Transcatheter Arterial Embolization with N-butyl-2 Cyanoacrylate Glubrans 2 for the Treatment of Acute Renal Hemorrhage Under Coagulopathic Condition

Abstract Background:The efficacy and safety of transcatheter arterial embolization (TAE) using the N-butyl-2 cyanoacrylate (NBCA) Glubran2 in the treatment of acute renal hemorrhage (RH) under coagulopathic conditionsarestill no consensus.Methods: Between February 2014 and June 2019, 8 patients underwent TAE with the NBCA Glubran2 for acute RH under coagulopathic conditions. Coagulopathy was defined as abnormal values of prothrombin time and activated partial thromboplastin time and/or a reduced platelet count.Angiograms and medical records were retrospectively reviewed to determine technical/clinical success, complications and recurrent hemorrhage after TAE, and follow-up outcomes were assessed.Results: Of note, one patient presented with severe coagulopathy, and three presented with severe RH and hemodynamic instability. The NBCA Glubran2 was employed as a sole embolic material in sixpatients. In the remaining two patients, it was employed for secondary embolization.Under coagulopathic conditions, due to the use of the NBCA Glubran2, both technical success and clinical success for acute RH were achieved in all patients. Duringa mean follow-up time of 30.1 months (range, 3-84 months), neither persistent nor recurrent active hemorrhage required repeat endovascular or surgical treatment for hemostasis. No Glubran2related complications occurred mid-TAE pro-cedure. In addition, renal function information was available for all patients, and there was no significant difference between the serum creatinine levels [(83.8 ± 15.5) vs (85.8 ± 32.2) μmol/L] before and one week after Glubran2 embolization (p=0.89; CI, -34.5 to 30.5).Conclusions: The present findings suggest that TAE with the NBCA Glubran2 may be a safe alternative treatment for the management of RH under coagulopathic conditions. In particular, this method appears to be a potentially attractive alternative when con-ventional embolic materials fail in patients with ongoing hemodynamic instability or even under severe coagulopathic conditions.

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The Efficacy and Safety of Transcatheter Arterial Embolization to Treat Renal Hemorrhage after Percutaneous Nephrolithotomy

BioMed Research International ◽

10.1155/2019/6265183 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Nan Du ◽

Jing-Qin Ma ◽

Jian-Jun Luo ◽

Qing-Xin Liu ◽

Zi-Han Zhang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Conservative Treatment ◽

Percutaneous Nephrolithotomy ◽

Transcatheter Arterial Embolization ◽

Univariate Analysis ◽

Arterial Embolization ◽

Endovascular Embolization ◽

Severe Bleeding ◽

Renal Hemorrhage

Purpose. The aim of this study was to evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in patients with renal hemorrhage after percutaneous nephrolithotomy (PCNL) and evaluate the risk factors that may result in severe bleeding requiring TAE. Methods. We retrospectively reviewed 121 patients with post-PCNL renal hemorrhage. Thirty-two patients receiving endovascular embolization were compared with 89 patients only receiving conservative treatment. The demographic and clinical data were recorded and compared between the two groups. The values of estimated glomerular filtration rate (eGFR) and serum creatinine (SCr) were recorded preoperatively, postoperatively, and at last follow-up and analyzed to evaluate the safety and efficiency of TAE. Results. The successful hemostasis rate of conservative therapy was 73.6% (89/121) and that of TAE was 100% (32/32). SCr and eGFR were not significantly different before PCNL and after the last follow-up of TAE (SCr: 0.95 vs. 0.95 mg/dl, P=0.857; eGFR: 86.77 vs. 86.18 ml/min/1.73m2, P=0.715). The univariate analysis demonstrated that advanced age, urinary tract infection, and diabetes mellitus were significantly associated with severe bleeding during PCNL. Multivariate analysis further identified that diabetes mellitus was an independent risk factor for severe bleeding needing TAE [odds ratio (OR): 3.778, 95% confidence interval (CI):1.276-11.190, and P=0.016]. Conclusion. TAE is a safe and effective procedure to treat renal hemorrhage that cannot be resisted by conservative treatment after PCNL. Diabetes mellitus was associated with high risks of severe bleeding needing TAE after PCNL.

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Superselective Renal Artery Embolization Management of Post-percutaneous Nephrolithotomy Hemorrhage and Its Methods

Frontiers in Surgery ◽

10.3389/fsurg.2020.582261 ◽

2020 ◽

Vol 7 ◽

Author(s):

Xiangjun Dong ◽

Yanqiao Ren ◽

Ping Han ◽

Lei Chen ◽

Tao Sun ◽

...

