Angiography in the diagnosis and therapy of bleeding from gastroesophageal varices.

Angiography, with its various techniques of catheterization and visualization of visceral vessels, is assuming an increasingly important role in both the diagnosis and treatment of bleeding from gastroesophageal varices. In the acute stage of bleeding, emergency arteriography has helped visualize gastroesophageal varices and, occasionally, the actual bleeding as an extravasation of contrast medium into the gut. It has also aided in the diagnosis of variceal bleeding by excluding arterial bleeding, delineating the type of portal obstruction, differentiating extrahepatic from intrahepatic portal blocks,and shedding light on the type and stage of the basic hepatic disease. Angiographic and manometric studies of the hepatic veins have been used to assess functional changes in the portal circulation, thereby providing information pertinent to therapeutic decisions, particularly in indicating the need for surgery and in selecting the appropriate procedure. In a more direct therapeutic role, the selective infusion of vasopressin into the superior mesenteric artery is now one of the means for controlling variceal bleeding, particularly successful in patients without advanced liver disease. Recently, several techniques for catheterizing the portal vein have been used to block or restrict variceal bleeding by catheter tamponade or the injection of occlusive material. In this report we will summarize our clinical and animal experience in the use of angiographic technique for the diagnosis and treatment of gastroesophageal variceal bleeding and discuss some other promising therapeutic catheter techniques. Although some of these techniques may sound like science fiction, they are practical procedures in the laboratory and may be of clinical use in the near future.