Efficacy of Transcatheter Arterial Embolization with N-Butyl Cyanoacrylate in Acute Bleeding Patient

급성 출혈 환자에서 N-Butyl Cyanoacrylate를 이용한 경도관 동맥색전술의 유용성

  • Jae, Hwan Jun (Department of Radiology, Seoul National University College of Medicine) ;
  • Kim, Sang Youn (Department of Radiology, Seoul National University College of Medicine) ;
  • Lee, Eui Jung (Department of Emergency Medicine, Seoul National University College of Medicine) ;
  • Lee, Whal (Department of Radiology, Seoul National University College of Medicine) ;
  • Suh, Gil Joon (Department of Emergency Medicine, Seoul National University College of Medicine)
  • 제환준 (서울대학교 의과대학 방사선과) ;
  • 김상윤 (서울대학교 의과대학 방사선과) ;
  • 이의중 (서울대학교 의과대학 응급의학과) ;
  • 이활 (서울대학교 의과대학 방사선과) ;
  • 서길준 (서울대학교 의과대학 응급의학과)
  • Received : 2005.10.27
  • Accepted : 2005.11.24
  • Published : 2005.12.30

Abstract

Background: N-Butyl Cyanoacrylate (NBCA) is a liquid embolic material that can be useful for transcatheter arterial embolization (TAE) of acute bleeding especially in patients with coagulopathy, because it does not depend on coagulation for its therapeutic effect. The aims of this study were to evaluate the clinical efficacy and safety of TAE with NBCA in acute bleeding patients. Methods: Between August 2003 and September 2004, TAE using NBCA for acute bleeding was performed in 23 patients (16 men, 7 women; mean age, 56.5years). The causes of bleeding were gastric ulcer (n=5), postoperative bleeding (n=4), post-biopsy bleeding (n=3), postpartum bleeding (n=3), duodenal ulcer (n=2), angiodysplasia (n=2), gastric lymphoma (n=1), iatrogenic injury (n=1), CMV gastritis (n=1), stab injury of the liver (n=1). TAE was performed using 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure-related complication and clinical outcomes were evaluated. Results: The angiographic and clinical success rate was 100% and 91.3% (21/23), respectively. There was no serious ischemic complication. Recurrent bleeding occurred in 2 patients (8.7%) and they were managed with successful second TAE (n=1) and endoscopic treatment (n=1). Nine patients (39.1%) had coagulopathy at the time of TAE and clinical success rate in this group of patients was 88.9% (8/9). Conclusions: TAE with NBCA is highly effective and safe treatment modality for acute bleeding patients, especially when the patient has a coagulopathy.

