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

Abstract

ObjectiveTo 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 MethodsBetween 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.ResultsThe 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.ConclusionNBCA can be an effective and feasible embolic agent in patients with active arterial esophageal bleeding, even with pre-existing coagulopathy.

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

“…Vascular embolization using NBCA was also demonstrated to be effective for postoperative bleeding in hemophiliacs who underwent radical prostatectomy [75]. In addition, angiographic and clinical success were achieved in four patients who had underlying coagulopathy (INR [ 1.5 or platelet count \ 80000/lL) at the time of vascular embolization using NBCA for arterial esophageal bleeding [135]. In a case-control study of acute arterial hemorrhaging, 63 arteries in 46 patients with coagulopathy (INR [1.5 or platelet count \50000/lL) were embolized with gelatin sponge particles, fibered microcoils, or NBCA.…”

“…Specific comments NBCA polymerizes after coming into contact with ionic media in the blood via the following three mechanisms [17,54,58,59,64,94,95,97,103,123,130,135,139,161]:…”

“…In particular, NBCA is a useful embolic material in the following situations: (a) cases in which pseudoaneurysms cannot be embolized via selective catheterization using the isolation technique; (b) embolization involving the preservation of the parent artery [56,134,149,163,167,174,183]; (c) cases in which coil embolization might be unsuitable because of the condition of the target vessels, e.g., those involving markedly tortuous, stenotic, or fine vessels [54,72,87,135,138,165]; (d) cases involving patients in a hypocoagulable state (refer to CQ6). Furthermore, vascular embolization with NBCA has also been reported to be useful for nasal bleeding [103,104], hemoptysis [16,141], and gastrointestinal bleeding.…”

Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes

“…More recently, very good results have also been reported with NBCA [54][55][56][57]. Toyoda et al [56] reported that the time required for TAE using NBCA was significantly lower than for TAE procedures that do not use NBCA.…”

Periesophageal Pseudoaneurysms: Rare Cause of Refractory Bleeding Treated with Transarterial Embolization

“…Transarterial embolization in the esophagus for nonvariceal bleeding is a very rare intervention with only 5 cases of ulcer related bleeding reported in the literature [10]. There are also reports of embolization for bleeding in patients with esophageal cancer [11].…”