Evaluation of Superselective Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate in Treating Lower Gastrointestinal Bleeding: A Retrospective Study on Seven Cases

Abstract

Background. To investigate the safety and efficacy of superselective transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA) in treating lower gastrointestinal bleeding caused by angiodysplasia. Methods. A retrospective study was performed to evaluate the clinical data of the patients with lower gastrointestinal bleeding caused by angiodysplasia. The patients were treated with superselective TAE with NBCA between September 2013 and March 2015. Angiography was performed after the embolization. The clinical signs including melena, anemia, and blood transfusion treatment were evaluated. The complications including abdominal pain and intestinal ischemia necrosis were recorded. The patients were followed up to evaluate the efficacy in the long run. Results. Seven cases (2 males, 5 females; age of 69.55 ± 2.25) were evaluated in the study. The embolization was successfully performed in all cases. About 0.2–0.8 mL (mean 0.48 ± 0.19 mL) NCBA was used. Immediate angiography after the embolization operation showed that the abnormal symptoms disappeared. The patients were followed up for a range of 2–19 months and six patients did not reoccur. No serious complications, such as femoral artery puncture point anomaly, vascular injury, and intestinal necrosis perforation were observed. Conclusion. For the patients with refractory and repeated lower gastrointestinal hemorrhage due to angiodysplasia, superselective TAE with NBCA seem to be a safe and effective alternative therapy when endoscopy examination and treatment do not work.

Successful laparoscopic surgery combined with selective arterial embolization for bleeding due to jejunal angiodysplasia: a case report

“…Many techniques to localize bleeding in the small intestine, including AGDs, have been reported in the literature, including preoperative DBE, angiography, computed tomography-guided dye injection, gastrointestinal bleeding scintigraphy, intraoperative transillumination, intraoperative endoscopy, and segmental clamping [ 1 , 4 – 6 , 9 – 15 ]. Ink tattoos injected during DBE or microcoils placed during angiography allow surgeons to identify the lesion site during operations; these landmarks are similarly effective during laparoscopic surgeries [ 1 , 5 – 7 , 9 – 11 ]. Transarterial embolization is a reliable approach that allows surgeons to locate bleeding as well as stabilize hemodynamics; however, patients should be operated on quickly thereafter to prevent re-bleeding (if temporary embolic materials were used) or intestinal necrosis.…”

Evaluation of Transcatheter Arterial Embolization in Treating Gastrointestinal Bleeding Due to Angiodysplasia: A Retrospective Study on Twelve Cases

“…Transcatheter arterial embolization is an important tool for treating active GI bleeding, particularly when endoscopic therapy has failed and the patient is not eligible for surgery (13). Immediately following determination of the bleeding source by angiography, intraarterial embolization can be performed to stop bleeding by embolizing the abnormal vessels with materials such as coils, PVA particles, ethylene vinyl alcohol copolymer (onyx) glue, nbutyl cyanoacrylate (NBCA) and gelatin sponge particles (14)(15)(16). Although the occurrence rate of rebleeding is approximately 20% in patients with lower GI bleeding, immediate hemostasis can be successfully achieved by embolization at a rate as high as 96% (17).…”

“…If the responsible arteries are relatively large and the bleeding rate is high, or in cases of rebleeding, PVA particles alone are not enough, and other embolic materials such as coils should be combined to reinforce the embolization. Onyx and glue may be a promising liquid embolic agent; however, controlling the glue penetration in vessels may be difficult and great experience with this technique may be required (15,16).…”

Acute Lower Gastrointestinal Hemorrhage

“…Slurry of absorbable gelatin sponge (Gelfoam, Pharmacia & Upjohn Company, MI) may be used in conjunction to facilitate hemostasis. Other embolic agents that have been explored include particles, 39 n-butyl cyanoacrylate (nBCA) glue, [40][41][42] and ethylene vinyl alcohol copolymer (Onyx; ev3, Plymouth, MN). 38,43 Glue and Onyx have a potential advantage of achieving immediate occlusion of the embolized vessel regardless of any underlying coagulopathy or thrombocytopenia.…”