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Parsi K, Zhang L, Whiteley MS, Vuong S, Kang M, Naidu N, Grace J, Connor DE. 899 serious adverse events including 13 deaths, 7 strokes, 211 thromboembolic events, and 482 immune reactions: The untold story of cyanoacrylate adhesive closure. Phlebology 2024; 39:80-95. [PMID: 37902099 DOI: 10.1177/02683555231211086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVE The aim was to retrieve and analyse the serious adverse events of venous occlusion systems used in cyanoacrylate adhesive closure (CAC) submitted to regulatory agencies. METHODS The Total Product Life Cycle (TPLC) database of the US Food and Drug Administration (FDA), the Database of Adverse Event Notifications (DAEN) of the Australian Therapeutic Goods Administration (TGA), and the Yellow Card database of the UK Medicines and Healthcare Products Regulatory Agency (MHRA) were reviewed. Three Freedom of Information (FOI) requests had to be submitted to the MHRA to obtain data. RESULTS The TPLC contained 899 reports which included 13 cases of death, 7 strokes, 211 thromboembolic events, and 482 immune reactions. The DAEN recorded three reportable adverse events, and the MHRA recorded seven adverse incidents including one death. CONCLUSION CAC is associated with serious adverse events including death. These events are under-reported in the medical literature and only sub-optimally reported to the regulatory agencies.
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Affiliation(s)
- Kurosh Parsi
- Department of Dermatology, St Vincent's Hospital, Darlinghurst, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| | - Lois Zhang
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| | | | - Selene Vuong
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| | - Mina Kang
- Department of Dermatology, St Vincent's Hospital, Darlinghurst, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| | - Nikita Naidu
- Department of Dermatology, St Vincent's Hospital, Darlinghurst, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| | - Joseph Grace
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| | - David E Connor
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, NSW, Australia
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Katrancioglu N, Serhatlioglu F, Katrancioglu O. Is intraoperative embolization with n-butyl cyanoacrylate an alternative option in carotid body tumors surgery? A case report. Int J Surg Case Rep 2023; 110:108636. [PMID: 37598489 PMCID: PMC10462829 DOI: 10.1016/j.ijscr.2023.108636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The risk of intraoperative bleeding is relatively considerable because carotid body tumors (CBT) have rich vascular structures. Aim is to reduce intraoperative bleeding with preoperative embolization. We present a unique technique for the successful surgical removal of a challenging CBT using intraoperative direct percutaneous intratumoral n-butyl cyanoacrylate (n-BCA) embolization in a patient whose preoperative embolization failed and the operation could not be continued due to intraoperative bleeding. CLINICAL PRESENTATION A 67-year-old female patient presented with 7 cm Shamblin class 3 CBT on her right neck. Due to the failure of the preoperative embolization, bleeding developed during the operation. In the case of Shamblin class 3 CBT, the primary concern was not the volume of bleeding, but the difficulty in seeing the dissection line due to hemorrhage. Intraoperative n-BCA straight embolization totally controlled the bleeding. The CBT was then readily removed. CLINICAL DISCUSSION Effective management of intraoperative hemorrhage is essential to ensure successful progression of surgical procedures of CBT. Hemorrhage causes complete disappearance of the dissection line, which is already difficult to detect due to adventitia invasion. It is clear that another method is needed when preoperative embolization or covered stenting fails. n-BCA has been used in the endovenous treatment of varicose veins for a long time, but to the best of our knowledge, there is no other case of its use in intraoperative CBT embolization. CONCLUSION Direct intraoperative embolization with n-BCA may be an alternative when other techniques are insufficient.
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Affiliation(s)
- Nurkay Katrancioglu
- Department of Cardiovascular Surgery, Malatya Turgut Ozal University, School of Medicine, Malatya, Turkey.
| | - Faruk Serhatlioglu
- Department of Cardiovascular Surgery, Niğde Ömerhalis Demir University, School of Medicine, Niğde, Turkey.
| | - Ozgur Katrancioglu
- Department of Thoracic Surgery, Malatya Turgut Ozal University, School of Medicine, Malatya, Turkey
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3
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Shibata E, Takao H, Abe O. N-butyl-2-cyanoacrylate Packing of a Gastroduodenal Artery Pseudoaneurysm due to Distal Pancreatectomy After Subtotal Esophagectomy. Vasc Endovascular Surg 2023:15385744231165207. [PMID: 36924267 DOI: 10.1177/15385744231165207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
We describe the successful n-butyl cyanoacrylate (NBCA) packing of a large gastroduodenal artery pseudoaneurysm after distal pancreatectomy in a patient with a history of subtotal esophagectomy and gastric tube reconstruction. The pseudoaneurysm was considered to be caused by direct injury to the gastroduodenal artery (GDA). However, embolization of the GDA was not possible in this case because due to prior esophageal surgery, the main blood vessel supplying the gastric tube was the right epigastric artery from the GDA. Packing a pseudoaneurysm with NBCA is a treatment option when preservation of the parent artery is required.
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Affiliation(s)
- Eisuke Shibata
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidemasa Takao
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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4
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Shoji MK, Tran AQ, Lee WW, Dubovy S, Kossler A. Ophthalmic artery occlusion following n-butyl cyanoacrylate embolization of an orbital arteriovenous malformation. Orbit 2023; 42:87-93. [PMID: 34365893 PMCID: PMC10954302 DOI: 10.1080/01676830.2021.1955937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/10/2021] [Indexed: 01/28/2023]
Abstract
A 33-year-old pregnant woman presented with six months of right-sided proptosis. Neuroimaging revealed a right orbital arteriovenous malformation arising from the second segment of the ophthalmic artery. As she was 9 weeks pregnant, the decision was made to monitor her closely. Over the following six months, her proptosis progressed, accompanied by decreased visual acuity, afferent pupillary defect, and red desaturation concerning for compressive optic neuropathy. After planned c-section, she underwent embolization with n-butyl cyanoacrylate. Upon awakening after embolization, she had no light perception vision from her right eye and was found to have ophthalmic artery obstruction. She ultimately developed a blind painful right eye and underwent enucleation with histopathology demonstrating glue in the central retinal artery, posterior ciliary arteries, and choroid. This case highlights ophthalmic artery occlusion as a rare complication of orbital arteriovenous malformation embolization and demonstrates correlating histopathological findings, which have not previously been reported.
