Evaluation of the Safety and Efficacy of Transcatheter Cyanoacrylate Glue Embolization in Acute Arterial Bleeding

Abstract

Objective: To demonstrate the safety and efficacy of endovascular embolization with N-butyl cyanoacrylate glue in acute bleeding. Methods: The data of 31 patients who underwent endovascular embolization using glue due to acute visceral hemorrhage were retrospectively evaluated. In order to detect the bleeding focus before the procedure, computed tomography with contrast-enhanced and non-contrast phases was routinely performed on the suspected bleeding site. Technical success was accepted as the closure of the targeted artery in control angiography, and clinical success was defined as the absence of bleeding that would require reoperation within one month postoperatively. Results: Eleven patients with gastrointestinal tract or vaginal bleeding or hematuria due to malignancy, nine with hemoptysis due to infection sequelae or bronchiectasis, four with bleeding secondary to percutaneous medical procedures, three with trauma-related hemorrhage, and four with hemorrhage due to peptic ulcers were treated with endovascular embolization. Embolization was undertaken using a glue-lipiodol mixture of 5% in 17 patients and 10% in 14 patients. Conclusion: N-butyl cyanoacrylate is a safe embolizing material with high technical and clinical success in patients with active bleeding.

Keywords

• N-butyl cyanoacrylate glue
• embolization
• hemorrhage
• endovascular treatment

Akut Arteriyel Kanamalarda Transkatater Siyanoakrilat Glue Embolizasyonun Güvenliğinin ve Etkinliğinin Değerlendirilmesi

Öz

Amaç: Akut kanamalarda N-butyl cyanoacrylate glue ile yapılan endovasküler embolizasyonun güvenliğini ve etkinliğini göstermek. Gereç ve Yöntem: Akut visseral kanama nedeni ile tarafımızca glue ile endovasküler embolizasyon uygulanan toplam 31 hastanın verileri retrospektif olarak değerlendirildi. Hastalara işlem öncesi kanama odağını saptama amacıyla rutin olarak kontrastsız ve kontrastlı fazlardan oluşan şüphe edilen kanama bölgesine yönelik bilgisayarlı tomografi çekildi. Teknik başarı kontrol anjiografide hedeflenen damarın kapatılması, klinik başarı ise post-op 1 aylık sürede tekrar işlem gerektirecek kanama olmaması şeklinde kabul edildi. Bulgular: Maligniteye bağlı gastrointestinal sistem (GİS), vajinal kanama ya da hematürisi olan 11 hasta, enfeksiyon sekeli ya da bronşektaziye bağlı hemoptizisi olan 9 hasta, perkütan tıbbi işlemler sonrası kanaması olan 4 hasta, travmaya bağlı kanaması olan 3 hasta, peptik ülser nedeni ile kanaması olan 4 hasta endovasküler embolizasyon ile tedavi edildi. 17 hastada %5’lik, 14 hastada ise %10’luk glue-lipiodol karışımı embolizasyon için kullanıldı. Sonuç: N-butil siyanoakrilat aktif kanaması olan hastalarda teknik ve klinik başarısı yüksek güvenilir bir embolizan materyaldir.

Anahtar Kelimeler

• N-butil siyanoakrilat glue
• embolizasyon
• hemoraji
• endovasküler tedavi

Kaynakça

1. 1. Kim PH, Tsauo J, Shin JH, Yun SC. Transcatheter arterial embolization of gastrointestinal bleeding with N-Butyl cyanoacrylate: a systematic review and metaanalysis of safety and efficacy. J Vasc Interv Radiol. 2017;28:522-31.
2. 2. Loffroy R, Mouillot T, Bardou M, Chevallier O. Current role of cyanoacrylate glue transcatheter embolization in the treatment of acute nonvariceal gastrointestinal bleeding. Expert Rev Gastroenterol Hepatol. 2020 Oct;14(10):975-84.
3. 3. Kodani M, Yata S, Ohuchi Y, Ihaya T, Kaminou T, Ogawa T. Safety and risk of superselective transcatheter arterial embolization for acute lower gastrointestinal hemorrhage with N-Butyl cyanoacrylate: angiographic and colonoscopic evaluation. J Vasc Interv Radiol. 2016;27:824-30.
4. 4. Okada T, Yamaguchi M, Takahashi T, Izaki K, Uotani K, Sakamoto N, et al. Is embolization of the pancreas safe? Pancreatic histological changes after selective transcatheter arterial embolization with N-butyl cyanoacrylate in a swine model. Cardiovasc Intervent Radiol. 2012;35:161-67.
5. 5. Abdulmalak G, Chevallier O, Falvo N, Di Marco L, Bertaut A, Moulin B, et al. Safety and efficacy of transcatheter embolization with Glubran®2 cyanoacrylate glue for acute arterial bleeding: a single-center experience with 104 patients. Abdom Radiol (NY). 2018;43:723-33.
6. 6. Jawhari R, Chevallier O, Falvo N, d’Athis P, Gehin S, Charles PE, et al. Outcomes of transcatheter arterial embolization with a modified N-Butyl cyanoacrylate glue for spontaneous Iliopsoas and rectus sheath hematomas in anticoagulated patients. J Vasc Interv Radiol. 2018;29:210-17.
7. 7. Kawai N, Sato M, Minamiguchi H, Ikoma A, Sanda H, Nakata K, et al. Basic study of a mixture of N-butyl cyanoacrylate, ethanol, and lipiodol as a new embolic material. J Vasc Interv Radiol. 2012;23:1516-21.
8. 8. Tanaka F, Kawai N, Sato M, Minamiguchi H, Nakai M, Nakata K, et al. Effect of transcatheter arterial embolization with a mixture of n-butyl cyanoacrylate, lipiodol, and ethanol on the vascular wall: macroscopic and microscopic studies. Jpn J Radiol. 2015;33:404-49.