Keyword(s):

Serum Creatinine ◽

Success Rate ◽

Clinical Data ◽

Clinical Success ◽

Clinical Success Rate ◽

Arterial Embolization ◽

Interventional Therapy ◽

Technical Success Rate ◽

Renal Hemorrhage ◽

Significant Difference

Objective: The purpose of this study was to evaluate the therapeutic efficacy and safety of superselective renal arterial embolization (SRAE) in the treatment of patients with renal hemorrhage after percutaneous nephroscopy (PCNL). In addition, embolization techniques and embolization materials during operation were also worthy of further discussion.Methods: From February 2015 to December 2019, clinical data of 49 consecutive patients with renal hemorrhage after PCNL were retrospectively analyzed. Demographic and clinical data of patients were recorded, changes in serum creatinine values were analyzed, and the safety and efficacy of TAE were evaluated. Clinical experience was also recorded.Results: A total of 49 patients underwent angiography, of which 46 patients received SRAE due to positive hemorrhagic foci detected by angiography, and the technical success rate of 46 patients was 100%. Among the three patients who did not receive embolization, one patient underwent nephrectomy, and two patients improved with conservative treatment, with a clinical success rate of 98%. There was no statistically significant difference between serum creatinine before PCNL and 7 days after SRAE (101.6 ± 36.5 to 100.5 ± 27.1 μmol/L; P = 0.634), and no significant change was observed in serum creatinine at the last follow-up (99.4 ± 34 μmol/L, P = 0.076). No major complications occurred after embolization.Conclusions: SRAE is safe and effective in patients with renal hemorrhage after PCNL. The experience of interventional therapy and the choice of embolization materials in this study may provide certain benefits for the treatment of patients with renal hemorrhage after PCNL.

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Ultraselective transcatheter arterial embolization with small-sized microcoils for acute lower gastrointestinal bleeding

CVIR Endovascular ◽

10.1186/s42155-021-00215-9 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Mitsuhiro Kinoshita ◽

Hiroshi Kondo ◽

Suguru Hitomi ◽

Takuya Hara ◽

Ryusei Zako ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Clinical Success Rate ◽

Arterial Embolization ◽

Lower Gastrointestinal Bleeding ◽

Recurrent Bleeding ◽

Major Complications ◽

Vasa Recta

Abstract Purpose To evaluate the clinical outcome of ultraselective transcatheter arterial embolization (TAE) with small-sized microcoils for acute lower gastrointestinal bleeding (LGIB). Materials and methods The subjects were 17 consecutive patients (mean age, 69 years) with LGIB who were treated with ultraselective TAE using small-sized microcoils between December 2013 and December 2019. Ultraselective TAE was defined as embolization of one or both of the long or short branches of the vasa recta. The etiologies of bleeding were colonic diverticulosis in 16 patients (94%) and malignancy in one patient (6%). The bleeding foci were in the ascending colon in 11 patients (65%), transverse colon in 2 patients (12%), and sigmoid colon in 4 patients (23%). A total of 18 branches (diameter: range 0.5–1.5 mm, mean 1.1 mm) of the vasa recta in 17 patients were embolized with small-sized microcoils (size range 1–3 mm, mean combined lengths of all microcoils 7.6 cm). The mean follow-up period was 19 months (range 1–80 months). The technical and clinical success rate, recurrent bleeding rate, major complications and long-term clinical outcomes were retrospectively evaluated. Results Technical and clinical success was achieved in all patients (17/17). The rates of early recurrent bleeding (within 30 days of TAE) and major complications were 0% (0/17). Recurrent bleeding occurred in one patient at 2 months after TAE, but was stopped with conservative treatment. There were no other bleeding episodes or complications in the follow-up period. Conclusion Ultraselective TAE with small-sized microcoils is a highly effective and safe treatment modality for LGIB.

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Transcatheter arterial embolization for hemorrhage after gynecologic hysterectomy: a multicenter study

Acta Radiologica ◽

10.1177/02841851211010395 ◽

2021 ◽

pp. 028418512110103

Author(s):

Cheng Shi Chen ◽

Young-Jong Cho ◽

Ji Hoon Shin ◽

Jeong Ho Kim ◽

Suyoung Park ◽

...

