions, selective embolization of the bleeding vessel, or catheter marking to guide limited surgical resection. Current interests include assessing the long-term effects of these endovascular treatments and the detection of occult sources of gastrointestinal bleeding.

Indications for use of and risk of temporary, retrievable, and permanent inferior vena cava filters: Deep venous thrombosis and pulmonary embolism are common problems that are increasingly being recognized. When anticoagulation is contraindicated or fails to control thromboembolism, inferior vena cava filtration is often utilized. These small metal devices are quickly and easily deployed within the inferior vena cava via endovascular routes. Since their deployment, filters have been permanent in nature, but recently temporary and retrievable filters have been developed for short-term caval filtration. These filters are particularly useful in young patients for whom anticoagulation is only temporarily contraindicated and prolonged filtration would carry a significant risk of caval thrombosis. Furthermore, the development of temporary and retrievable filters opens the door for potential short-term prophylaxis in patients who have no history of thromboembolic disease but are at high risk for its development due to events such as recent trauma or a planned surgical procedure.