Korean J Radiol.  2007 Feb;8(1):48-56. 10.3348/kjr.2007.8.1.48.

Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

• Jae HJ
• Chung JW
• Jung AY
• Lee W
• Park JH

• KMID: 753865
• DOI: http://doi.org/10.3348/kjr.2007.8.1.48

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.

Keyword

Gastrointestinal tract, hemorrhage; Angiography, therapeutic embolization

MeSH Terms

Treatment Outcome
Middle Aged
Male
Humans
Gastrointestinal Hemorrhage/radiography/*therapy
Female
Enbucrilate/*therapeutic use
Embolization, Therapeutic/*methods
Angiography
Aged, 80 and over
Aged
Adult

Figure

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  Fig. 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.

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  Fig. 2 Sixty-seven-year-old male with duodenal stent placement for duodenal adenocarcinoma 20 days previously. A. Celiac arteriography shows suspected extravasation of contrast media into the duodenum (arrow). B. Gastroduodenal arteriography reveals a pseudoaneurysm of a duodenal branch supplied by the gastroduodenal artery (arrow). C. The mixture of N-Butyl Cyanoacrylate and lipiodol was injected into the bleeding artery. The radiopaque N-Butyl Cyanoacrylate mixture accumulated beside the duodenal stent. D. Post-embolic celiac arteriography shows the successful embolization of the bleeding artery and the preserved blood flow through the gastroduodenal artery.

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  Fig. 3 Fifty-nine-year-old male presented with gastric cancer bleeding. A. Celiac arteriography shows a area of contrast collection supplied by the right gastroepiploic artery (arrow). B. Selective right gastroepiploic arteriography reveals pseudoaneurysm formation (arrow). C. After embolization with the NBCA mixture (arrow), post-embolic celiac arteriography shows the successful embolization of the bleeding artery. D. The radiopaque N-Butyl Cyanoacrylate mixture casting in the right gastroepiploic artery is seen on post-embolic radiography (white arrow).

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