Adherence of Cyanoacrylate which Leaked from Gastric Varices to the Left Renal Vein During Endoscopic Injection Sclerotherapy: A Histopathologic Study

Abstract

We report a case involving leakage of cyanoacrylate (CA) to the inferior vena cava (IVC) through a gastrorenal shunt and left renal vein. A 72-year-old man with liver cirrhosis was admitted to our hospital to undergo emergency treatment for massive hemorrhage of gastric varices. Endoscopic injection sclerotherapy (EIS) using CA was performed on the varices. Radiographic fluoroscopy revealed that most of the injected CA had adhered firmly to the gastric varices, but a certain portion of the CA had flowed to the IVC through the gastrorenal shunt and left renal vein. At that point, the patient did not complain of any symptoms. However, 6 months later, he died of hepatic failure and an autopsy was performed. Histopathologic examination of the wall of the IVC and renal vein, to which CA had adhered, revealed that the CA was covered with endothelial cells of the vessel and no nearby thrombus was present. Long-term anticoagulant therapy may not be indicated in cases of leakage of CA from the gastric varices to other veins, since the leaked CA may be readily covered with endothelium without thrombus formation as in our patient. It is possible for CA to flow to the IVC and have a fatal impact. Our patient was fortunate, and for safe EIS it is important that these complications are prevented.

Effect of endoscopic injection therapy with combined cyanoacrylate and lipiodol for bleeding gastric varices: A single center experience

“…14 Patients with HCC were excluded in some studies. 25,[30][31][32][33] In our study, one patient developed a splenic infarction later attributed to acute splenic vein thrombosis. 16 Complications of the cyanoacrylate injection are rare, with reports in the literature on systemic and local embolic adverse effects as well as variceal tear.…”

“…16 Complications of the cyanoacrylate injection are rare, with reports in the literature on systemic and local embolic adverse effects as well as variceal tear. 25,[30][31][32][33] In our study, one patient developed a splenic infarction later attributed to acute splenic vein thrombosis. Another patient was referred to surgical shunting due to rebleeding.…”

Balloon-occluded retrograde transvenous obliteration for gastric varices: the relationship between the clinical outcome and gastrorenal shunt occlusion

“…Because of poor liver function and rapid blood flow in patients with gastric varices, the development of effective treatment for this condition is a challenge. Gastric varices can be treated by endoscopic injection therapy with cyanoacrylate, but there is a risk of migration of this compound into systemic circulation through the inferior vena cava via the gastrorenal shunt [5]. Balloon-occluded retrograde transvenous obliteration (B-RTO), a minimally invasive procedure that was introduced in the mid-1990s, has been widely accepted in Japan.…”

Transcatheter Obliteration of Gastric Varices

“…Furthermore, this method carries a potential risk of migration of NBCA from the varices to the systemic venous circulation, especially in patients with fundal varices associated with a large gastrosystemic venous shunt. This migration of NBCA may result in fatal complications such as pulmonary embolism (11,12). Transjugular intrahepatic portosystemic shunt (TIPS) placement is effective in reducing portal pressure and has been widely used in patients with variceal bleeding or refractory ascites associated with portal hypertension (13,14).…”