Evaluation and Treatment of Gastrointestinal Angiodysplasia

Abstract

Angiodysplasia is an acquired vascular malformation that is a relatively common cause of lower gastrointestinal bleeding, typically affecting elderly patients. It is also seen more frequently in specific medical conditions including aortic stenosis and end-stage renal disease. These lesions are characteristically located in the cecum, where wall tension is high. The high wall tension likely obstructs outflow from submucosal venules, leading to the thin-walled and dilated submucosal capillaries, venules, and veins which define this lesion. Diagnosis and treatment of angiodysplasia requires a multidisciplinary approach with endoscopists, interventional radiologists, and surgeons all playing important roles. Argon plasma coagulation is the preferred endoscopic treatment, and superselective coil embolization, in which coils are placed beyond the marginal artery and into the vasa recta, is the preferred endovascular treatment. Bowel resection may be necessary if these less-invasive treatments are unsuccessful, or may be required if there is recanalization after coil embolization, which occurs with some frequency in angiodysplasia.