ABSTRACT
PURPOSE: To retrospectively evaluate the safety and risk of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for urgent acute arterial bleeding control in the lower gastrointestinal tract by angiography and colonoscopy. MATERIALS AND METHODS: NBCA TAE was performed in 16 patients (mean age, 63.7 y) with lower gastrointestinal bleeding (diverticular hemorrhage, tumor bleeding, and intestinal tuberculosis). Angiographic evaluation was performed by counting the vasa recta filled with casts of NBCA and ethiodized oil (Lipiodol) after TAE. Patients were classified as follows: group Ia, with a single vas rectum with embolization of 1 branch (n = 6); group Ib, with a single vas rectum with embolization of ≥ 2 branches (n = 8); group II, with embolization of multiple vasa recta (n = 2). All patients underwent colonoscopy within 1 month, and ischemic complications (ulcer, scar, mucosal swelling, fibrinopurulent debris, and necrosis) were evaluated. RESULTS: The procedure was successful in all patients. No ischemic change was observed in any patients in group Ia and in two patients in group Ib. Ischemic changes were observed in six group Ib patients and both group II patients. Group Ib patients experienced ischemic complications that improved without treatment. One patient in group II underwent resection for intestinal perforation after embolization of three vasa recta. One patient in group II with sigmoid stricture with embolization of six vasa recta required prolonged hospitalization. CONCLUSIONS: NBCA embolization of ≥ 3 vasa recta can induce ischemic bowel damage requiring treatment. NBCA TAE of one vas rectum with ≥ 2 branches could also induce ischemic complications. However, these were silent and self-limited.
Subject(s)
Angiography, Digital Subtraction , Colonoscopy , Embolization, Therapeutic/methods , Enbucrilate/administration & dosage , Gastrointestinal Hemorrhage/therapy , Intestinal Diseases/therapy , Adult , Aged , Embolization, Therapeutic/adverse effects , Enbucrilate/adverse effects , Ethiodized Oil/administration & dosage , Female , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/pathology , Humans , Intestinal Diseases/diagnostic imaging , Intestinal Diseases/pathology , Male , Mesenteric Ischemia/diagnostic imaging , Mesenteric Ischemia/etiology , Mesenteric Ischemia/pathology , Middle Aged , Predictive Value of Tests , Retrospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
AIMS AND OBJECTIVES: Ethanol is widely used for the embolization treatment of vascular malformations, but it can also cause serious complications such us pulmonary hypertension, cardiopulmonary collapse and death. The complications are considered secondary to pulmonary vasospasm and ethanol-induced sludge embolism, etc., We studied the hemodynamic effects of intravenous absolute ethanol injection and ethanol sludge injection in pigs. MATERIALS AND METHODS: A total of 5 pigs underwent intravenous injection of ex vivo generated ethanol-induced sludge in which residual ethanol was removed (Group S) and 4 pigs underwent intravenous injection of absolute ethanol (Group E). Hemodynamic parameters related to the pulmonary and systemic circulation were compared between the groups. RESULTS: Transient pulmonary hypertension was observed in both groups and the hemodynamic changes were similar in both groups. CONCLUSIONS: Sludge can induce transient pulmonary hypertension or cardiopulmonary collapse, without ethanol and may be the mechanism by which ethanol induces its adverse hemodynamic effects.
