GDA Ulcer Embolization

Harris Chengazi, MD

Vascular and Interventional Physician

Great Lakes Medical Imaging

A 69-year-old male with a history of HTN, BPH, GERD and AFib on Pradaxa presented to the hospital with syncope and occasional black stools.
Angiography demonstrated frank active arterial extravasation from the known duodenal ulcer.
The microcatheter was navigated beyond the site of bleeding to select the gastroepiploic and superior pancreaticoduodenal arteries, and these were successfully and rapidly occluded with LOBO-3 to prevent back filling of the GDA.
Immediate post embolization angiography showed complete occlusion of the gastroduodenal artery.
The LOBO occluder allowed for rapid and accurate embolization with near immediate occlusion.

Figure 1: Angiography from the GDA (black arrow) demonstrates frank abnormality of the vessel at site of ulcer (white arrow) with active bleeding (red arrow). The gastroepiploic artery (blue arrows) and superior pancreaticoduodenal artery (yellow arrow) are seen distal to the site of active bleeding.

Figure 2: Post embolization angiography from the GDA demonstrates 3 LOBO-3 occluders. The superior pancreaticoduodenal artery (yellow bracket) and gastroepiploic artery (blue bracket) are occluded to prevent back filling of the gastroduodenal artery. A LOBO-3 device is also deployed across the site of ulceration (white bracket). The previously seen ulcer and active bleeding are no longer seen.

Figure 3: CTA with 3D reconstruction performed 3 days after embolization shows the GDA (white arrow) with cutoff at the level of the 3 LOBO devices (brackets). The radiopaque markers well delineate the LOBO devices and the embolized vessel with minimal artifact.

Three days after embolization CTA demonstrates occlusion of the GDA and minimal artifact from the LOBO devices.