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Affiliation(s)
- Marissa K. Shoji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL
| | - Ann Q. Tran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, Northwell Health, New York, NY
| | - Wendy W. Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL
| | - Sander Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL
| | - Andrea Kossler
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA
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Abstract
Purpose The purpose of this study is to assess the safety and clinical outcomes of transcatheter arterial embolization (TAE) via the cystic artery for treating patients with bleeding from the cystic artery. Materials and Methods This retrospective study included 20 patients who underwent TAE via the cystic artery between January 2010 and May 2022. Radiological images and clinical data were reviewed to evaluate causes of bleeding, procedure-related complications, and clinical outcomes. Technical success was defined as the disappearance of contrast media extravasation or pseudoaneurysm, as demonstrated on completion angiography. Clinical success was defined as discharge from the hospital without any bleeding-related issues. Results Hemorrhagic cholecystitis (n = 10) was the most common cause of bleeding, followed by iatrogenic (n = 4), duodenal ulcer (n = 3), tumor (n = 2), and trauma (n = 1). Technical success was achieved in all cases, and clinical success was achieved in 70% (n = 14) of patients. Three patients developed ischemic cholecystitis as a complication. Six patients with clinical failure died within 45 days after embolization. Conclusion TAE through the cystic artery has a high technical success rate in treating cystic artery bleeding, but clinical failure remains a common occurrence due to concurrent medical conditions and the development of ischemic cholecystitis.
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Affiliation(s)
- Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun Soo Jeong
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kichang Han
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Correspondence: Gyoung Min Kim
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Housley SB, Cappuzzo JM, Waqas M, Levy EI. Facial Arteriovenous Malformation Embolized using n-BCA and Contrast Stasis rather than Tantalum Powder with Double Flow Arrest to Prevent Skin Discoloration: Technical Note. World Neurosurg 2022; 164:350-352. [PMID: 35690310 DOI: 10.1016/j.wneu.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Arteriovenous malformations (AVM) are congenital errors of vascular morphogenesis that occur during development of the cardiovascular system. Multiple treatment options exist, including coil embolization, Onyx (Medtronic) embolization, n-butyl-2 cyanoacrylate (n-BCA), alcohol embolization or sclerotherapy, and open surgical treatments. When the AVM involves superficial regions of the face, head, and neck, it is important to consider cosmetic side effects, such as surgical scarring and skin discoloration. METHODS A 23-year-old woman presented with a large, anterior mandibulofacial AVM first identified on computed tomography angiography and confirmed with digital subtraction angiography. The lesion was subsequently embolized using n-BCA and contrast stasis for visualization during the procedure, instead of traditional tantalum powder. RESULTS Flow arrest accompanied by contrast stasis allowed changes in density observed using digital subtraction software, thus avoiding use of material that might be cosmetically disfiguring. CONCLUSION This technique for treatment of superficial AVMs avoids the use of materials that may be seen through or discolor the skin and other soft tissue.
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
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7
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Parlar H, Arıkan AA. Internal Perivenous Compression for venous insufficiency at the Saphenofemoral Junction: Early and Midterm Results and Operative Pain. Phlebology 2021; 37:143-148. [PMID: 34648388 DOI: 10.1177/02683555211051959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the postoperative pain and midterm results of patients undergoing internal perivenous compression with internal compression therapy (ICT) for venous insufficiency at the saphenofemoral junction (SFJ). MATERIALS AND METHODS Patients managed with ICT between April and October 2019 for grade 4 venous reflux at the SFJ were retrospectively evaluated. The venous clinical severity score (VCSS) was calculated preoperatively and 1, 3, and 6 months postoperatively. Postoperative pain was assessed with the visual analog scale (VAS). Control Doppler ultrasound imaging was performed 6 months postoperatively. RESULTS Forty-five patients [14 (31%) males and 31 (69%) females; mean age, 47 ± 13 years] were included. The median preoperative VCSS was 7 (5-8.5). The median VCSS at 1, 3, and 6 months postoperatively was 6 (4-7.5), 4 (3-5.5), and 3 (2-4), respectively, and these values were significantly lower than the preoperative score (p = 0,001, p < 0.001, and p < 0.001, respectively). The postoperative VAS score was 0 in 6 patients (13%), 1 in 17 patients (38%), 2 in 6 patients (13%), 3 in 15 patients (33%), and 4 in 1 patient (2%). At 6 months, reflux was absent in 9 (20%), grade 1 in 20 (44%), and grade 2 in 16 (36%) patients. A vena saphena magna diameter of >6.7 mm predicted grade >1 reflux at 6 months [87.5%, with an area under the curve of 0.78 (p < 0.001)]. No complications occurred. CONCLUSION ICT alleviated symptoms and reduced reflux grade in patients with venous insufficiency at the SFJ. This therapy can be applied with satisfactory patient comfort.
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Affiliation(s)
- Hakan Parlar
- Department of Cardiovascular Surgery, Health Science University Derince Training and Research Hospital, Kocaeli, Turkey
| | - Ali Ahmet Arıkan
- Department of Cardiovascular Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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8
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Eysenbach LM, Koo KSH, Monroe EJ, Reis J, Perkins JA, Shivaram GM. Migration of n-BCA glue as a complication of venous malformation treatment in children. Radiol Case Rep 2021; 16:3526-3533. [PMID: 34584591 PMCID: PMC8450196 DOI: 10.1016/j.radcr.2021.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/13/2022] Open
Abstract
Preoperative n-butyl cyanoacrylate (n-BCA) embolization of venous malformations facilitates surgical resection. Although embolization is generally well-tolerated, central venous n-BCA migration can occur. The purpose of this article is to describe 3 cases of glue migration requiring glue embolectomy. Strategies for prevention and treatment of glue migration during embolization of venous malformations are reviewed.
