Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

Abstract

ing, renal arterial bleeding, and even gastrointestinal tract bleeding [2][3][4][5][6][7][8]. NBCA is highly penetrable because of its liquid nature and is less affected by coagulopathies; thus, it may be used as an adjunct to other embolic materials to ensure the embolic effect [9,10]. However, NBCA is difficult to handle effectively and safely and is inherently more prone to cause ischemic necrosis.Although there have been several reports on the use of TAE with NBCA for acute gastrointestinal tract bleeding, 9-84 patients were included in those studies, and neither long-term clinical data nor analyses evaluating clinical factors affecting the clinical success of NBCA were presented [11][12][13][14][15][16]. Therefore, studies in larger patient populations are warranted to determine the clinical effectiveness of NBCA in the setting of acute gastrointestinal tract bleeding, with or AJR 2015; 204:662-668 0361-803X/15/2043-662 © American Roentgen Ray Society E ndoscopy is a rapid diagnostic and therapeutic modality that is widely accepted as the preferred method for identifying and providing hemostasis at sites of gastrointestinal tract bleeding. In cases of endoscopic treatment failure or where the site of bleeding is inaccessible by endoscopy, such as distal small-bowel bleeding, transcatheter arterial embolization (TAE) may be an effective alternative to endoscopy. A previous study showed that TAE in the management of gastrointestinal tract bleeding is effective with good long-term clinical outcomes [1]. Va s c u l a r a n d I nt e r ve nt io n a l R a d io l og y • O r ig i n a l R e s e a rc hAmong the various embolic materials that have been evaluated, N-butyl-2-cyanoacrylate (NBCA) was first used to embolize cerebral aneurysms but now is widely used for controlling active bleeding, including intramuscular hemorrhage, uterine arterial bleed- OBJECTIVE. The purpose of this article is to evaluate the clinical effectiveness of transcatheter arterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA), with or without other embolic materials for acute nonvariceal gastrointestinal tract bleeding, and to determine the factors associated with clinical outcomes.MATERIALS AND METHODS. TAE using NBCA only or in conjunction with other materials was performed for 102 patients (80 male and 22 female patients; mean age, 61.3 years) with acute nonvariceal gastrointestinal tract bleeding. Technical success, clinical success, and clinical factors, including age, sex, bleeding tendency, endoscopic attempts at hemostasis, number of transfusions, and bleeding causes (i.e., cancer vs noncancer), were retrospectively evaluated. Univariate and multivariable logistic regression analyses were performed to evaluate clinical factors and their ability to predict patient outcomes. Survival curves were obtained using Kaplan-Meier analyses and log-rank tests.RESULTS. There were 36 patients with cancer-related bleeding and 66 with non-cancerrelated bleeding. Overall technical and clinical success rates were 100% (102/102) and 76.5% ...

Recurrent Walled-Off Necrosis Following Embolization with N-Butyl-2-Cyanoacrylate in a Patient with Upper Gastrointestinal Tract Bleeding

“…TAE is generally regarded as a safe procedure with few complications. Indeed, Koo et al [5] reported a case series of 102 patients managed with TAE with a 76.5% success rate and 2 cases of ischemic complications. Two patients developed bowel infarction after TAE due to inadvertent embolization of adjacent, non-target vessels.…”

“…In our patient, some NBCA might have overflowed into the ASPDA, suggesting that careless injection at a high speed or the use of an overdiluted NBCA mixture should be avoided to prevent overflow of the mixture into non-target vessels. Indeed, Koo et al [5] reported a case of duodenal infarction after extensive embolization of the ASPDA with NBCA. This patient died of septic shock due to duodenal perforation.…”

“…Unlike coil embolization, NBCA injections may also embolize potential collateral vessels [18]. NBCA can therefore increase the success rate of and reduce the rebleeding rate after interventional embolization for hemorrhaging from the pancreaticoduodenal artery [4,5]. During TAE with NBCA for active bleeding from the pancreaticoduodenal arteries, physicians should be aware of the rare but potentially serious complication of pancreatic necrosis (or WON) due to overflow of NBCA into non-target branches.…”

“…NBCA can also enable simultaneous embolization of the collateral vessels connected to the bleeding focus, which can prevent recurrent bleeding from the retrograde collateral flow. According to previous reports that described the use of NBCA embolization for the treatment of GI tract bleeding, the technical success rate was nearly 100%, with a clinical success rate > 70% [4,5]. However, there have been few reports on the complications associated with this technique.…”

Emergency Endovascular Hemostatic Technique Using N-butyl Cyanoacrylate for Retroperitoneal Hematoma Caused by Inferior Epigastric Artery Injury after Undergoing Catheter Ablation for Atrial Fibrillation: A Case Report

“…1) Recently, n-butyl cyanoacrylate (NBCA) has been used as a liquid embolic agent in various non-traumatic situations, with a high technical success rate and low recurrent bleeding rate, particularly in patients with coagulopathy. 1,2) EVT using large-diameter catheter devices under anticoagulant therapy has become increasingly popular for the treatment of stroke. 3) Femoral vascular access-site complications are sometimes fatal and thus, initial resuscitation is a high priority for acute hemorrhage in hemorrhagic shock.…”