Korean J Radiol.  2009 Aug;10(4):361-365. 10.3348/kjr.2009.10.4.361.

Transcatheter Arterial Embolization of Arterial Esophageal Bleeding with the Use of N-Butyl Cyanoacrylate

Affiliations
  • 1Department of Radiology, Seoul National University College of Medicine; Institute of Radiation Medicine, Seoul National University Medical Research Center; and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea. hyocheol

Abstract


OBJECTIVE
To evaluate the clinical efficacy and safety of a transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for the treatment of arterial esophageal bleeding.
MATERIALS AND METHODS
Between August 2000 and April 2008, five patients diagnosed with arterial esophageal bleeding by conventional angiography, CT-angiography or endoscopy, underwent a TAE with NBCA. We mixed NBCA with iodized oil at ratios of 1:1 to 1:4 to supply radiopacity and achieve a proper polymerization time. After embolization, we evaluated the angiographic and clinical success, recurrent bleeding, and procedure-related complications.
RESULTS
The bleeding esophageal artery directly originated from the aorta in four patients and from the left inferior phrenic artery in one patient. Although four patients had an underlying coagulopathy at the time of the TAE, angiographic and clinical success was achieved in all five patients. In addition, no procedure-related complications such as esophageal infarction were observed during this study.
CONCLUSION
NBCA can be an effective and feasible embolic agent in patients with active arterial esophageal bleeding, even with pre-existing coagulopathy.

Keyword

Esophageal artery; Hemorrhaging; Angiography; Therapeutic embolization

MeSH Terms

Adult
Aged
Angiography
Arteries
Catheterization
Embolization, Therapeutic/*methods
Enbucrilate/administration & dosage/*therapeutic use
Esophageal Diseases/radiography/*therapy
Female
Gastrointestinal Hemorrhage/radiography/*therapy
Humans
Male
Middle Aged

Figure

  • Fig. 1 41-year-old man (patient 3) presenting with arterial esophageal bleeding and underwent liver transplant 30 days prior.A. Selective angiography of esophageal artery arising from descending thoracic aorta shows extravasation of contrast media (arrows) in distal esophagus.B. Image obtained after embolization shows N-butyl cyanoacrylate and Lipiodol mixture in esophageal artery (arrow) and in lumen of esophagus (arrowhead).C. Selective angiography of esophageal artery after performing embolization shows no evidence of extravasation of contrast media. Note subtraction artifact (arrow) caused by N-butyl cyanoacrylate and Lipiodol mixture in esophageal artery.

  • Fig. 2 64-year-old man (patient 2) with arterial esophageal bleeding that underwent subtotal gastrectomy 49 days prior.A. Selective angiography of left inferior phrenic artery shows extravasation of contrast media (arrowhead) originating from esophageal branch (arrow).B. Image during embolization shows N-butyl cyanoacrylate and Lipiodol mixture in esophageal artery (arrowhead) and in lumen of esophagus (open arrowhead). Note tip (arrow) of microcatheter in esophageal branch.


Reference

1. Burke SJ, Golzarian J, Weldon D, Sun S. Nonvariceal upper gastrointestinal bleeding. Eur Radiol. 2007; 17:1714–1726. PMID: 17058080.
Article
2. Schenker MP, Duszak R Jr, Soulen MC, Smith KP, Baum RA, Cope C, et al. Upper gastrointestinal hemorrhage and transcatheter embolotherapy: clinical and technical factors impacting success and survival. J Vasc Interv Radiol. 2001; 12:1263–1271. PMID: 11698624.
Article
3. Kuo WT, Lee DE, Saad WE, Patel N, Sahler LG, Waldman DL. Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol. 2003; 14:1503–1509. PMID: 14654483.
Article
4. Ripoll C, Bañares R, Beceiro I, Menchén P, Catalina MV, Echenagusia A, et al. Comparison of transcatheter arterial embolization and surgery for treatment of bleeding peptic ulcer after endoscopic treatment failure. J Vasc Interv Radiol. 2004; 15:447–450. PMID: 15126653.
Article
5. Carsen GM, Casarella WJ, Spiegel RM. Transcatheter embolization for treatment of Mallory-Weiss tears of the esophagogastric junction. Radiology. 1978; 128:309–313. PMID: 307258.
Article
6. Michal JA 3rd, Brody WR, Walter J, Wexler L. Transcatheter embolization of an esophageal artery for treatment of a bleeding esophageal ulcer. Radiology. 1980; 134:246. PMID: 6965326.
Article
7. Kos X, Trotteur G, Dondelinger RF. Delayed esophageal hemorrhage caused by a metal stent: treatment with embolization. Cardiovasc Intervent Radiol. 1998; 21:428–430. PMID: 9853152.
Article
8. Vogten JM, Overtoom TT, Lely RJ, Quispel R, de Vries JP. Superselective coil embolization of arterial esophageal hemorrhage. J Vasc Interv Radiol. 2007; 18:771–773. PMID: 17538140.
Article
9. Jae HJ, Chung JW, Jung AY, Lee W, Park JH. Transcatheter arterial embolization of nonvariceal upper gastrointestinal bleeding with N-butyl cyanoacrylate. Korean J Radiol. 2007; 8:48–56. PMID: 17277563.
Article
10. Encarnacion CE, Kadir S, Beam CA, Payne CS. Gastrointestinal bleeding: treatment with gastrointestinal arterial embolization. Radiology. 1992; 183:505–508. PMID: 1561358.
Article
11. Aina R, Oliva VL, Therasse E, Perreault P, Bui BT, Dufresne MP, et al. Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol. 2001; 12:195–200. PMID: 11265883.
Article
12. Cromwell LD, Kerber CW. Modification of cyanoacrylate for therapeutic embolization: preliminary experience. AJR Am J Roentgenol. 1979; 132:799–801. PMID: 107749.
Article
13. Stoesslein F, Ditscherlein G, Romaniuk PA. Experimental studies on new liquid embolization mixtures (histoacryl-lipiodol, histoacryl-panthopaque). Cardiovasc Intervent Radiol. 1982; 5:264–267. PMID: 6297733.
Article
14. Toyoda H, Nakano S, Kumada T, Takeda I, Sugiyama K, Osada T, et al. Estimation of usefulness of N-butyl-2-cyanoacrylate-lipiodol mixture in transcatheter arterial embolization for urgent control of life-threatening massive bleeding from gastric or duodenal ulcer. J Gastroenterol Hepatol. 1996; 11:252–258. PMID: 8742922.
Article
15. Swigart LL, Siekert RG, Hambley WC, Anson BJ. The esophageal arteries; an anatomic study of 150 specimens. Surg Gynecol Obstet. 1950; 90:234–243. PMID: 15401971.
16. Michels NA. Underlying blood supply and anatomy of the upper abdominal organs, with a descriptive atlas. 1955. Philadelphia: Lippincott;p. 266–270.
17. Lee CW, Liu KL, Wang HP, Chen SJ, Tsang YM, Liu HM. Transcatheter arterial embolization of acute upper gastrointestinal tract bleeding with N-butyl-2-cyanoacrylate. J Vasc Interv Radiol. 2007; 18:209–216. PMID: 17327553.
Article
Full Text Links
  • KJR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr