Determinants of clinical outcome after transarterial embolization for nonvariceal gastrointestinal bleeding: a retrospective cohort study

TL;DR

This study examines factors affecting outcomes after a procedure called transarterial embolization for gastrointestinal bleeding, finding that shock severity is a key predictor of failure and death.

Contribution

The study identifies vasopressor use as a strong predictor of treatment failure and mortality in nonvariceal gastrointestinal bleeding patients undergoing TAE.

Findings

Technical success was 100%, with 82% clinical success in treating nonvariceal GIB.

Vasopressor or inotropic therapy and antithrombotic use were linked to treatment failure.

Higher comorbidity scores and vasopressor use were associated with 30-day mortality.

Abstract

Transarterial embolization (TAE) is an established therapeutic option for non-variceal gastrointestinal bleeding (GIB), but standardized criteria for patient selection and predictors of treatment outcomes remain limited. This study aimed to evaluate clinical outcomes after TAE and identify factors associated with treatment failure and 30-day mortality.

We retrospectively reviewed all TAE procedures performed for nonvariceal GIB at Semmelweis University between May 2022 and July 2025. Clinical, laboratory, and procedural parameters were collected, including bleeding location, comorbidity burden, antithrombotic therapy, transfusion requirements, vasopressor or inotropic support, and embolization technique. Predictors of clinical failure (rebleeding within 30 days) and 30-day mortality were assessed using multivariable logistic regression.

A total of 111 embolizations were performed in 100 patients. Technical success was 100%, and clinical success was achieved in 82% of patients. The 30-day all-cause mortality rate was 26%, with disease-specific mortality at 15%. Complications occurred in 4% of cases. Vasopressor or inotropic therapy and antithrombotic use were independent predictors of clinical failure. Vasopressor requirement and higher Charlson Comorbidity Index (CCI) scores were significantly associated with 30-day mortality. Empiric embolization was associated with a lower likelihood of rebleeding but did not influence mortality.

TAE provided high technical success and favorable overall outcomes with a low complication rate in the management of nonvariceal GIB. Vasopressor requirement was the strongest predictor of both rebleeding and mortality, likely reflecting the underlying severity of shock physiology rather than the direct effects of vasopressor therapy. These results highlight the need for further prospective studies to guide management strategies in hemodynamically unstable patients requiring vasopressor support.

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