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Affiliation(s)
- Lindsay M Eysenbach
- Department of Radiology, Section of Interventional Radiology, University of Washington School of Medicine
| | - Kevin S H Koo
- Department of Radiology, Section of Interventional Radiology, University of Washington School of Medicine.,Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital
| | - Eric J Monroe
- Department of Radiology, Section of Interventional Radiology, University of Washington School of Medicine.,Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital
| | - Joseph Reis
- Department of Radiology, Section of Interventional Radiology, University of Washington School of Medicine.,Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital
| | - Jonathan A Perkins
- Department of Otolaryngology-Head & Neck Surgery, University of Washington School of Medicine.,Division of Pediatric Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital
| | - Giridhar M Shivaram
- Department of Radiology, Section of Interventional Radiology, University of Washington School of Medicine.,Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital
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Mine T, Yasui D, Saito H, Ueda T, Yokoyama T, Ikeda S, Mizushima S, Happoh S, Kumita SI. Effects of temperature alteration on viscosity, polymerization, and in-vivo arterial distribution of N-butyl cyanoacrylate-iodized oil mixtures. Jpn J Radiol 2021; 39:1111-1118. [PMID: 34106382 PMCID: PMC8568870 DOI: 10.1007/s11604-021-01143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/20/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Temperature alteration can modify the polymerization of n-butyl cyanoacrylate (NBCA)-iodized oil mixtures during vascular embolization; its effects on viscosity, polymerization time, and intra-arterial distribution of the NBCA-iodized oil mixture were investigated. MATERIALS AND METHODS In vitro, the viscosities of NBCA, iodized oil, and NBCA-iodized oil mixtures (ratio, 1:1-8) were measured at 4-60 ºC using a rotational rheometer. The polymerization times (from contact with blood plasma to stasis) were recorded at 0-60 ºC using a high-speed video camera. In vivo, the 1:2 mixture was injected into rabbit renal arteries at 0, 20, and 60 ºC; intra-arterial distribution of the mixture was pathologically evaluated. RESULTS The mixtures' viscosities decreased as temperature increased; those at 60 ºC were almost four to five times lower than those at 4 ºC. The polymerization time of NBCA and the 1:1-4 mixtures increased as temperature decreased in the 0-30 ºC range; the degree of time prolongation increased as the percentage of iodized oil decreased. The 0 ºC group demonstrated distributions of the mixture within more peripheral arterial branches than the 20 and 60 ºC groups. CONCLUSION Warming reduces the mixture's viscosity; cooling prolongs polymerization. Both can be potential factors to improve the handling of NBCA-iodized oil mixtures for lesions requiring peripheral delivery. Temperature alteration influences the polymerization time, viscosity, and intra-arterial distribution of NBCA-iodized oil mixtures. Warming reduces the viscosity of the mixture, while cooling prolongs polymerization.
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Affiliation(s)
- Takahiko Mine
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
| | - Daisuke Yasui
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hidemasa Saito
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Taro Yokoyama
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Shinpei Ikeda
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Shohei Mizushima
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Seigoh Happoh
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Shin-Ichiro Kumita
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Zhang ZH, Zhang W, Liu QX, Ma JQ, Yang MJ, Liu LX, Luo JJ, Yan ZP. Embolization of the Transhepatic Tract after Percutaneous Portal Vein Interventions: Single-Centre Retrospective Study Comparing n-butyl Cyanoacrylate Versus Coils. Cardiovasc Intervent Radiol 2021; 44:1728-1733. [PMID: 34089077 DOI: 10.1007/s00270-021-02883-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/24/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to compare the safety and efficacy of transhepatic puncture tract embolization with n-butyl cyanoacrylate (n-BCA) versus coils after percutaneous transhepatic portal vein interventions in patients with hepatocellular carcinoma (HCC). It was also the aim of the study to evaluate the extent of artifacts in CT exams during FU. METHODS Single-center retrospective study from 2017-2019 in 190 patients who underwent percutaneous transhepatic portal vein interventions. The transhepatic puncture tracts were embolized with n-BCA in 88 patients (Group A) and with coils in 102 patients (Group B). Procedure-related complications and image noise around coils and n-BCA were compared between the groups. No significant differences were noted at baseline between both groups (platelets, coagulation, liver disease, types of procedures, liver function, liver tumors). RESULTS All patients underwent transhepatic puncture tract embolization. Procedure-related complications were only observed in patients from Group B: subcapsular hemorrhage (n = 2; 1.96%), hepatic artery hemorrhage (n = 1; 0.98%), and pseudoaneurysms combined with hemobilia occurred (n = 1; 0.98%). In Group A, the distal part of the punctured portal vein branch was embolized with n-BCA in 1 patient (1.14%). Four major complications in Group B Vs 0 in Group A were observed, respectively (p < 0.0001). The image noise around n-BCA was significantly lower than that around coils (10.7 ± 1.7 HU vs. 54.3 ± 15.0 HU, p < .001). CONCLUSIONS n-BCA tract embolization is more effective than using coils, with fewer bleeding events, at the cost of a higher potential for unintended embolization of portal vein branches.
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Affiliation(s)
- Zi-Han Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qing-Xin Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Jing-Qin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Min-Jie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Ling-Xiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Jian-Jun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Institute of Medical Imaging, Shanghai, China.
| | - Zhi-Ping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Institute of Medical Imaging, Shanghai, China.
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Hubrechts J, Dooms C, Maleux G, Gewillig M. Direct EBUS-guided transtracheal lymphosclerosis for plastic bronchitis after Fontan. Catheter Cardiovasc Interv 2021; 97:E371-E375. [PMID: 32990404 DOI: 10.1002/ccd.29284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/01/2020] [Accepted: 09/14/2020] [Indexed: 01/31/2023]
Abstract
We report on a new puncture technique with direct transtracheal mediastinal lymphatic access to treat plastic bronchitis after Fontan repair. High resolution contrast-enhanced spiral CT identified enlarged lymph nodes in the paratracheal region. Inguinal intranodal Gadolinium Dynamic Contrast-enhanced Magnetic Resonance lymphangiography (DCMRL) confirmed the pathologic centrifugal lymph flow passing through these lymph nodes before leaking into the bronchial tree. The abnormal hypertrophic paratracheal, subcarinal, and hilar lymph nodes were punctured with a 22G needle through an endobronchial ultrasound bronchoscope. Occlusion of the lymph vessels was obtained by injecting a mixture of lipiodol/NBCA N-butyl cyanoacrylate (Histoacryl) 5/1 under fluoroscopic control. There was a total remission of PB with now 10 months of follow-up.
