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Transcatheter Embolotherapy with N-Butyl Cyanoacrylate for Ectopic Varices

  • Clinical Investigation
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Abstract

Purpose

To address technical feasibility and clinical outcome of transcatheter embolotherapy with N-butyl cyanoacrylate (NBCA) for bleeding ectopic varices.

Methods

The institutional review board approved this retrospective study and waived informed consent. From January 2004 to June 2013, a total of 12 consecutive patients received transcatheter embolotherapy using NBCA for bleeding ectopic varices in our institute. Clinical and radiologic features of the endovascular procedures were comprehensively reviewed.

Results

Preprocedural computed tomography images revealed ectopic varices in the jejunum (n = 7), stoma (n = 2), rectum (n = 2), and duodenum (n = 1). The 12 procedures consisted of solitary embolotherapy (n = 8) and embolotherapy with portal decompression (main portal vein stenting in 3, transjugular intrahepatic portosystemic shunt in 1). With regard to vascular access, percutaneous transhepatic access (n = 7), transsplenic access (n = 4), and transjugular intrahepatic portosystemic shunt tract (n = 1) were used. There was no failure in either the embolotherapy or the vascular accesses (technical success rate, 100 %). Two patients died within 1 month from the procedure from preexisting fatal medical conditions. Only one patient, with a large varix that had been partially embolized by using coils and NBCA, underwent rebleeding 5.5 months after the procedure. The patient was retreated with NBCA and did not undergo any bleeding afterward for a follow-up period of 2.5 months. The remaining nine patients did not experience rebleeding during the follow-up periods (range 1.5–33.2 months).

Conclusion

Transcatheter embolotherapy using NBCA can be a useful option for bleeding ectopic varices.

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References

  1. Norton ID, Andrews JC, Kamath PS (1998) Management of ectopic varices. Hepatology 28:1154–1158

    Article  CAS  PubMed  Google Scholar 

  2. Helmy A, Al Kahtani K, Al Fadda M (2008) Updates in the pathogenesis, diagnosis and management of ectopic varices. Hepatol Int 2:322–334

    Article  PubMed Central  PubMed  Google Scholar 

  3. Almadi MA, Almessabi A, Wong P et al (2011) Ectopic varices. Gastrointest Endosc 74:380–388

    Article  PubMed  Google Scholar 

  4. Saad WE, Lippert A, Saad NE, Caldwell S (2013) Ectopic varices: anatomical classification, hemodynamic classification, and hemodynamic-based management. Tech Vasc Interv Radiol 16:108–125

    Article  Google Scholar 

  5. Watanabe N, Toyonaga A, Kojima S et al (2010) Current status of ectopic varices in Japan: results of a survey by the Japan Society for Portal Hypertension. Hepatol Res 40:763–776

    Article  PubMed  Google Scholar 

  6. Macedo TA, Andrews JC, Kamath PS (2005) Ectopic varices in the gastrointestinal tract: short- and long-term outcomes of percutaneous therapy. Cardiovasc Radiol 28:178–184

    Article  Google Scholar 

  7. Vangeli M, Patch D, Terreni N et al (2004) Bleeding ectopic varices—treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation. J Hepatol 41:560–566

    Article  PubMed  Google Scholar 

  8. Vidal V, Joly L, Perreault P et al (2006) Usefulness of transjugular intrahepatic portosystemic shunt in the management of bleeding ectopic varices in cirrhotic patients. Cardiovasc Interv Radiol 29:216–219

    Article  CAS  Google Scholar 

  9. Chu HH, Kim HC, Jae HJ et al (2012) Percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver disease. Cardiovasc Interv Radiol 35:1388–1395

    Article  Google Scholar 

  10. Tuite DJ, Rehman J, Davies MH et al (2007) Percutaneous transsplenic access in the management of bleeding varices from chronic portal vein thrombosis. J Vasc Interv Radiol 18:1571–1575

    Article  PubMed  Google Scholar 

  11. Zhu K, Meng X, Zhou B et al (2013) Percutaneous transsplenic portal vein catheterization: technical procedures, safety, and clinical applications. J Vasc Interv Radiol 24:518–527

    Article  PubMed  Google Scholar 

  12. Okahara M, Kiyosue H, Ueda S et al (2012) Anatomic features and retrograde transvenous obliteration of duodenal varices associated with mesocaval collateral pathway. J Vasc Interv Radiol 23:1339–1346

