Transcatheter Arterial Embolization Using Cone-beam Computed Tomography during Angiography and Automated Vessel Detection Software for Obscure Colonic Diverticular Hemorrhage after Unsuccessful Endoscopic Clipping: A Report of Two Cases

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  • Kamei Seiji
    Department of Radiology, Aichi Prefectural Welfare Federation of Agricultural Cooperatives Kainan Hospital
  • Yamamoto Takahiro
    Department of Radiology, Aichi Prefectural Welfare Federation of Agricultural Cooperatives Kainan Hospital
  • Okada Hiroaki
    Department of Radiology, Aichi Medical University
  • Kinbara Yuki
    Department of Emergency/Intensive Care, Nagoya Medical Center
  • Takahata Kyohei
    Department of Radiology, Aichi Prefectural Welfare Federation of Agricultural Cooperatives Kainan Hospital
  • Horikawa Yoshimi
    Department of Radiology, Aichi Prefectural Welfare Federation of Agricultural Cooperatives Kainan Hospital
  • Yamada Kuniya
    Department of Gastroenterology, Aichi Prefectural Welfare Federation of Agricultural Cooperatives Kainan Hospital
  • Kitajima Yukiya
    Department of Radiological Technology, Aichi Prefectural Welfare Federation of Agricultural Cooperatives Kainan Hospital
  • Hattori Tesuya
    Department of Radiological Technology, Aichi Prefectural Welfare Federation of Agricultural Cooperatives Kainan Hospital
  • Suzuki Kojiro
    Department of Radiology, Aichi Medical University

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<p>We report the usefulness of cone-beam computed tomography angiography (CBCTA) and automated vessel detection (AVD) software in transcatheter arterial embolization in two cases of obscure ascending colonic diverticular hemorrhage after unsuccessful endoscopic clipping. Arteriography of the superior mesenteric artery demonstrated no active bleeding. Considering the positional relationship of the clips, we could narrow the responsible vessel down to two candidates but could not definitively identify the responsible vessel. We performed CBCTA at the marginal artery of the right colic artery, and the responsible branch was identified using AVD. The responsible vessel could be embolized, and hemostasis was achieved with no ischemic complications. CBCTA and AVD software for colonic diverticular hemorrhage after endoscopic clipping were useful for identifying the responsible vessel and in performing selective embolization.</p>

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