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Affiliation(s)
- Jelena Hubrechts
- Department of Pediatric and Congenital Cardiology, Leuven University Hospital, Leuven, Belgium
| | - Christophe Dooms
- Department of Respiratory Diseases, Leuven University Hospital, Leuven, Belgium
| | - Geert Maleux
- Interventional Radiology, Leuven University Hospital, Leuven, Belgium
| | - Marc Gewillig
- Department of Pediatric and Congenital Cardiology, Leuven University Hospital, Leuven, Belgium
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12
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Wong GR, Yu H, Isaacson AJ. Comparison of Cost and Efficacy of Trufill® vs Histoacryl® n-Butyl Cyanoacrylate for Translumbar Type 2 Endoleak Embolization. Vasc Endovascular Surg 2020; 55:152-157. [PMID: 33208033 DOI: 10.1177/1538574420973821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The study aimed to compare the cost and efficacy of translumbar approach type 2 endoleak repairs using either Trufill® or Histoacryl® n-BCA liquid embolic. METHOD AND MATERIALS This was a retrospective review of patients who had translumbar approach type 2 endoleak repairs using either Trufill® or Histoacryl®. Patients were included if they underwent a technically successful type 2 endoleak repair via a translumbar approach with Trufill® or Histoacryl® n-BCA. A multivariable analysis was performed with the primary clinical outcome of percent change in aneurysm diameter per month compared. Procedure cost was calculated based on typical materials used. RESULTS 20 Trufill® and 14 Histoacryl® patients were included. The mean procedure cost was higher for Trufill® ($5,757.30 vs. $1,586.09, p ≤ 0.001). There was no significant difference between Trufill® or Histoacryl® patients for age at first embolization, gender, total number of embolizations, number of feeding branches, aneurysm sac size prior to embolization, or residual endoleak at first follow-up. Trufill® patients had more coils used (12.0 vs. 4.3, p = 0.0007), less glue used (0.9 vs. 2.1 mL, p < 0.001), longer follow-up duration (33.5 vs. 13.2 months, p = 0.002), more follow-up CT angiograms (CTA) (3.7 vs. 1.9, p = 0.01), and larger excluded aneurysm sac size at most recent CTA (7.1 cm vs. 5.9 cm, p = 0.04). Percent change in sac diameter per month was not significantly different between Trufill® and Histoacryl® (0.21% vs. -0.25%/month, p = 0.06, respectively). There were no complications. CONCLUSION Use of Histoacryl® over Trufill® n-BCA resulted in significantly less procedural cost while maintaining safety and efficacy.
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Affiliation(s)
- George Raymond Wong
- Division of Vascular and Interventional Radiology, Department of Radiology, 6797University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Hyeon Yu
- Division of Vascular and Interventional Radiology, Department of Radiology, 6797University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Ari J Isaacson
- Division of Vascular and Interventional Radiology, Department of Radiology, 6797University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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13
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Mori K, Obata-Yasuoka M, Saida T, Nishida K, Takahashi H, Hosokawa Y, Takei Y, Tsumagari A, Yoshida M, Kimura Y, Abe T, Tsukuda Y, Harada S, Kojima T, Minami M. Pelvic arterial embolisation with cyanoacrylate during caesarean hysterectomy for placenta accreta. MINIM INVASIV THER 2020; 31:396-403. [PMID: 32907432 DOI: 10.1080/13645706.2020.1811730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare n-butyl cyanoacrylate (NBCA) and gelatine sponge (GS) as embolic materials for prophylactic pelvic arterial embolisation during caesarean hysterectomy for placenta accreta spectrum (PAS). MATERIAL AND METHODS This retrospective study comprised 12 women (age range, 23-42 years; mean, 34.1 years) who underwent caesarean hysterectomy for PAS. Following caesarean delivery, bilateral uterine and non-uterine parasitic arteries were embolized with GS in the first four cases (GS group) and primarily with NBCA mixed with iodized oil in the subsequent eight cases (NBCA group). Procedure time for embolisation and hysterectomy and total blood loss were compared between the two groups using Welch's t-test. RESULTS Although procedure time for embolisation tended to be longer in the NBCA group than in the GS group (111 ± 47 min versus 71 ± 32 min, p=.11), that for hysterectomy was significantly reduced in the NBCA group when compared to the GS group (158 ± 42 min versus 236 ± 39 min, p=.02). Total blood loss was significantly lower in the NBCA group than in the GS group (1375 ± 565 mL versus 2668 ± 587 mL, p=.01). CONCLUSION Procedure time for hysterectomy and total blood loss during caesarean hysterectomy can be reduced by using NBCA instead of GS in prophylactic pelvic arterial embolisation for PAS.
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Affiliation(s)
- Kensaku Mori
- Department of Radiology, University of Tsukuba, Tsukuba, Japan
| | - Mana Obata-Yasuoka
- Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba, Japan
| | - Tsukasa Saida
- Department of Radiology, University of Tsukuba, Tsukuba, Japan
| | - Keiko Nishida
- Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba, Japan
| | - Hiroaki Takahashi
- Department of Radiology, Mayo Clinic Rochester, Rochester, United States
| | - Yoshihiko Hosokawa
- Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba, Japan
| | - Yohei Takei
- Department of Radiology, University of Tsukuba, Tsukuba, Japan
| | - Ayako Tsumagari
- Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba, Japan
| | - Miki Yoshida
- Department of Radiology, University of Tsukuba, Tsukuba, Japan
| | - Yutaku Kimura
- Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Radiology, University of Tsukuba, Tsukuba, Japan
| | - Yoko Tsukuda
- Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba, Japan
| | - Shu Harada
- Department of Radiology, University of Tsukuba, Tsukuba, Japan
| | - Takahiro Kojima
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Manabu Minami
- Department of Radiology, University of Tsukuba, Tsukuba, Japan
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14
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Sun LC, Su Y, Ding XC, Xu DS, Li CM, Wang L, Li WL, Sun XD, Yu JM, Meng X. In vitro and in vivo evaluation of the safety and efficacy of a novel liquid fiducial marker for image-guided radiotherapy. Oncol Lett 2020; 20:569-580. [PMID: 32565982 PMCID: PMC7286123 DOI: 10.3892/ol.2020.11591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 03/26/2020] [Indexed: 12/30/2022] Open
Abstract
The true extent of a tumor is difficult to visualize, during radiotherapy, using current modalities. In the present study, the safety and feasibility of a mixture of N-butyl cyanoacrylate and lipiodol (NBCA/Lip) was evaluated in order to investigate the optimal combination for application as a fiducial marker for radiotherapy. Four combinations of NBCA/Lip injection (1:1–0.1, 1:1–0.15, 1:3–0.1 and 1:3–0.15 ml) were injected into the subcutaneous tissue of BALB/c mice. The changes in gross histopathology, body weight, skin score, marker volume, neutrophil and macrophage counts were observed to analyze the effects of the different mixing ratios and injection volumes, in order to identify the best combination. Evaluation according to the International Organization for Standardization criteria was further conducted in order to test the biocompatibility of the mixture, including an acute systematic assay with mice, cytotoxicity with L929 fibroblasts and delayed-type hypersensitivity tests with guinea pigs and an intradermal test with rabbits. The results revealed that at the seventh week, 42 markers (42/48; 87.5%) were still visible using computed tomography (CT) imaging. No serious adverse effects were observed throughout the study period; however, the combination of 1:1–0.1 ml had the lowest body weight and worst skin score. A review of the histopathological reaction to NBCA/Lip revealed a combination of acute inflammation, chronic inflammation, granulation tissue, foreign-body reaction and fibrous capsule formation. The 1:1 NBCA combination ratio resulted in the most intense tissue repair reaction and a slower degradation rate of markers. In general, the combination of 1:3–0.15 ml had a better fusion with local tissue, maintained a stable imaging nodule on CT images for 7 weeks and the final biocompatibility test demonstrated its safety. Overall, the findings of the present study demonstrated NBCA/Lip as a safe and feasible fiducial marker, when using the 1:3–0.15 ml combination.