Keyword(s):

Multicenter Study ◽

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Arterial Embolization ◽

Exploratory Laparotomy ◽

Hemodynamic Instability ◽

Active Bleeding ◽

Success Rates ◽

Contrast Extravasation ◽

Anterior Division

Background Transcatheter arterial embolization (TAE) is not common for hemorrhagic complications after gynecologic hysterectomy. Purpose To evaluate the effectiveness and safety of TAE for hemorrhage after hysterectomy for gynecologic diseases. Material and Methods This is a retrospective, multicenter study, which investigated 11 patients (median age = 45 years) who underwent TAE for hemorrhage after gynecologic hysterectomy between 2004 and 2020. Results The median interval between surgery and angiography was one day (range = 0–82 days). Hemodynamic instability and massive transfusion were present in 6 (54.5%) and 4 (36.4%) patients, respectively. CT scans (n = 7) showed contrast extravasation (n = 5), pseudoaneurysm (n = 1), or both (n = 1). On angiography, the bleeding arteries were the anterior division branches of the internal iliac artery (IIA) (n = 6), posterior division branch (lateral sacral artery, n = 1), and inferior epigastric artery (n = 1) in eight patients with active bleeding. In the remaining three patients, angiographic staining without active bleeding foci was observed at the vaginal stump, and the feeders for staining were all anterior division branches of the IIA. Technical and clinical success rates were 100% and 90.9% (10/11), respectively. In one patient, active bleeding focus was successfully embolized on angiography, but surgical hemostasis was performed for suspected bleeding on exploratory laparotomy. Postembolization syndrome occurred in one patient. Conclusions TAE is effective and safe for hemorrhage after hysterectomy for gynecologic diseases. Angiographic findings are primarily active bleeding, but angiographic staining is not uncommon. A bleeding focus is possible in any branch of the IIA, as well as the arteries supplying the abdominal wall.

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Transcatheter arterial embolization for massive hemobilia with N-butyl cyanoacrylate (NBCA) Glubran 2

Acta Radiologica ◽

10.1177/0284185121992971 ◽

2021 ◽

pp. 028418512199297

Author(s):

Yadong Shi ◽

Liang Chen ◽

Boxiang Zhao ◽

Hao Huang ◽

Zhaoxuan Lu ◽

...

Keyword(s):

Transcatheter Arterial Embolization ◽

Coil Embolization ◽

Treatment Time ◽

Clinical Success ◽

Arterial Embolization ◽

Technical Success ◽

Promising Alternative ◽

Major Complications ◽

Glubran 2

Background Massive hemobilia is a life-threatening condition and therapeutic challenge. Few studies have demonstrated the use of N-butyl cyanoacrylate (NBCA) for massive hemobilia. Purpose To investigate the efficacy and safety of transcatheter arterial embolization (TAE) using NBCA Glubran 2 for massive hemobilia. Material and Methods Between January 2012 and December 2019, the data of 26 patients (mean age 63.4 ± 12.6 years) with massive hemobilia were retrospectively evaluated for TAE using NBCA. The patients’ baseline characteristics, severities of hemobilia, and imaging findings were collected. Emergent TAE was performed using 1:2–1:4 mixtures of NBCA and ethiodized oil. Technical success, clinical success, procedure-related complications, and follow-up outcomes were assessed. Results Pre-procedure arteriography demonstrated injuries to the right hepatic artery (n = 24) and cystic artery (n = 2). Initial coil embolization distal to the lesions was required in 5 (19.2%) patients to control high blood flow and prevent end-organ damage. After a mean treatment time of 11.2 ± 5.3 min, technical success was achieved in 100% of the patients without non-target embolization and catheter adhesion. Clinical success was achieved in 25 (96.2%) patients. Major complications were noted in 1 (3.8%) patient with gallbladder necrosis. During a median follow-up time of 16.5 months (range 3–24 months), two patients died due to carcinomas, whereas none of the patients experienced recurrent hemobilia, embolic material migration, or post-embolization complications. Conclusion NBCA embolization for massive hemobilia is associated with rapid and effective hemostasis, as well as few major complications. This treatment modality may be a promising alternative to coil embolization.

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Transcatheter arterial embolization for massive hemobilia with N-butyl cyanoacrylate (NBCA) Glubran 2

10.21203/rs.3.rs-30316/v1 ◽

2020 ◽

Author(s):

Yadong Shi ◽

Liang Chen ◽

Boxiang Zhao ◽

Jianping Gu ◽

Hao Huang ◽

...

Keyword(s):

