Interventional Radiologist Donald Garbett and our host Sabeen Dhand discuss their standard workups and procedural decision making for GI bleeds, including radial vs. femoral approach and preferred embolics.

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SHOW NOTES

In this episode, interventional radiologist Dr. Donald Garbett and our host Dr. Sabeen Dhand discuss their standard workups and procedural decision making for GI bleeds.

The doctors start by describing the workup. Dr. Garbett says that the majority of his cases are referred from GI, either when GI cannot find the bleed or cannot access the bleed because of excessive bleeding into the GI lumen. Dr. Garbett often uses triple phase CT angiography. He emphasizes the importance of doing triple phase, in order to distinguish between arterial bleeds and varices, as this difference will guide further treatment decisions.

In non-emergency situations, Dr. Garbett prefers transradial access. He discusses his use of various embolic agents such as glue and combination of both detachable and pushable coils. Dr. Dhand mentions newer embolics such as Onyx. He adds that he sometimes administers a low dose of glucagon to inhibit bowel movements.

Finally, the doctors share various pearls of wisdom for GI embolization, such as the advantages of provocative angiogram, treatment decisions when a patient is crashing, and variceal indications for balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS).

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RESOURCES

Ep. 118 BRTO vs. PARTO in Gastric Variceal Bleeding:
https://www.backtable.com/shows/vi/podcasts/47/brto-vs-parto-in-gastric-variceal-bleeding

YouTube Video: Embolization and Provocative Angiography in Lower GI Bleeds:
https://youtu.be/0MESQkTG6hI