Glue Embolization Research Articles

Endovascular Management of Auricular Arteriovenous Malformations

This is a retrospective review of eight patients with extracranial arteriovenous malformations (AVMs) of the auricular region. All cases presented with significant hemorrhages or cosmetic defects. Highflow AVMs of the auricular are quite rare in contrast to low flow vascular lesions of the head and neck, making early diagnosis and treatment critical as incidences of recurrence are high if not managed properly. The purpose of this study is to present our experience of experimental endovascular treatment in a series of eight patients with auricular AVMs. From January 2015 to December 2017, eight patients with auricular AVM were put through transcatheter arterial embolization and percutaneous direct puncture embolization with polyvinyl alcohol (PVA) and bleomycin in five patients, glue embolization in one patient and coiling along with PVA in two patients to occlude high-flow fistula. Clinical outcomes were obtained through physical examination, and symptoms and a degree of devascularization on follow-up angiography. We performed 10 therapeutic embolization procedures. Of these, 3 resulted in absolute devascularization while 5 resulted in 75% obstruction. In 5 patient's embolization was performed as a palliative procedure. The other 3 were embolized as a sole mean of treatment for occluding the AVM. Only two patients developed postembolization necrosis and infection, and there has been no reexpansion of lesions to date. While thus far only having been used as percutaneous local sclerotherapy, this study found that bleomycin and PVA mixture, if used intraarterially can be more effective in the management of auricular AVM's.

Efficacy and safety of combined endoscopic cyanoacrylate injection and balloon-occluded retrograde transvenous occlusion (BRTOcc) of gastrorenal shunts in patients with bleeding gastric fundal varices

BackgroundEndoscopic cyanoacrylate (glue) injection of fundal varices may result in life-threatening embolic adverse events through spontaneous gastrorenal shunts (GRSs). Balloon-occluded retrograde transvenous occlusion (BRTOcc) of GRSs during cyanoacrylate injection may prevent serious systemic glue embolization through the shunt. This study aimed to evaluate the efficacy and safety of a combined endoscopic–interventional radiologic (BRTOcc) approach for the treatment of bleeding fundal varices.MethodsWe retrospectively analysed the data of patients who underwent the combined procedure for acutely bleeding fundal varices between January 2010 and April 2018. Data were extracted for patient demographics, clinical and endoscopic findings, technical details, and adverse events of the endoscopic–BRTOcc approach and patient outcomes.ResultsWe identified 30 patients (13 [43.3%] women; median age 58 [range, 25–92] years) with gastroesophageal varices type 2 (53.3%, 16/30) and isolated gastric varices type 1 (46.7%, 14/30) per Sarin classification, and median clinical and endoscopic follow-up of 151 (range, 4–2,513) days and 98 (range, 3–2,373) days, respectively. The median volume of octyl-cyanoacrylate: Lipiodol injected was 7 (range, 4–22) mL. Procedure-related adverse events occurred in three (10.0%) patients, including transient fever, non-life-threatening pulmonary glue embolism, and an injection-site ulcer bleed. Complete gastric variceal obturation was achieved in 18 of 21 patients (85.7%) at endoscopic follow-up. Delayed variceal rebleeding was confirmed in one patient (3.3%) and suspected in two patients (6.7%). Although no procedure-related deaths occurred, the overall mortality rate was 46.7%, primarily from liver-disease progression and co-morbidities.ConclusionThe combined endoscopic–BRTOcc procedure is a relatively safe and effective technique for bleeding fundal varices, with a high rate of variceal obturation and a low rate of serious adverse events.

Reversed Approach through Lymphocele/Lymphatic Fluid Collection for Glue Embolization of Injured Lymphatic Vessels

A total of 9 glue embolization procedures of injured lymphatic vessels with a reversed approach from the lymphocele/lymphatic fluid collection in 8 patients were retrospectively reviewed. The approach routes were via the indwelling chest tube for pleural effusion (n = 2), the drainage catheter tract for abdominopelvic lymphocele/lymphatic fluid collection/thigh lymphocele (n = 4), and the direct puncture of the lymphatic fluid collection at the operation bed (n = 2). All the procedures were technically successful without complications. The mean daily leakage rate decreased from 465 mL/d before the procedure to 42 mL/d after the procedure, and the drainage catheters could be removed after 8 procedures, achieving a clinical success rate of 88.9% (8 of 9 procedures).

Embolization of Urinary Tract Fistulae Using an AMPLATZER Vascular Plug and Glue

Six patients (mean age, 57.7 y ± 19.7) with persistent urinary fistulae underwent 7 urinary tract embolizations with AMPLATZER Vascular Plugs (AVPs) and glue: 5 with concomitant cavity obliteration with glue and 2 without. A single procedure was successful in resolving urinary leakage in 5 patients (71%) at a mean follow-up of 27.3 wk ± 31.5 (median, 9.7 wk; range, 4.9–80 wk). Repeat cavity embolization was required in 2 instances to achieve clinical success. Mean survival was 42.3 wk (median, 16.4 wk; range, 11.7–104 wk). Combined AVP and glue embolization may prove to be a primary approach in the control of persistent fistulae.

Endovascular management of intracranial pseudoaneurysm: an institutional experience.

