Coeliac angiography demonstrated high-grade active arterial bleeding arising from a branch of the gastroduodenal artery. Generalised small calibre vessels with areas of vasospasm.
A replaced right hepatic artery arising from the SMA.
Eventually a microcatheter was able to be manipulated to the site of bleeding and the GDA was coiled to a point just distal to the bifurcation with the left hepatic artery.
Some mild ongoing active bleeding was noted arising from the vessels arising from the SMA and replaced right hepatic. Due to small vessel calibre and vasospasm in the was difficult to completely approximate the inflow from this however the main feeder from the right hepatic was embolised as possible to reduce flow.
The patient stabilised during the procedure with these techniques. Haemostasis was achieved with a 5-French exoseal
Comment: Successful embolisation of the main bleeding point arising from the GDA.
There may be some possible mild ongoing blood loss from collateral flow which was partially embolised, in combination however this is expected to secure the bleeding point.