Transcatheter arterial embolization for massive hemobilia with N-butyl cyanoacrylate (NBCA) Glubran 2

Abstract

Background Massive hemobilia is a life-threatening condition and therapeutic challenge. Few studies have demonstrated the use of N-butyl cyanoacrylate (NBCA) for massive hemobilia. Purpose To investigate the efficacy and safety of transcatheter arterial embolization (TAE) using NBCA Glubran 2 for massive hemobilia. Material and Methods Between January 2012 and December 2019, the data of 26 patients (mean age 63.4 ± 12.6 years) with massive hemobilia were retrospectively evaluated for TAE using NBCA. The patients’ baseline characteristics, severities of hemobilia, and imaging findings were collected. Emergent TAE was performed using 1:2–1:4 mixtures of NBCA and ethiodized oil. Technical success, clinical success, procedure-related complications, and follow-up outcomes were assessed. Results Pre-procedure arteriography demonstrated injuries to the right hepatic artery (n = 24) and cystic artery (n = 2). Initial coil embolization distal to the lesions was required in 5 (19.2%) patients to control high blood flow and prevent end-organ damage. After a mean treatment time of 11.2 ± 5.3 min, technical success was achieved in 100% of the patients without non-target embolization and catheter adhesion. Clinical success was achieved in 25 (96.2%) patients. Major complications were noted in 1 (3.8%) patient with gallbladder necrosis. During a median follow-up time of 16.5 months (range 3–24 months), two patients died due to carcinomas, whereas none of the patients experienced recurrent hemobilia, embolic material migration, or post-embolization complications. Conclusion NBCA embolization for massive hemobilia is associated with rapid and effective hemostasis, as well as few major complications. This treatment modality may be a promising alternative to coil embolization.

N-Butyl-cyanoacrylate-assisted retrograde transvenous obliteration (NARTO) for gastric varices

“…NARTO is a simple technique that uses nBCA to embolize the GRS after injecting a sclerosant under balloon occlusion, unlike in CARTO-II, which uses coils [6] . NARTO thus offers advantages in terms of cost-effectiveness and saves time compared with CARTO-II because nBCA is cheaper than coils, and it is quicker to inject nBCA than to insert a sufficient number of coils to occlude the GRS [8] . In addition, because NARTO can be performed independently of the diameter of the GRS, when the GRS can be completely blocked using a balloon catheter.…”

Transcatheter arterial embolization using n-butyl cyanoacrylate–Lipiodol mixture and metallic coils in a patient with biliary hemorrhage after removing a bile duct metallic stent: a case description

“…The clinical success rate of transcatheter arterial embolization for biliary hemorrhage is high, ranging from 80% to 100%, and it is a treatment that should be actively considered for such events ( 5 ). Liquid embolic materials such as NBCA and metallic coils are often used for embolization of biliary hemorrhage ( 6 , 7 ). Advantages of NBCA are that embolization is independent of its coagulation ability and it allows a shorter procedure time.…”

Clinical application of medical adhesive in endovascular embolization treatment of peripheral pseudoaneurysm

“…At present, there are few related clinical studies. [ 6 , 7 ] This study retrospectively analyzed the clinical data of patients with peripheral pseudoaneurysms treated with vascular medical adhesive embolization in our hospital from July 2021 to June 2023 and analyzed the effectiveness and safety of medical adhesive embolization in the treatment of pseudoaneurysms.…”