Keywords

References

  1. Rosch J, Dotter CT, Brown MJ. Selective arterial embolization. A new method for control of acute gastrointestinal bleeding. Radiology 1972;102 ( 2 ) : 303 - 306 https://doi.org/10.1148/102.2.303
  2. Aina R, Oliva VL, Therasse E, Perreault P, Bui BT, Dufresne MP, Soulez G. Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol 2001; 12(2):195-200 https://doi.org/10.1016/S1051-0443(07)61825-9
  3. Goldman ML, LAND WC, Bradley EL, Anderson RT. Transcatheter therapeutic embolization in the management of massive upper gastrointestinal bleeding. Radiology 1976; 120(3):513-521 https://doi.org/10.1148/120.3.513
  4. Pollak JS, White RI, Jr. The use of cyanoacrylate adhesives in peripheral embolization. J Vasc Interv Radiol 2001; 12(8):907-913 https://doi.org/10.1016/S1051-0443(07)61568-1
  5. Parildar M, Oran I, Memis A. Embolization of visceral pseudoaneurysms with platinum coils and Nbutyl cyanoacrylate. Abdom Imaging 2003; 28(1):36- 4 0 https://doi.org/10.1007/s00261-002-0021-7
  6. Yamakado K, Nakatsuka A, Tanaka N, Takano K, Matsumura K, Takeda K. Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate. J Vasc Interv Radiol 2000; 11(1):66-72 https://doi.org/10.1016/S1051-0443(07)61284-6
  7. Encarnacion CE, Kadir S, Beam CA, Payne CS. Gastrointestinal bleeding: treatment with gastrointestinal arterial embolization. Radiology 1992; 183 ( 2 ) : 505 - 508 https://doi.org/10.1148/radiology.183.2.1561358
  8. Schenker MP, Duszak R, Jr., Soulen MC, Smith KP, Baum RA, Cope C, Freiman DB, Roberts DA, Shlansky-Goldberg RD. Upper gastrointestinal hemorrhage and transcatheter embolotherapy: clinical and technical factors impacting success and survival. J Vasc Interv Radiol 2001; 12(11):1263-1271 https://doi.org/10.1016/S1051-0443(07)61549-8
  9. Kish JW, Katz MD, Marx MV, Harrell DS, Hanks SE. N-butyl cyanoacrylate embolization for control of acute arterial hemorrhage. J Vasc Interv Radiol 2004; 15(7):689-695 https://doi.org/10.1097/01.RVI.0000133505.84588.8C
  10. Killeen KL, Shanmuganathan K, Boyd-Kranis R, Scalea TM, Mirvis SE. CT findings after embolization for blunt splenic trauma. J Vasc Interv Radiol 2001; 12(2):209-214 https://doi.org/10.1016/S1051-0443(07)61827-2
  11. Dempsey DT, Burke DR, Reilly RS, McLean GK, Rosato EF. Angiography in poor-risk patients with massive nonvariceal upper gastrointestinal bleeding. Am J Surg 1990; 159(3):282-286 https://doi.org/10.1016/S0002-9610(05)81218-8
  12. Lang EK. Transcatheter embolization in management of hemorrhage from duodenal ulcer: long-term results and complications. Radiology 1992; 182 ( 3 ) : 703 - 707 https://doi.org/10.1148/radiology.182.3.1535883
  13. Toyoda H, Nakano S, Kumada T, Takeda I, Sugiyama K, Osada T, Kiriyama S. Estimation of usefulness of N-butyl-2-cyanoacrylate-lipiodol mixture in transcatheter arterial embolization for urgent control of life-threatening massive bleeding from gastric or duodenal ulcer. J Gastroenterol Hepatol 1996; 11(3):252-258 https://doi.org/10.1111/j.1440-1746.1996.tb00071.x
  14. Gomes AS, Lois JF, McCoy RD. Angiographic treatment of gastrointestinal hemorrhage: comparison of vasopressin infusion and embolization. AJR Am J Roentgenol 1986; 146(5):1031-1037 https://doi.org/10.2214/ajr.146.5.1031
  15. Hagiwara A, Yukioka T, Ohta S, Nitatori T, Matsuda H, Shimazaki S. Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolization. AJR Am J Roentgenol 1996; 167(1):159-166 https://doi.org/10.2214/ajr.167.1.8659363
  16. Goldman ML, Freeny PC, Tallman JM, Galambos JT, Bradley EL, III, Salam A, Oen KT, Gordon IJ, Mennemeyer R. Transcatheter vascular occlusion therapy with isobutyl 2-cyanoacrylate (bucrylate) for control of massive upper-gastrointestinal bleeding. Radiology 1978; 129(1):41-49 https://doi.org/10.1148/129.1.41
  17. Stoesslein F, Ditscherlein G, Romaniuk PA. Experimental studies on new liquid embolization mixtures (histoacryl-lipiodol, histoacryl-panthopaque). Cardiovasc Intervent Radiol 1982;5 ( 5 ) : 264 - 267 https://doi.org/10.1007/BF02565409
  18. Widlus DM, Lammert GK, Brant A, Tsue T, Samphillipo MA, Jr., Magee C, Starr FL, Anderson JH, White RI Jr. In vivo evaluation of iophendylate- cyanoacrylate mixtures. Radiology 1992;185 ( 1 ) : 269 - 273 https://doi.org/10.1148/radiology.185.1.1523322