Rectal Artery Embolization for Acute Uncontrollable Rectal Bleeding: Case Series and Systematic Literature Review

Abstract

Purpose: The article aims to evaluate the possibilities of transcatheter arterial embolization (TAE) as a method of hemostasis in inoperable, life-threatening rectal cancer bleeding by embolizing rectal arteries related to the tumor.

Materials and Methods: Using PubMed, Embase, Web of Science, and Cochrane Library, a systematic literature review following the PRISMA 2020 guidelines was performed on October 26, 2023. The search focused exclusively on patients with bleeding rectal cancer controlled by TAE. In addition, in alignment with the PROCESS 2016 guidelines, we describe three patients who underwent transcatheter embolization of the rectal arteries for rectal cancer bleeding from Surgery Department No.2, admitted to the Municipal Saint Trinity Hospital, in Moldova, Chisinau, over the period 2020-2023.

Results: Out of 4,958 articles identified, 89 were included for analysis, and only nine were relevant to the topic addressed. In total, 33 cases of rectal cancer bleeding controlled by the rectal artery embolization (RAE) approach were found. Technical success was achieved in 32 out of 33 patients. Technical failure was encountered in one patient due to a practical shortfall in advancing the microcatheter to the source of bleeding. The most frequently embolized artery was the superior rectal artery (in 22 patients). Bleeding control was achieved in 24 patients from the first attempt. Recurrent bleeding was observed in nine patients who successfully responded to repeated RAE. There was no evidence of bowel infarction, and the procedure was well tolerated, in general.

Conclusions: The present review and case presentation of patients who underwent endovascular approaches to treat rectal cancer bleeding showed that rectal artery embolization is a safe and feasible procedure, with a high technical success rate.