Endovascular intervention for the treatment of acute arterial gastrointestinal hemorrhage

Advances in pharmacologic and minimally invasive therapies have revolutionized the treatment of nonvariceal gastrointestinal hemorrhage. Endoscopic and endovascular procedures have supplanted surgery as the preferred initial therapies for patients with bleeding refractory to medical management. In the upper gastrointestinal tract, endoscopic therapy is the initial treatment of choice followed by embolization. The treatment algorithm for lower gastrointestinal bleeding is less clear and institution specific. Catheter-based modalities have evolved from local vasoconstrictive infusion to embolization. Advances in catheter technology and embolic agents have facilitated upper gastrointestinal embolotherapy and enabled safe superselective embolization of lower gastrointestinal bleeding. This article summarizes the current role of interventional radiology in acute arterial gastrointestinal hemorrhage.