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.