Transcatheter Arterial Embolization ◽

Coil Embolization ◽

Treatment Modality ◽

Clinical Success ◽

Arterial Embolization ◽

Cystic Artery ◽

Technical Success ◽

Promising Alternative ◽

Glubran 2

Abstract Background Massive hemobilia is a life-threatening scenario and therapeutic challenge. This study aimed to investigate the efficacy and safety of transcatheter arterial embolization (TAE) using N-butyl cyanoacrylate (NBCA) Glubran 2 for massive hemobilia with arterial injuries. Methods From January 2014 to February 2019, 12 patients (mean age, 63.2 ± 12 years) with massive hemobilia were retrospectively evaluated for TAE using NBCA Glubran 2. Patient baseline characteristics, severities of hemobilia, and imaging findings were collected. Emergent TAE was performed using 1:2 − 1:4 mixtures of NBCA and ethiodized oil. Technical success, clinical success, procedure-related complications, and follow-up outcomes were assessed. Results Pre-procedure arteriography demonstrated injuries of the right hepatic artery (n = 10), and cystic artery (n = 2). Initial coil embolization distal to the lesions was required in 4 (33.3%) patients to control the high blood flow and prevent end-organ damage. After a mean treatment time of 10.1 ± 5.5 min, technical success was achieved in 100% of the patients without non-target embolization and catheter adhesion. Clinical success was achieved in 11 (91.7%) patients. Major complication was noted in 1 (8.3%) patient with gallbladder necrosis owing to embolization of the cystic artery. During a median follow-up time of 16 months (range, 6–36 months), one patient died owing to carcinoma, whereas no patient encountered recurrent hemobilia, embolic material migration or post-embolization complications. Conclusions TAE using NBCA Glubran 2 is a rapid, effective, and safe treatment modality for massive hemobilia. This treatment modality may be reserved as a promising alternative option to coil embolization.

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Palliative Treatment of Hepatocellular Carcinoma with Transcatheter Arterial Embolization

Acta Radiologica ◽

10.1177/028418519303400106 ◽

1993 ◽

Vol 34 (1) ◽

pp. 26-29 ◽

Cited By ~ 4

Author(s):

S. Savastano ◽

G. P. Feltrin ◽

D. Neri ◽

P. da Pian ◽

M. Chiesura-Corona ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Transcatheter Arterial Embolization ◽

Palliative Treatment ◽

Arterial Embolization ◽

Percutaneous Ethanol Injection ◽

Ethanol Injection ◽

History Of ◽

The Mean ◽

Hcc Recurrence

Thirty-three consecutive patients with previously untreated hepatocellular carcinoma (HCC) and 6 patients with recurrent HCC were treated with transcatheter arterial embolization (TAE). The patients were not eligible for surgical resection or percutaneous ethanol injection. TAE was performed with Lipiodol Ultra-Fluid, epidoxorubicin and Gelfoam, with a mean of 1.7 treatments per patient. CT was performed 15 days after TAE. The mean cumulative survival was 14.2 months in patients with previously untreated HCC. The survival of patients stages Okuda I and II did not differ significantly (p > 0.05); tumor size did not affect survival (p > 0.05). Two patients with recurrent HCC died 7.0 and 9.3 months after the diagnosis of tumor recurrence; the remaining 4 patients are still alive with a maximum follow-up of 22.5 months from the diagnosis of HCC recurrence. Ten complications occurred in 8 patients, and were controlled by medical therapy. Eleven patients died during the study; no death was related to TAE. The series was not randomized, but comparison with the natural history of HCC suggests that TAE is effective as palliative treatment of advanced or recurrent HCC.

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Spontaneously ruptured hepatocellular carcinoma in Fontan-associated liver disease: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x20922030 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2092203

Author(s):

Takahiro Kubo ◽

Yosuke Aihara ◽

Hideto Kawaratani ◽

Tadashi Namisaki ◽

Ryuichi Noguchi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Disease ◽

Transcatheter Arterial Embolization ◽

Fontan Procedure ◽

Arterial Embolization ◽

Palliative Operation ◽

First Case ◽

Ruptured Hepatocellular Carcinoma ◽

Enhanced Computed Tomography

The prognosis of congenital heart disease is dramatically improved by cardiac surgery. The Fontan procedure is the definitive palliative operation for patients with single-ventricle physiology. In parallel with the longer survival time achieved with the Fontan procedure, the incidence of Fontan-associated liver disease is increasing. A 40-year-old man who underwent Fontan procedures at the ages of 9 was referred to our hospital for further evaluation of multiple hepatic tumors. Enhanced computed tomography showed large hepatocellular carcinomas with portal thrombi (Vp3). Spontaneous hepatocellular carcinoma rupture occurred 2 weeks after the first visit to our hospital, and emergent transcatheter arterial embolization of the hepatic artery was performed. Three months later, the patient died of liver failure. Autopsy findings showed moderately differentiated hepatocellular carcinoma with a cirrhotic liver characterized by centrilobular fibrosis and sinusoidal dilation similar to that in Fontan-associated liver disease. We reported the first case of spontaneously ruptured hepatocellular carcinoma treated by emergent transcatheter arterial embolization in Fontan-associated liver disease. As the early diagnosis of liver cirrhosis and hepatocellular carcinoma results in better patients’ outcome, cardiologists and hepatologists should be aware of Fontan-associated liver disease and advise patients to have regular follow-up of the liver.

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