Limits...
Transcatheter arterial embolization of nonvariceal upper gastrointestinal bleeding with N-butyl cyanoacrylate.

Jae HJ, Chung JW, Jung AY, Lee W, Park JH - Korean J Radiol (2007 Jan-Feb)

Bottom Line: The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery.Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2).TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul 110,744, Korea.

ABSTRACT

Objective: To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding.

Materials and methods: Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1-1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated.

Results: The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18).

Conclusion: TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy.

Show MeSH

Related in: MedlinePlus

Thirty-three-year-old male presented with gastric ulcer bleeding who underwent liver transplantation 11 days previously.A. Celiac arteriography shows suspected extravasation of contrast media in the antrum of the stomach (arrow).B. Superselective gastroduodenal arteriography using a microcatheter reveals extravasation of contrast media from the antral branch (arrow).C. Radiography obtained after test injection of contrast media. The tip of the microcatheter (white arrow) could not advance to the bleeding point, but effective wedging of the microcatheter, into the bleeding artery, was achieved to restrict pericatheter flow.D. Post-embolic celiac arteriography shows the successful embolization of the bleeding focus after embolization with NBCA mixture.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2626693&req=5

Figure 1: Thirty-three-year-old male presented with gastric ulcer bleeding who underwent liver transplantation 11 days previously.A. Celiac arteriography shows suspected extravasation of contrast media in the antrum of the stomach (arrow).B. Superselective gastroduodenal arteriography using a microcatheter reveals extravasation of contrast media from the antral branch (arrow).C. Radiography obtained after test injection of contrast media. The tip of the microcatheter (white arrow) could not advance to the bleeding point, but effective wedging of the microcatheter, into the bleeding artery, was achieved to restrict pericatheter flow.D. Post-embolic celiac arteriography shows the successful embolization of the bleeding focus after embolization with NBCA mixture.

Mentions: N-Butyl Cyanoacrylate (Histoacryl, Braun, Melsungen, Germany) was used as an embolic agent in all participating patients. After a common femoral artery puncture, a standard 5-F angiographic catheter was used to access the sites of suspected bleeding and it was also used as an introducing catheter. Diagnostic angiography was performed to identify the bleeding site; next a 3-F microcatheter (Microferret; Cook, Bloomington, IN) was advanced, to as close as possible, to the bleeding point. The indications for using NBCA as an embolic material were inability to adequately reach the bleeding site and effective wedging of the microcatheter into the bleeding artery to restrict pericatheter flow (Figs. 1, 2).


Transcatheter arterial embolization of nonvariceal upper gastrointestinal bleeding with N-butyl cyanoacrylate.

Jae HJ, Chung JW, Jung AY, Lee W, Park JH - Korean J Radiol (2007 Jan-Feb)

Thirty-three-year-old male presented with gastric ulcer bleeding who underwent liver transplantation 11 days previously.A. Celiac arteriography shows suspected extravasation of contrast media in the antrum of the stomach (arrow).B. Superselective gastroduodenal arteriography using a microcatheter reveals extravasation of contrast media from the antral branch (arrow).C. Radiography obtained after test injection of contrast media. The tip of the microcatheter (white arrow) could not advance to the bleeding point, but effective wedging of the microcatheter, into the bleeding artery, was achieved to restrict pericatheter flow.D. Post-embolic celiac arteriography shows the successful embolization of the bleeding focus after embolization with NBCA mixture.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2626693&req=5

Figure 1: Thirty-three-year-old male presented with gastric ulcer bleeding who underwent liver transplantation 11 days previously.A. Celiac arteriography shows suspected extravasation of contrast media in the antrum of the stomach (arrow).B. Superselective gastroduodenal arteriography using a microcatheter reveals extravasation of contrast media from the antral branch (arrow).C. Radiography obtained after test injection of contrast media. The tip of the microcatheter (white arrow) could not advance to the bleeding point, but effective wedging of the microcatheter, into the bleeding artery, was achieved to restrict pericatheter flow.D. Post-embolic celiac arteriography shows the successful embolization of the bleeding focus after embolization with NBCA mixture.
Mentions: N-Butyl Cyanoacrylate (Histoacryl, Braun, Melsungen, Germany) was used as an embolic agent in all participating patients. After a common femoral artery puncture, a standard 5-F angiographic catheter was used to access the sites of suspected bleeding and it was also used as an introducing catheter. Diagnostic angiography was performed to identify the bleeding site; next a 3-F microcatheter (Microferret; Cook, Bloomington, IN) was advanced, to as close as possible, to the bleeding point. The indications for using NBCA as an embolic material were inability to adequately reach the bleeding site and effective wedging of the microcatheter into the bleeding artery to restrict pericatheter flow (Figs. 1, 2).

Bottom Line: The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery.Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2).TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul 110,744, Korea.

ABSTRACT

Objective: To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding.

Materials and methods: Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1-1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated.

Results: The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18).

Conclusion: TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy.

Show MeSH
Related in: MedlinePlus