Keywords:
Interventional vascular, Gastrointestinal tract, Haematologic, Catheter arteriography, Outcomes analysis, Catheters, Arterial access
Authors:
D. Bürgler, C. Bucher, J. Passweg, A. Fischmann; Basle/CH
DOI:
10.1594/ecr2013/C-1041
Methods and Materials
Patient selection and inclusion criteria
Patients were eligible for inclusion if they developed GI aGvHD.
All included patients were not responding to intravenous methylprednisolone administered at 2 mg / kg body weight within 14 days after onset of GI aGvHD; and had a GI aGvHD clinical stage of 2 – 4.
The diagnosis and severity of aGvHD was graded according to the 1994 consensus conference on acute GvHD grading by Przepiorka et al [1].
An infectious cause of the gastrointestinal symptoms was excluded.
Treatment procedure
Catheter guided intraarterial steroid administration (IASA) was performed using standard sterile technique and local anesthesia.
By accessing the right or left common femoral artery a 4 Fr angiography catheter was used to locate and select the superior (SMA) and inferior mesenteric artery (IMA) and,
in patients with upper gastrointestinal symptoms into the celiac trunk (7 patients) and the left gastric artery (2 patients) Fig. 1.
Drug infusion into each artery was performed over 3 minutes per artery.
The median total dose of methylprednisolone was 182 mg (120-240 mg).
In 7 patients with persistent or recurring symptoms,
IASA was repeated within 14 days.
Treatment response and follow-up
Treatment response was evaluated: Non-response was defined as persisting symptoms and death during hospitalization after onset of GI aGvHD.
Partial response was defined as patients with improved gastrointestinal symptoms after IASA but remaining symptoms at discharge.
Complete response was defined as patients with complete resolution of gastrointestinal symptoms at discharge from hospital.
All patients received follow-up in post transplant consultation at our institution or by medical chart reviews of further hospitalization.
There was a follow-up 100 days after initial IASA,
re-evaluating patient’s GvHD grade.
Overall Survival
All patients still alive at September 2012 were defined as survivors.
All other patients had documented times of death in their medical charts.
The time was measured form initial IASA and HSCT to death.