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

• Park JH
• Kim HC
• Chung JW
• Jae HJ
• Park JH

• KMID: 1777264
• DOI: http://doi.org/10.3348/kjr.2009.10.4.361

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.

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