9. 9. Chewning RH, Monroe EJ, Lindberg A, Koo KSH, Ghodke BV, Gow KW, Javid PJ, Jinguji TM, Perkins JA, Shivaram GM. Combined glue embolization and excision for the treatment of venous malformations. CVIR Endovasc. 2018;1:22.
10. 10. Chevallier O, Comby PO, Guillen K, Pellegrinelli J, Mouillot T, Falvo N, Bardou M, Midulla M, Aho-Glélé S, Loffroy R. Efficacy, safety and outcomes of transcatheter arterial embolization with N-butyl cyanoacrylate glue for non-variceal gastrointestinal bleeding: A systematic review and meta-analysis. Diagn Interv Imaging. 2021;102:479-87.
11. 11. Chevallier O, Fauque P, Poncelet C, Guillen K, Comby PO, Astruc K, Barberet J, Falvo N, Simon E, Loffroy R. Relevant Biological Effects of Varicocele Embolization with N-Butyl Cyanoacrylate Glue on Semen Parameters in Infertile Men. Biomedicines. 2021;9:1423
12. 12. Doniselli FM, Paolucci A, Conte G, Rampini P, Arrichiello A, Triulzi FM. Glue embolization of a pial arteriovenous fistula of the spinal artery. Acta Biomed. 2020;91(10-S):e2020004.
13. 13. Soga S, Suyama Y, Shinmoto H. Balloon-occluded retrograde glue embolization for intractable lymphorrhea from bilateral iliac lymphatics following surgery for rectal cancer. Radiol Case Rep. 2020;15:371-74.
14. 14. Cho, Y.C., Park, W., Kang, J.M. et al. Newly Developed N-butyl Cyanoacrylate (EG glue) for Arterial Embolization: A Preclinical Study in Rabbit Renal Artery. Macromol. Res. 2021;178–84.
15. 15. Yip SWY, Li YL, Chu YLE, et al. Adrenal and renal abscesses following glue embolization of gastric varices: a case description. Quant Imaging Med Surg. 2020;1566-69.
16. 16. Hargis PA, Henslee B, Pokala N, Bhat A. Percutaneous Lymphatic Maceration and Glue Embolization for High-output Chylous Ascites after Robot-assisted Laparoscopic Nephrectomy and Lymphadenectomy. J Clin Imaging Sci. 2021;11:56.
17. 17. Toyoda H, Kumada T, Sone Y, et al. Late-onset colonic occlusion after emergent selective embolization of sigmoid artery with N-butyl cyanoacrylate for lifethreatening traumatic bleeding. J Vasc Interv Radiol. 2009;20:1376–79.
18. 18. Gordhan AD, Newey CR, Wong G, Wieland J. N-butyl cyanoacrylate embolization of small bowel arteriovenous malformation presenting with acute massive lower gastrointestinal hemorrhage. J Vasc Interv Radiol. 2008;19:1669–70.
19. 19. Kodani M, Yata S, Ohuchi Y, et al. Safety and risk of superselective transcatheter arterial embolization for acute lower gastrointestinal hemorrhage with N-butyl cyanoacrylate: angiographic and colonoscopic evaluation. J Vasc Interv Radiol. 2016;27:824–30.
20. 20. Morishita H, Yamagami T, Matsumoto T, et al. Transcatheter arterial embolization with N-butyl cyanoacrylate for acute life-threatening gastroduodenal bleeding uncontrolled by endoscopic hemostasis. J Vasc Interv Radiol. 2013;24:432–38.
21. 21. Lee CW, Liu KL, Wang HP, et al. Transcatheter arterial embolization of acute upper gastrointestinal tract bleeding with N-butyl-2-cyanoacrylate. J Vasc Interv Radiol. 2007;18:209–16.