Intraarterial ethanol as a long-term occlusive agent in renal, hepatic, and gastrosplenic arteries of pigs

N-butyl cyanoacrylate embolization for control of acute arterial hemorrhage

PURPOSE

To report the initial clinical experience with the use of n-butyl cyanoacrylate (NBCA) for embolization of acute arterial hemorrhage from varied etiologies and at varied anatomic sites.

MATERIALS AND METHODS

Sixteen patients who demonstrated active extravasation of contrast material and/or arterial abnormality underwent NBCA embolization. Sites of embolization included the gastrointestinal tract, kidney, liver, uterus, adrenal gland, extremity, and chest wall. Standard coil or particulate embolization had previously failed in 10 patients. NBCA was used as the initial embolic agent in the remaining six patients. After treatment, serial hematocrit levels, transfusion requirements, and clinical signs and symptoms were monitored for stabilization. Patients were evaluated for signs and symptoms of end-organ damage.

RESULTS

NBCA embolization was successful in 12 of 16 patients (75%), who exhibited complete cessation of bleeding. In four patients (25%), NBCA embolization was of no benefit. Embolization failed in two of 16 patients (12.5%), who showed evidence of recurrent bleeding after use of NBCA. The remaining two patients (12.5%) died within 24 hours of the procedure. None of the 16 patients developed clinical signs of end-organ damage or iatrogenic ischemia attributable to NBCA.

CONCLUSIONS

In this initial limited series, NBCA embolization was shown to be a feasible and effective method to control acute arterial hemorrhage. NBCA embolization was able to stop arterial bleeding even when previous coil or particulate embolization had failed.

The use of cyanoacrylate adhesives in peripheral embolization

Although liquid adhesives or glue have been used as embolic agents for nearly three decades, experience with them outside of neurointerventional indications is generally limited. Cyanoacrylates are the main liquid adhesives used in the vascular system and have an important role in managing vascular abnormalities, especially arteriovenous malformations. Vascular occlusion results as these agents polymerize on exposure to the ions in blood. A description of the properties, biologic interactions, techniques of use, and indications for acrylic embolization in the peripheral circulation is especially pertinent at this time because of the recent approval of n-butyl cyanoacrylate by the United States Food and Drug Administration.

Computed tomography-guided neurolytic celiac plexus block with alcohol complicated by superior mesenteric venous thrombosis

Neurolytic celiac plexus block (CPB) under radiological guidance is often performed to manage pain associated with pancreatic cancer. Serious complications related to the block are rare. Computed Tomography (CT)-guided neurolytic CPB is advocated to improve the efficacy of the block and to reduce the incidence of associated complications. We describe a case of superior mesenteric vein thrombosis associated with neurolytic CPB performed under CT guidance.

Total or partial percutaneous renal ablation in the treatment of renovascular hypertension: radiological and clinical aspects

In 15 patients with renovascular hypertension, considered unsuitable for angioplasty or surgery, percutaneous renal ablation was performed by injection of ethanol into the renal vasculature. Partial or complete renal ablation was confirmed by follow-up intravenous pyelography or arteriography. Patients were followed-up for a mean of 24.8 months after therapy and blood pressure was improved in all patients with five being cured. This study shows that percutaneous renal ablation is a useful and successful method of therapy for renal hypertension, and that it should be considered in patients unsuitable for surgery or angioplasty.

Renal embolization: a study of the interaction of contrast media and ethanol

In a lethal case of peripheral embolization of the leg and the inferior mesenteric artery after ethanol embolization of the left kidney, we thought that contrast media might have been part of the cause of the peripheral complications as a result of flocculation of the contrast media and secondary dislocation of friable thrombotic material. The interactions of ethanol with different contrast media were tested.