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Affiliation(s)
- Liang-Chao Sun
- Department of Radiation Oncology and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, Shandong 300060, P.R. China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Yi Su
- Department of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University Institution, Yantai, Shandong 264001, P.R. China
| | - Xing-Chen Ding
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Dong-Shui Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Cheng-Ming Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Lu Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Wan-Long Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Xin-Dong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Jin-Ming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
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15
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Cuoco JA, Guilliams EL, Klein BJ, Malaty GR, Witcher MR, Entwistle JJ. N-butyl cyanoacrylate embolization of a traumatic pseudoaneurysm and arteriovenous fistula of the middle meningeal artery. Radiol Case Rep 2020; 15:321-325. [PMID: 31993092 PMCID: PMC6974703 DOI: 10.1016/j.radcr.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/08/2019] [Accepted: 12/16/2019] [Indexed: 11/27/2022] Open
Abstract
We report a case of combined traumatic pseudoaneurysm and arteriovenous fistula of the middle meningeal artery, which presented clinically 1 year after initial head trauma. A 39-year-old male presented with seizure activity after a closed head injury from a fall. He was hospitalized for multiple intraparenchymal hemorrhages and ultimately discharged 2 weeks later without neurologic deficits. One year later, he presented with a new right anterior temporal intraparenchymal hemorrhage after a syncopal event. Selective angiography of the right external carotid artery demonstrated a chronic appearing traumatic laceration of the proximal middle meningeal artery with a 6 × 10 mm pseudoaneurysm and a single fistula with venous varix draining into the lateral pterygoid veins. The pseudoaneurysm and arteriovenous fistula were successfully embolized with n-butyl cyanoacrylate.
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Affiliation(s)
- Joshua A Cuoco
- Carilion Clinic, Section of Neurosurgery, 1906 Belleview Ave, Roanoke, VA 24014, USA.,Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA.,Virginia Tech School of Neuroscience, 300 Turner Street NW, Blacksburg, VA 24061, USA.,Edward Via College of Osteopathic Medicine, 2265 Kraft Dr, Blacksburg, VA, 24060, USA
| | - Evin L Guilliams
- Carilion Clinic, Section of Neurosurgery, 1906 Belleview Ave, Roanoke, VA 24014, USA.,Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA.,Virginia Tech School of Neuroscience, 300 Turner Street NW, Blacksburg, VA 24061, USA.,Edward Via College of Osteopathic Medicine, 2265 Kraft Dr, Blacksburg, VA, 24060, USA
| | - Brendan J Klein
- Carilion Clinic, Section of Neurosurgery, 1906 Belleview Ave, Roanoke, VA 24014, USA.,Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA.,Virginia Tech School of Neuroscience, 300 Turner Street NW, Blacksburg, VA 24061, USA.,Edward Via College of Osteopathic Medicine, 2265 Kraft Dr, Blacksburg, VA, 24060, USA
| | - Giovanni R Malaty
- Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA
| | - Mark R Witcher
- Carilion Clinic, Section of Neurosurgery, 1906 Belleview Ave, Roanoke, VA 24014, USA.,Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA.,Virginia Tech School of Neuroscience, 300 Turner Street NW, Blacksburg, VA 24061, USA
| | - John J Entwistle
- Carilion Clinic, Section of Neurosurgery, 1906 Belleview Ave, Roanoke, VA 24014, USA.,Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA.,Virginia Tech School of Neuroscience, 300 Turner Street NW, Blacksburg, VA 24061, USA.,Edward Via College of Osteopathic Medicine, 2265 Kraft Dr, Blacksburg, VA, 24060, USA
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16
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Karsonovich TW, Hawkins JC, Gordhan A. Traumatic Pseudoaneurysm of the Ascending Cervical Artery Treated with N-butyl Cyanoacrylate Embolization: A Case Report and Review of the Literature. Cureus 2019; 11:e6276. [PMID: 31911869 PMCID: PMC6939969 DOI: 10.7759/cureus.6276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pseudoaneurysms of the thyrocervical trunk and its branches are commonly iatrogenic in nature; however, trauma is often an inciting mechanism. Open surgical repair was considered the main treatment modality until recent advances in endovascular therapy proved to be a viable treatment option. We report a case of a traumatic pseudoaneurysm arising from the ascending cervical artery with an associated arteriovenous fistula (AVF) that was treated using n-butyl cyanoacrylate (NBCA) embolization. The use of a liquid embolysate such as NBCA provided an efficient and effective means of achieving both pseudoaneurysm occlusion and AVF disconnection.
