ABSTRACT
Objective To evaluate the clinical outcome of transvenous embolization withdetachable coils and N-butyl cyanoacrylate (n-BCA) for management of dural carotid-cavernous sinusfistulas (dCCFs). Methods Six patients with angiographically confirmed spontaneous dCCF wereinvolved in this study, including two with concurrent ipsilateral internal jugular vein occlusion. All thepatients received surgeries for transvenous embolization through the superior ophthalmic vein (2 cases) orthe inferior petrosal sinus (4 cases), using detachable coils (2 cases) or detachable coils combined withn-BCA (4 cases). Results The vascular murmur, exophthalmos and conjunctival congestiondisappeared in 4 patients shortly after the total embolization of the fistulas, while eyeball movementdisorder, diplopia and visual deterioration persisted for at least 1 month and gradually recovered 3 monthsafter the surgery. The fistulas failed to be completely embolized in two patients, and in one of the patients,the symptoms resolved after intermittent carotid artery compression for one week; in the other patient,exophthalmos recurred and worsened 1 month after embolization, and was successfully managed withtransarteriai embolization of the fistula. No symptomatic complications were found in these 6 patientsafter transvenous embolization in spite of the presence of a few small n-BCA granules in the lungs of twopatients. Conclusion Transvenous embolization is safe and effective for management of dCCF, andcombined use of detachable coils and n-BCA may enhance the success rate of total fistula embolization.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the technique, safety and clinical efficacy of transportal variceal sclerotherapy with n-butyl-2-cyanoacrylate (NBCA) for gastric fundal varices.</p><p><b>METHODS</b>Twenty-one patients with gastric fundal varices confirmed by endoscopy were enrolled in this study. The causes of the gastric varices were cirrhosis caused by hepatitis virus B or C (n = 16) and hepatocellular carcinoma with portal venous obstruction (n = 5). Percutaneous transhepatic or transplenic portography were performed on all 21 patients. The gastric varices were treated with NBCA-lipiodol mixture injected via a microcatheter introduced into the varices. For 8 patients who had large gastrorenal shunts (GRS), a balloon-occluded catheter was introduced into the GRS via the right femoral and left renal veins before injecting the NBCA-lipiodol. During the NBCA-lipiodol injection, the balloon was inflated to block the flow of GRS. Follow-up evaluations included findings of the laboratory liver function tests, upper intestinal endoscopies, and the occurrences of rebleeding.</p><p><b>RESULTS</b>In 20 patients (95.2%), the gastric varices were successfully obliterated with 2-8 ml of NBCA-lipiodol. In one patient with a large GRS, sclerotherapy was not successfully performed because a balloon-occluded catheter was not available during the procedure. In five patients, small amounts of NBCA-lipiodol entered into the distal pulmonary artery branches. Two of them suffered from transient irritable coughs; no patient developed severe pulmonary embolism. Embolization of portal venous branches occurred in two patients, which were not treated specifically. In comparison with the findings before the treatments, the serum alanine aminotransferase levels decreased at both 3 and 6 months after treatments (P less than 0.05); serum albumin levels increased at 6 months (P less than 0.05); the prothrombin times decreased at 6 months (P less than 0.05); but no significant changes were seen in the serum bilirubin levels. Fifteen patients were followed-up endoscopically for 3 months after the treatment. Gastric varices were completely resolved in 10 patients (66.7%) and were markedly smaller in 4 patients (26.6%). Worsening of the esophageal varices occurred in 3 patients (20%). All the patients were followed-up from 1 to 30 months [(16.7+/-8.8) months]. Rebleeding was observed in 4 patients, and the cumulative rebleeding rate at 1 year was 9.52%.</p><p><b>CONCLUSION</b>Transportal variceal sclerotherapy with NBCA is a safe and effective method for treating gastric varices. Microcatheter technique and occlusion of the large gastrorenal shunt with a balloon-occluded catheter are necessary to ensure obliteration of gastric varices and prevent pulmonary embolism.</p>