Multiple systemic embolisms with septicemia after gastric variceal obliteration with cyanoacrylate

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

“…Blood flow control should be considered when NBCA migration is expected in high-flow lesions. Flow stagnation via the use of balloon catheters or wedge catheters, the combined use of vascular embolization and metallic coils or other materials, or temporary vasoconstriction via the local injection of diluted epinephrine, have been reported in such situations [15,29,30,33,42,50,72,92,105,128,137,139,152,158,187]. However, the injection of NBCA using balloon or wedge catheters can cause unexpected migration of the adhesive into a non-target area through vascular anastomoses that have not been detected on preoperative angiography, so these procedures should be carried out with great care.…”

Cerebral embolism following N-butyl-2-cyanoacrylate injection for esophageal postbanding ulcer bleed: a case report

“…2 Contrasted transthoracic echocardiogram showing microbubbles seen as white specks present mainly in the right-sided heart chambers. This image, which was captured when the patient performed Valsalva maneuver soon after intravenous agitated saline injection, showed that the microbubbles escaped into the left atrium via a defect (patent foramen ovale) in the inter-atrial septum [16][17][18]. In theory, using undiluted Histoacryl may prevent distal embolization because the polymer solidifies rapidly upon contact with blood.…”

“…Among the case reports on systemic Histoacryl embolism, echocardiographic study showed either patent foramen ovale [7,9] or no evidence of intracardiac shunt [8,18]. Other authors did not report on echocardiographic findings and have presumed that the paradoxical embolization occurred via an arteriovenous pulmonary shunt [16,17].…”

Spontaneous splenic infarction in an elderly cirrhotic patient with multiple comorbidities

“…Iatrogenic infarction may occur during selective intraarterial infusion of vasopressin for gastrointestinal bleed, resulting in angiographically demonstrable splenic artery spasm and subsequent splenic infarction in cirrhotic patients (9). There are also case reports of splenic infarction after cyanoacrylate injection to gastric fundal varices (10,11), histoacryl embolization (12)(13)(14), splenic artery ligation (15), and liver transplantation (16). Splenic infarction can be the presenting symptom of other underlying illnesses, so a high index of suspicion for this condition is appropriate in the presence of predisposing conditions for thrombosis, left flank pain, and splenomegaly.…”