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Affiliation(s)
| | - John C Hawkins
- Neurological Surgery, Advocate BroMenn Medical Center, Normal, USA
| | - Ajeet Gordhan
- Neurointerventional Radiology and Surgery, OSF HealthCare, Bloomington, USA
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17
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Li HB, Zhang J, Li XM, Zhou SY, Niu CQ, Liu ZY, Lu LG. Clinical efficacy of absolute ethanol combined with n-butyl cyanoacrylate sclerotherapy in the treatment of Puig's classified advanced venous malformation in children. Exp Ther Med 2019; 17:1276-1281. [PMID: 30680003 PMCID: PMC6327634 DOI: 10.3892/etm.2018.7051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 11/07/2018] [Indexed: 12/27/2022] Open
Abstract
The aim of the present retrospective study was to investigate the clinical safety and efficacy of absolute ethanol combined with n-butyl cyanoacrylate sclerotherapy in the treatment of Puig's classified advanced venous malformation. Sclerotherapy was performed in 121 children (52 males and 69 females; age range, 5 months to 16 years) with venous malformations under general anesthesia between April 2009 and October 2014 at the Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China. The patients with venous malformations were diagnosed and classified according to the diagnostic criteria of the International Society for the Study of Vascular Anomalies. According to the characteristics of intraoperative percutaneous angiography, 21 patient cases (9 males and 12 females; age range, 6 months to 14 years) were classified as advanced Puig's venous malformation. These 21 patients were treated with absolute ethanol combined with n-butyl cyanoacrylate. The patients were followed-up for 6–24 months (average, 15 months) after treatment. Following treatment with absolute ethanol combined with n-butyl cyanoacrylate, 15 cases were controlled and the total effective rate was 71% (15/21). However, 1 patient developed skin ulcerations, which was classed as a minor complication, 1 patient developed ectopic embolism caused by n-butyl cyanoacrylate reflux, and 1 patient developed transient pulmonary hypertension, the latter two complications were classified as major. Notably, the incidence rate of minor and major complications were 14.3%. To conclude, the present findings indicated that absolute ethanol combined with n-butyl cyanoacrylate sclerotherapy was a safe and effective method with a low complication rate in the treatment of Puig's classified advanced venous malformation in patients.
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Affiliation(s)
- Hai-Bo Li
- Department of Interventional Radiology, Affiliated South China Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.,Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou Medical Univercity, Guangzhou, Guangdong 510120, P.R. China
| | - Jing Zhang
- Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou Medical Univercity, Guangzhou, Guangdong 510120, P.R. China
| | - Xiao-Mei Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Shao-Yi Zhou
- Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou Medical Univercity, Guangzhou, Guangdong 510120, P.R. China
| | - Chuan-Qiang Niu
- Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou Medical Univercity, Guangzhou, Guangdong 510120, P.R. China
| | - Zhen-Yin Liu
- Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou Medical Univercity, Guangzhou, Guangdong 510120, P.R. China
| | - Li-Gong Lu
- Department of Interventional Radiology, Affiliated South China Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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18
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Nakai M, Ikoma A, Loffroy R, Midulla M, Rao P, Kamisako A, Higashino N, Fukuda K, Sonomura T. Transgraft sac Embolization Combined with Graft Reinforcement for Refractory Mixed-Type Endoleak. Cardiovasc Intervent Radiol 2019; 42:620-4. [PMID: 30539235 DOI: 10.1007/s00270-018-2144-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
An 80-year-old female underwent EVAR 4 years ago. She presented type II endoleak with sac expansion from 68 to 80 mm during 3-year follow-up after EVAR. Although she underwent translumbar percutaneous sac embolization, the AAA sac continued to enlarge, suggesting mixed-type endoleak including type I, II, and III. Transgraft direct sac angiography revealed endoleak cavity without demonstrable feeding vessel. Transgraft sac embolization using n-butyl cyanoacrylate and graft reinforcement was performed concurrently, without complications. The graft reinforcement consisted of graft extension for eliminating occult type I endoleak, and relining for eliminating occult type III endoleak. Six months after the procedure, CT showed no signs of sac expansion. Transgraft sac embolization combined with graft reinforcement is one of the available options for persistent and refractory mixed-type endoleak.
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19
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Nakai M, Ikoma A, Loffroy R, Midulla M, Kamisako A, Higashino N, Fukuda K, Sonomura T. Type II endoleak model creation and intraoperative aneurysmal sac embolization with n-butyl cyanoacrylate-lipiodol-ethanol mixture (NLE) in swine. Quant Imaging Med Surg 2018; 8:894-901. [PMID: 30505718 DOI: 10.21037/qims.2018.10.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to evaluate the feasibility of type II endoleak model creation and efficacy of intraoperative aneurysmal sac embolization using n-butyl-2-cyanoacrylate-lipiodol-ethanol mixture (NLE) for type II endoleak in swine. Methods In six swine (mean body weight 53.5 kg), abdominal aortic aneurysm (AAA) was created and then end-to-side anastomosis between the left renal artery and AAA sac was performed. And then, endovascular abdominal aortic aneurysm repair (EVAR) was performed, leading to creation of a type II endoleak model. As control group, EVAR without sac embolization was performed in two swine. In four swine, AAA sac was embolized using NLE immediately after EVAR via the microcatheter placed in AAA sac (NLE embolization group). Follow-up aortography was performed immediately and three days after the procedure, and then the aneurysms were extracted. Results The AAA sac and type II endoleak model were successfully created in all cases. In control group, type II endoleak persisted three days after the procedure. In NLE embolization group, endoleak disappeared immediately and three days after the procedure. In NLE embolization group, AAA sac was occupied with thrombus and embolic material. Inflammatory changes were recognized in aneurysmal sac wall in NLE embolization group. Conclusions This experimental study suggests that creation of a type II endoleak model in swine is feasible and that intraoperative AAA sac embolization with NLE during EVAR might reduce the occurrence of type II endoleak.
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Affiliation(s)
- Motoki Nakai
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Atsufumi Kamisako
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | | | - Kodai Fukuda
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
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20
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Abstract
Arteriovenous malformation (AVM) embolization can serve as a crucial adjunct before surgical resection, a partial approach to target high-risk features, or, rarely, as a curative approach for high-risk, surgically inaccessible lesions. Specifically, embolization is a welcome surgical adjunct to reduce the size of medium to large AVMs, to target perforator supply, and/or to target the deep portion of a nidus. In addition, a crucial role for embolization is the targeting of associated aneurysms, particularly in the setting of a ruptured lesion, regardless of the subsequent therapeutic modality. Rarely, a deep, small ruptured AVM that cannot be accessed surgically may be embolized with intent to cure. This chapter will review patient selection, technical nuances, and published results for AVM embolization. With appropriate patient selection and well-defined goals of embolization, the risk of procedural morbidity can be outweighed by its benefit.
