Transcatheter arterial embolization with tissue adhesive for acute gastrointestinal arterial hemorrhage

Abstract

Objective To evaluate the feasibility and efficacy of transcatheter arterial embolization with tissue adhesive for the treatment of acute gastrointestinal arterial hemorrhage. Methods Endovascular embolization performed in 24 patients (15 male and 9 female, aged 28–87, mean age, 41 years) with angiographic appearance of contrast extravasion, pseudoaneurysm, enlarged and tortuous vessels was retrospectively analyzed. Upper gastrointestinal hemorrhage was found in 14 patients and lower gastrointestinal hemorrhage in 10 patients. Transcatheter superselective embolization was performed with the mixture of N-butyl cyanocrylate (NBCA) and iodized oil. Among them, 4 patients who were not cured by embolization with coils and embolic particles were transferred to our hospital, receiving transcatheter arterial embolization with tissue adhesive. We chose tissue adhesive as the embolic agents of first choice in the remaining 20 patients. The technical and clinical success rate, rebleeding rate and complications were summarized. Results The technical success rate was 100.0% (24/24). The bleeding was controlled in 21 patients who had no rebleeding during follow-up period and the clinical success rate was 87.5%(21/24). Rebleeding occurred in two patients, one was managed with emergency surgery and the other underwent the second embolization therapy. Mild abdominal pain occurred in 20 patients with spontaneous symptom alleviation within 24 hours after embolization. One patient died of disseminated inravascular coagulation at 20 hours after the procedure. Of 13 cases with coagulation dysfunction, embolization was successful in 12 patients (92.3% ) without rebleeding. Neither ectopic embolism nor severe complications such as intestinal necrosis was observed. Conclusion Transcatheter superselective embolization with the mixture of NBCA and iodized oil is a safe and effective treatment for acute gastrointestinal arterial hemorrhage. Key words: Gastrointestinal hemorrhage; Embolization, therapeutic; Radiology, interventional