Embolization of cyanoacrylate glue in systemic circulation in a case of hepatocellular carcinoma: an autopsy report

Histopathological changes to the vascular wall after treatment of great saphenous veins using n-butyl-2-cyanoacrylate

Summary. Background: A histopathological examination was conducted on vein samples from six patients who had undergone great saphenous vein sealing with Histoacryl and Lipiodol to treat chronic venous insufficiency of the superficial venous system. Patients and methods: In each patient a sample of the complete vein including the surrounding tissue was obtained through a minor incision under perioperative sonographic monitoring. Each patient had signed an informed consent form. Samples were taken at the following intervals: six days, six weeks, six months, one year, two years, and three years after treatment. Results: N-butyl-2-cyanoacrylate with Lipiodol induces a thrombotic reaction in the acute phase and endothelium is destroyed but no significant inflammation or substantial vascular wall damage is present. In the subsequent period, a foreign body giant cell reaction emerges accompanied by only moderate chronic inflammation that does not extend to the vascular wall or the surrounding tissue. The thrombus is organized with minimal recanalization. The foreign material is gradually degraded, and it is no longer detectable after three years. The vessel wall showed slight sclerotization. Conclusions: N-butyl-2-cyanoacrylate that has been applied gradually degrades over the course of three years accompanied by a giant cell reaction, mild chronic inflammation and cicatrices, but there is minimal recanalization of the obturated section.

Saphenous vein histopathology 5.5 years after cyanoacrylate closure

VenaSeal (Medtronic, Minneapolis, Minn) is a cyanoacrylate polymer adhesive for the treatment of patients with chronic venous insufficiency. As an implanted device, questions remain about how long cyanoacrylate persists after closure. In this report, a 65-year-old man was examined 5.5 years after cyanoacrylate closure, and a segment of great saphenous vein was excised for histopathologic analysis. Findings were typical of a foreign body reaction. The vessel was occluded with collagenized mature fibrous tissue and polymer remnants, which were encapsulated by multinucleated giant cells. Focal areas of granulomatous inflammation were present in the vein wall extending to the adventitia.

N-butyl-2 cyanoacrylate (NBCA) embolus in the graft portal vein after portosystemic collateral embolization in liver transplantation recipient: what is the clinical significance?

Background An N-butyl-2 cyanoacrylate (NBCA) embolus in the graft portal vein was frequently observed after an intraoperative embolization of portosystemic collaterals performed to prevent portal steal in liver transplant (LT) recipients. The radiological and clinical features of NBCA emboli have not yet been described. Purpose To describe radiological and clinical features of NBCA embolus in graft portal vein after portosystemic collateral embolization in LT recipients. Material and Methods A total of 165 consecutive LT recipients who had undergone intraoperative NBCA embolization of varix were found in single institution's computerized databases of a clinical cohort of LT. Patients were evaluated for NBCA emboli (categorized into major and minor emboli according to location) on first postoperative computed tomography (CT). All electronic medical records and radiologic studies including follow-up was evaluated to determine any radiological and clinical abnormality associated with NBCA embolus. Results NBCA emboli were found in 24% (39/165) of recipients. Although most patients had minor emboli (77%, 30/39) without remarkable ultrasonography (US) abnormalities, seven (78%) of nine recipients with major emboli showed intraluminal echogenic lesions in graft portal vein on grayscale US, and five of them (71%) showed partial portal flow obstruction, although none exhibited any abnormality on contrast-enhanced US. Recipients with NBCA portal emboli showed no significant clinical abnormalities and were discharged safely. NBCA embolus eventually disappeared mostly within six months (82%, 32/39). Conclusion NBCA emboli are frequently observed after portosystemic collateral embolization in LT recipients and are not associated with poor clinical outcome. They may mimic ordinary thromboemboli on US.

Cyanoacrylate adhesive for the closure of truncal veins: 60-day swine model results

BACKGROUND

The introduction of cyanoacrylate (CA) within a blood vessel triggers polymerization, followed by an inflammatory reaction.

METHODS

A sheath was positioned 2.0 cm caudad to the junction of the superficial epigastric and abdominus rectus veins in 2 swine, followed by ultrasound-guided injection of 0.16 mL of CA glue. After glue delivery, the catheter was pulled back 3 cm, compression was applied to the treatment site, and the process was repeated for the entire length. At 60 days postimplantation, the veins were harvested surgically and examined histologically.

RESULTS

The histologic changes were consistent with a chronic foreign-body-type inflammatory response. Venous closure, segmental wall thickening, and fibrosis were observed.

CONCLUSION

Injection of CA is feasible for closure of superficial veins in animal models. Vein closure is achieved via an inflammatory process which ultimately leads to fibrosis.