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Affiliation(s)
- Bradley A Gross
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - Karam Moon
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Cameron G Mcdougall
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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21
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Jani K. Randomised controlled trial of n-butyl cyanoacrylate glue fixation versus suture fixation of mesh in laparoscopic totally extraperitoneal hernia repair. J Minim Access Surg 2016; 12:118-23. [PMID: 27073302 PMCID: PMC4810943 DOI: 10.4103/0972-9941.169954] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND: We present a randomised control trial to compare suture fixation of the mesh with non-mechanical fixation using n-butyl cyanoacrylate (NBCA) glue for laparoscopic totally extraperitoneal (TEP) hernioplasty. PATIENTS AND METHODS: After a standard dissection for laparoscopic TEP hernioplasty, the mesh was fixed using sutures or NBCA glue to the Cooper's ligament as per the randomised allocation. The primary endpoints were recurrence at 24 months and chronic groin pain. The secondary endpoints were pain scores, analgesic requirement in the post-operative period and duration of surgery. RESULTS: Group A consisting of suture fixation had 127 patients which included a total of 173 hernias while Group B consisting of NBCA had 124 patients including a total of 171 hernias. The patients’ age, sex distribution, body mass indices and co-morbidities were comparable in both groups. No patient suffered any major intra-operative or post-operative complication or mortality. There were no conversions to open surgery in either of the groups. The operating time was similar in both the groups though there was a tendency toward a shorter surgery time in Group B. There was lesser consumption of analgesics in the immediate post-operative period in Group B but this did not reach statistical significance. Using visual analogue scale to measure pain, there was no difference in pain at 48 h; however, Group B patients complained of significantly less pain on day 7 as compared to Group A. Almost 98% of Group A patients and 99.2% of Group B patients completed 24 months of follow-up. There were no recurrences in either groups or was there any significant difference in chronic groin pain, in fact, none of the Group B patients complained of chronic groin pain. CONCLUSION: Using NBCA glue to fix the mesh in laparoscopic TEP hernia repair is effective and associated with less pain on day 7 as compared to suture fixation of the mesh.
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Affiliation(s)
- Kalpesh Jani
- Consultant Surgical Gastroenterologist and Laparoscopic Surgeon, Sigma Surgery, Abhishek House, Opp Tulsidham Appt, Manjalpur, Baroda, Gujarat, India
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22
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Yamamoto T, Ohshima T, Nishihori, M, Goto S, Nishizawa T, Shimato S, Kato K. Preoperative embolization of meningiomas with low-concentration n-butyl cyanoacrylate. Nagoya J Med Sci 2015; 77:347-53. [PMID: 26412880 PMCID: PMC4574321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/09/2015] [Indexed: 11/29/2022]
Abstract
The aim of this study was to determine the clinical safety and efficacy of preoperative embolization of meningiomas with low-concentration n-butyl cyanoacrylate (NBCA). Nineteen cases of hypervascular intracranial meningiomas were treated by preoperative embolization with 14% NBCA, using a wedged superselective catheterization of feeding arteries and reflux-hold-reinjection technique. Clinical data of the patients and radiological and intra-surgical findings were reviewed. All tumors were successfully devascularized without any neurological complications. Marked reduction of tumor staining with extensive NBCA penetration was achieved in 13 cases. Perioperative blood transfusion was only required in two cases. These results indicate that preoperative embolization of meningiomas with low-concentration NBCA is both safe and effective.
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Affiliation(s)
- Taiki Yamamoto
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Tomotaka Ohshima
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
| | | | - Shunsaku Goto
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
| | | | - Shinji Shimato
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Kyozo Kato
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
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Nakai M, Sato H, Sato M, Ikoma A, Minamiguchi H, Kawai N, Sonomura T, Nishimura Y, Okamura Y. Successful endovascular treatment of iliac arteriovesical fistula with secondary stent-graft infection. J Vasc Interv Radiol 2014; 24:1409-12. [PMID: 23973028 DOI: 10.1016/j.jvir.2013.05.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 03/26/2013] [Accepted: 05/16/2013] [Indexed: 11/24/2022] Open
Abstract
A 58-year-old woman initially presented with massive gross hematuria and iliac arteriovesical fistula (IAVF). Endovascular stent-graft repair achieved complete exclusion of the IAVF and controlled the bleeding, but sepsis subsequently developed because of endograft infection. Endovascular embolization of the infected stent graft was performed after extraanatomic bypass surgery. The patient recovered and showed no signs of graft infection or recurrent fistulization at 14 months after treatment. Endovascular embolization of infected stent grafts combined with extraanatomic bypass may be an acceptable treatment option for graft-related sepsis in cases that are resistant to conservative treatment and pose high surgical risk for graft excision.
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Affiliation(s)
- Motoki Nakai
- Department of Radiology, Wakayama Medical University, 811-1, Kimiidera, Wakayama Shi, Wakayama 641-8510, Japan.
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24
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Jordan JA, Llibre JC, Vázquez F, Rodríguez R, Prince JA, Ugarte JC. Predictors of hemorrhagic complications from endovascular treatment of cerebral arteriovenous malformations. Interv Neuroradiol 2014; 20:74-82. [PMID: 24556303 DOI: 10.15274/inr-2014-10011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/25/2013] [Indexed: 11/12/2022] Open
Abstract
Post-embolization hemorrhage is the most severe, dramatic and morbidity-mortality-related complication in the treatment of endovascular arteriovenous malformations (AVMs). The objective of this study was to determine predictive factors of post-embolization hemorrhage. This is a retrospective study in 71 patients with cerebral AVMs having undergone 147 embolization sessions with n-butyl cyanoacrylate (n-BCA), carried out between 2006 and 2011. Clinical-demographic, morphological and treatment data as well as results were recorded. The relationship of post-procedure hemorrhage with demographic and morphological factors, percentage devascularization per session, venous drainage and whether or not post-procedure hypotension had been induced was investigated. Six post-embolization hemorrhages occurred, all in sessions characterized by extensive devascularization without the induction of post-procedure hypotension; which disappeared after a limit to the extent of devascularization per session and post-procedure hypotension were introduced. In the multivariate analysis, hemorrhage predictors were: nidus diameter < 3 cm (OR= 45.02; CI=95%:1.17-203.79; P=0.005); devascularization > 40% (OR=32.4; CI=95%: 3.142- 518.6; P=0.009) per session; intranidal aneurysms (OR=7.5; CI=95%:1.19-341.3; P=0.041) and lack of post-procedure hypotension (OR=16.51; CI=95%:1.81-324.4; P=0.049) and the association of sessions with devascularization exceeding 40% with lack of post-procedure hypotension, showed an increase in the risk of hemorrhage (OR=36.4; CI=95%:3.67-362.4; P=0.002). Extensive devascularization and the absence of post-procedure hypotension increase the risk of hemorrhage. We suggest partial, 25-30%, devascularization per session and the induction of post-procedure hypotension, which produces a 20% decrease of the basal mean arterial pressure (MAP).
