The site of bleeding is visualized and identified on the image monitor. While the patient is still under the gamma camera, a small 10 millimeter diameter cobalt-57 marker is placed directly on the patient’s skin over the identified bleeding site (using the image monitor for guidance). The radioactive source should be placed immediately when extravasation is identified either during the early flow phase of the study or the subsequent five minute static images depending on rate of bleeding. Fedratinib supplier The skin

is then marked in this location using a permanent ink marker. A metal object (2 inch paper clip) is then placed over the localized bleeding site in order to identify the site during angiography. During the subsequent arteriogram the arterial supply to the bleeding site was MAPK Inhibitor Library price easily localized if actively bleeding. However, when extravasations were not visualized on the arteriogram, the arterial supply was unique to the extravasations site and empiric embolization could be considered. Embolization technique Superselection of the artery supplying the area of hemorrhage was performed using a 3-French microcatheter

(Renegade, Boston Scientific, Natick, MA). This catheter was advanced coaxially to the bleeding site (marked by the clip) through the indwelling 4 or 5-French catheter. Attempts were made to position the

catheter as close to the bleeding site as possible. Depending on the anatomy the catheter was either advanced through the superior mesenteric artery or inferior mesenteric artery distal branch (i.e. distal middle colic artery marginal artery). Embolization was then performed using 2.0–2.5 cc of 500–700 micron particles either Polyvinyl alcohol (Contour, Boston Scientific, Natick, Massachusetts, USA), Embospheres (Biosphere Medical, Rockland, Massachusetts, USA), or Bead Block Compressible Microspheres (Terumo Medical Systems (Tokyo, Japan). 2.0–2.5 cc of particles were used for each branch whether the bleeding site was angiographically visible or not with the goal of occluding the distal branch of the artery (marginal artery and vasa recta) close to the bleeding site. HDAC activation Results (See Progesterone Table 1) Summary of Results Summary of Results Patient # Age/Sex Nuclear Medicine Source of Bleeding Transfusion Requirment (Packed Red Cells Units) Hgb level prior to transfusion g/dl Time between marker placement and angiography Angiographically positive Hemostasis after embolization Etiology of bleeding 1 70/M Hepatic Flexure of Colon 5 11.4 < 2 hours Yes Yes Diverticulosis 2 84/F Hepatic Flexure of Colon 5 5.4 < 2 hours No Yes Suspected diverticulosis 3 65/F Splenic Flexure of Colon 5 7 < 2 hours No Yes Unknown 4 55/F Splenic Flexure of Colon 12 7.