    Article  PubMed  Google Scholar 

  13. Zamora CA, Sugimoto K, Tsurusaki M et al (2006) Endovascular obliteration of bleeding duodenal varices in patients with liver cirrhosis. Eur Radiol 16:73–79

    Article  PubMed  Google Scholar 

  14. Samuelson SD, Louie JD, Sze DY (2013) N-butyl cyanoacrylate glue embolization of arterial networks to facilitate hepatic arterial skeletonization before radioembolization. Cardiovasc Intervent Radiol 36:690–698

    Article  PubMed  Google Scholar 

  15. Hur S, Jae HJ, Lee M et al (2014) Safety and efficacy of transcatheter arterial embolization for lower gastrointestinal bleeding: a single-center experience with 112 patients. J Vasc Interv Radiol 25:10–19

    Article  PubMed  Google Scholar 

  16. Guiu B, Bize P, Gunthern D et al (2013) Portal vein embolization before right hepatectomy: improved results using n-butyl-cyanoacrylate compared to microparticles plus coils. Cardiovasc Interv Radiol 36:1306–1312

    Article  Google Scholar 

  17. Caldwell S (2012) Gastric varices: is there a role for endoscopic cyanoacrylates, or are we entering the BRTO era? Am J Gastroenterol 107:1784–1790

    Article  PubMed  Google Scholar 

  18. Takasawa C, Seiji K, Matsunaga K et al (2012) Properties of N-butyl cyanoacrylate-iodized oil mixtures for arterial embolization: in vitro and in vivo experiments. J Vasc Interv Radiol 23:1215–1221

    Article  PubMed  Google Scholar 

  19. Yamakado K, Nakatsuka A, Tanaka N et al (2001) Portal venous stent placement in patients with pancreatic and biliary neoplasms invading portal veins and causing portal hypertension: initial experience. Radiology 220:150–156

    Article  CAS  PubMed  Google Scholar 

  20. Ota S, Suzuki S, Mitsuoka H et al (2005) Effect of a portal venous stent for gastrointestinal hemorrhage from jejunal varices caused by portal hypertension after pancreatoduodenectomy. J Hepatobiliary Pancreat Surg 12:88–92

    Article  PubMed  Google Scholar 

  21. Wang J, Tian XG, Li Y et al (2013) Comparison of modified percutaneous transhepatic variceal embolization and endoscopic cyanoacrylate injection for gastric variceal rebleeding. World J Gastroenterol 19:706–714

    Article  PubMed Central  PubMed  Google Scholar 

  22. Yonemitsu T, Kawai N, Sato M et al (2009) Evaluation of transcatheter arterial embolization with gelatin sponge particles, microcoils, and N-butyl cyanoacrylate for acute arterial bleeding in a coagulopathic condition. J Vasc Interv Radiol 20:1176–1187

    Article  PubMed  Google Scholar 

  23. Yamakado K, Nakatsuka A, Tanaka N et al (2000) Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate. J Vasc Interv Radiol 11:66–72

    Article  CAS  PubMed  Google Scholar 

  24. Boyer TD, Haskal ZJ; American Association for the Study of Liver Diseases (2010) The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension: update 2009. Hepatology 51:306

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Conflict of interest

Jin Woo Choi, Hyo-Cheol Kim, Hwan Jun Jae, Hyun-Seok Jung, Saebeom Hur, Myungsu Lee, and Jin Wook Chung declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Jin Woo Choi, Hyo-Cheol Kim, Hwan Jun Jae, Hyun-Seok Jung, Saebeom Hur, Myungsu Lee & Jin Wook Chung

  2. Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea

    Jin Woo Choi, Hyo-Cheol Kim, Hwan Jun Jae, Hyun-Seok Jung, Saebeom Hur, Myungsu Lee & Jin Wook Chung

Authors
  1. Jin Woo Choi
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  2. Hyo-Cheol Kim
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  3. Hwan Jun Jae
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  4. Hyun-Seok Jung
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  5. Saebeom Hur
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  6. Myungsu Lee
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  7. Jin Wook Chung
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Corresponding authors

Correspondence to Hyo-Cheol Kim or Hwan Jun Jae.

Additional information

Hyo-Cheol Kim and Hwan Jun Jae have contributed equally to this work.

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Choi, J.W., Kim, HC., Jae, H.J. et al. Transcatheter Embolotherapy with N-Butyl Cyanoacrylate for Ectopic Varices. Cardiovasc Intervent Radiol 38, 344–351 (2015). https://doi.org/10.1007/s00270-014-0943-9

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  • DOI: https://doi.org/10.1007/s00270-014-0943-9

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