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Affiliation(s)
- José A Jordan
- Department of Radiology, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), Medical University of Havana; Havana, Cuba -
| | - Juan Carlos Llibre
- Department of Neurology, Stroke Unit, Instituto de Neurología y Neurocirugía (INN), Medical University of Havana; Havana, Cuba
| | - Frank Vázquez
- Department of Radiology, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), Medical University of Havana; Havana, Cuba
| | - Raúl Rodríguez
- Department of Anesthesia, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), Medical University of Havana; Havana, Cuba
| | - José A Prince
- Department of Neurosurgery, Centro Internacional de Restauración Neurológica (CIREN), Medical University of Havana; Havana, Cuba
| | - José Carlos Ugarte
- Department of Neurology, Stroke Unit, Instituto de Neurología y Neurocirugía (INN), Medical University of Havana; Havana, Cuba
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Hur S, Jae HJ, Lee M, Kim HC, Chung JW. Safety and efficacy of transcatheter arterial embolization for lower gastrointestinal bleeding: a single-center experience with 112 patients. J Vasc Interv Radiol 2013; 25:10-9. [PMID: 24286939 DOI: 10.1016/j.jvir.2013.09.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/03/2013] [Accepted: 09/04/2013] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of transcatheter arterial embolization for lower gastrointestinal bleeding (LGIB) and to determine the prognostic factors that affect clinical outcome. MATERIALS AND METHODS All patients diagnosed with LGIB by angiography at a single institution from April 2006 to January 2013 were included in a retrospective study. The rates of technical success, early recurrent bleeding, major complications, clinical success, and in-hospital mortality for transcatheter arterial embolization were determined. The influence of possible prognostic factors on the outcome was analyzed. RESULTS A total of 112 patients were included (36 with small-bowel LGIB, 36 with colon LGIB, and 40 with rectal LGIB). N-butyl cyanoacrylate (NBCA) was the embolic agent for 84 patients (75.0%), whereas gelatin sponge pledgets (n = 20), microcoils (n = 2), polyvinyl alcohol particles with adjunctive gelatin sponge pledgets (n = 1), and blood clots (n = 1) were used in the other patients. The technical success rate was 96.4%. For the entire group, the rates of early recurrent bleeding, major complications, clinical success, and in-hospital mortality were 17.4%, 4.6%, 74.5%, and 25.0%, respectively. These were 15.2%, 4.8%, 75.3%, and 26.2%, respectively, in the NBCA group. Hematologic malignancy, immobilization status, and coagulopathy were significant prognostic factors for clinical outcomes. CONCLUSIONS Transcatheter arterial embolization is a safe and effective treatment for LGIB. NBCA could be used as a primary embolic agent for this procedure.
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Affiliation(s)
- Saebeom Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, Republic of Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, Republic of Korea.
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, Republic of Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, Republic of Korea
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26
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Pietura R, Toborek M, Dudek A, Boćkowska A, Janicka J, Piekarski P. Endovascular embolization of varicoceles using n-butyl cyanoacrylate (NBCA) glue. Pol J Radiol 2013; 78:26-30. [PMID: 23807881 PMCID: PMC3693833 DOI: 10.12659/pjr.889181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/07/2013] [Indexed: 11/09/2022] Open
Abstract
Background: Varicoceles are abnormally dilated veins within the pampiniform plexus. They are caused by reflux of blood in the internal spermatic vein. The incidence of varicoceles is approximately 10–15% of the adolescent male population. The etiology of varicoceles is probably multifactorial. The diagnosis is based on Doppler US. Treatment could be endovascular or surgical. The aim of the study was to describe and evaluate a novel method of endovascular embolization of varicoceles using n-butyl cyanoacrylate (NBCA) glue. Material/Methods: 17 patients were subjected to endovascular treatment of varicoceles using NBCA. A 2.8 Fr microcatheter and a 1:1 mixture of NBCA and lipiodol were used for embolization of the spermatic vein. Results: All 17 procedures were successful. There were no complications. Discussion: Embolization of varicoceles using NBCA glue is efficient and safe for all patients. The method should be considered as a method of choice in all patients. Phlebography and Valsalva maneuver are crucial for technical success and avoidance of complications. Conclusions: Endovascular treatment of varicoceles using NBCA glue is very effective and safe.
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Affiliation(s)
- Radosław Pietura
- Depertment of Radiography, Medical University of Lublin; Department of Interventional Radiology and Diagnostic Imaging, Independent Public Clinical Hospital No. 1 in Lublin, Lublin, Poland
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27
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Aki A, Ueda T, Koizumi J, Cho Y, Shimura S, Furuya H, Myojin K, Okada K, Tanaka C. Mycotic Celiac Artery Aneurysm Following Infective Endocarditis: Successful Treatment Using N-butyl Cyanoacrylate with Embolization Coils. Ann Vasc Dis 2013; 5:208-12. [PMID: 23555513 DOI: 10.3400/avd.cr.11.00052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 02/21/2012] [Indexed: 11/13/2022] Open
Abstract
Mycotic celiac artery aneurysm following infective endocarditis is extremely rare and, to our knowledge, only four cases have been reported in the literature to date. We describe the case of a 60 year-old man who developed a mycotic aneurysm of the celiac artery, which was detected by computed tomography (CT) following an episode of infective endocarditis. He successfully underwent endovascular isolation and packing of the aneurysm using N-butyl cyanoacrylate (NBCA) with embolization coils.
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Affiliation(s)
- Akira Aki
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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