Angiography in Lower GIB

Q: In the absence of prior localization, which of the following vessel is evaluated first in angiography for lower Gastrointestinal Bleed (GIB)? (select one)

A) superior mesenteric artery 

B) inferior mesenteric artery

Answer: A

In the real world, clinicians usually have some idea of area involved in GIB either via nuclear scan ot CT-Angiography (CTA). In case of acute severe GIB where patient is taken directly for angiography due to it's advantage of simultaneous embolization of involved vessel, superior mesenteric artery is generally evaluated first followed by the inferior mesenteric and celiac arteries. In contrast to conventional expectations, success rate runs anywhere from 25 to 70 percent.

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References:

1. Browder W, Cerise EJ, Litwin MS. Impact of emergency angiography in massive lower gastrointestinal bleeding. Ann Surg 1986; 204:530.

2.  Udén P, Jiborn H, Jonsson K. Influence of selective mesenteric arteriography on the outcome of emergency surgery for massive, lower gastrointestinal hemorrhage. A 15-year experience. Dis Colon Rectum 1986; 29:561. 

3. Speir EJ, Ermentrout RM, Martin JG. Management of Acute Lower Gastrointestinal Bleeding. Tech Vasc Interv Radiol. 2017 Dec;20(4):258-262. doi: 10.1053/j.tvir.2017.10.005. Epub 2017 Oct 9. PMID: 29224658.