ObjectivePseudoaneurysms (PSAs) of the internal carotid artery (ICA) and vertebral artery are rare entities but with varied treatment options. PSAs can be spontaneous or secondary to trauma, infections, malignancies or iatrogenic. To find out the efficacy of various endovascular interventions in the management of ICA and vertebral PSAs.MethodsThe study included 14 patients diagnosed with intracranial PSAs who underwent endovascular interventions in SMS Medical College, Jaipur (Rajasthan) between June 2015 to January 2019. The clinical and radiological findings (computed tomography angiography and digital subtraction angiography) were reviewed and the consequent endovascular intervention carried out and their results were analyzed.ResultsTotal 14 patients were studied out of which 8 (57.1%) were anterior circulation PSAs and 6 (42.9%) were posterior circulation PSAs There were 10 (71.4%) females and 4 (28.5%) males between the age of 9 to 65 years. Only 2 patients with PSA had past history of trauma. Coiling was done in 8 patients (57.1%), stenting in 2 patients (14.2%), parent artery occlusion in 1 patient (7.1%), glue embolization in 1 patient (7.1%) while coiling with glue in 1 patient (7.1%) and flow diverter in 2 patients (14.2%). Immediate and complete occlusion was achieved in 11 (78.6%) patients while 3 (21.4%) patients had subtotal occlusion. 11 patients under follow up till June 2019 did not report recurrence or new neurological deficit.ConclusionsEndovascular interventions is minimally invasive and safe treatment strategy for intracranial PSAs. The ultimate choice of technique depends on clinical and imaging characteristics.

S2346 Successful Treatment of Persistent Bile Duct Leaks Using Choledochoscopy and Glue Embolization During Endoscopic Retrograde Cholangiopancreatography

S2346 Successful Treatment of Persistent Bile Duct Leaks Using Choledochoscopy and Glue Embolization During Endoscopic Retrograde Cholangiopancreatography

A STICKY SITUATION

SESSION TITLE: Medical Student/Resident Pulmonary Vascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Patients with cirrhosis regularly undergo endoscopy for management of portal hypertensive complications. Little is known about the pulmonary complications of such procedures. Here, we present an acute pulmonary complication post gastric variceal gluing. CASE PRESENTATION: A 61-year-old female with type 2 diabetes, hypertension, and Child Pugh A cirrhosis secondary to non-alcoholic steatohepatitis presented with a two-day history of right-sided shoulder and sub-diaphragmatic pain, 3 days after elective injection of a gastric varix with Glubran and Lipidol. She described the pain as being sharp and pleuritic. She denied shortness of breath, hemoptysis, or constitutional symptoms. She had a temperature of 36.7 degrees Celsius, heart rate of 83 beats/min, blood pressure of 136/81, respiratory rate of 18/min, and an oxygen saturation of 91% on room air. Her physical exam was unremarkable. She was tender to palpation of the right sub-diaphragmatic area. Stigmata of chronic liver disease were not noted. Her investigations revealed normal electrolytes, creatinine, hemoglobin and white blood cell count. Her platelets were 111, INR 1.2, ALT 27 U/L, Bilirubin 38 umol/L, GGT 43 U/L, and the D-dimer was 1.82 mg/L. Her chest x-ray showed several new nodular densities in both lungs. Computed tomography pulmonary angiogram reported diffuse pulmonary arterial calcification; it was later addended to reveal a large caliber variceal gastrorenal shunt and high density filling defects consistent with severe burden of embolized glue throughout the segmental and subsegmental pulmonary vasculature bilaterally. DISCUSSION: The use of glue is commonly used in endoscopic therapeutics to prevent and treat gastrointestinal bleeding [1,2]. It has an associated 0.5%-4.3% risk of embolization [1], which can result in cardiopulmonary collapse [2]. Embolization is believed to occur through travel through gastrorenal and splenorenal veins into the inferior vena cava, with eventual deposition into the pulmonary circulation [2]. Large, high-flow portosystemic shunts and glue injections of more than 1 mL are predicted risk factors for pulmonary embolization [3]. The differential diagnosis for our patient included septic emboli, pulmonary embolus, malignancy, or pulmonary hypertension associated with vessel calcification. Initial management included administration of Cefazolin for a possible infection, followed by watchful waiting as the patient was hemodynamically stable. A secondary review of her imaging by Radiology further confirmed the findings of embolized glue. CONCLUSIONS: Pulmonary embolization of glue is an uncommon endoscopic complication of variceal treatment that has been linked to complications such as cardiopulmonary collapse and septic emboli [2]. It is important that clinicians keep this on the differential diagnosis when evaluating patients with chest pain or hemodynamic instability after gluing of varices. Reference #1: Al-Hillawi L, Wong T, Tritto G, Berry PA. Pitfalls in histoacryl glue injection therapy for oesophageal, gastric and ectopic varices: A review. World J Gastrointest Surg. 2016;8(11):729–734. doi:10.4240/wjgs.v8.i11.729 Reference #2: Hameed F, Pepperell J, Sidney J. A rare complication of endoscopic intervention. Breathe. 2018;14(2):e40-e42. doi:10.1183/20734735.019017 Reference #3: Jindal A, Philips CA. Pulmonary Glue Embolization after Endoscopic Treatment of Bleeding Sigmoid Colon Varices. ACG Case Rep J. 2017;4:e52. Published 2017 Apr 12. doi:10.14309/crj.2017.52 DISCLOSURES: No relevant relationships by Jennifer Landry, source=Web Response No relevant relationships by Dana Saleh, source=Web Response

S1874 EUS-Guided Cyanoacrylate Glue Embolization of Rectal Varices Prior to EMR of Large Rectal Polyp

S1874 EUS-Guided Cyanoacrylate Glue Embolization of Rectal Varices Prior to EMR of Large Rectal Polyp

S2176 Small Bowel Varices: A Covert Source of Overt Bleeding

INTRODUCTION: Alcoholic cirrhosis is one of the most common causes of liver failure, accounting for millions of hospitalizations each year. Although esophageal, gastric, and rectal varices are extensively described as a result of portal hypertension, small bowel varices (SBV) are rarely implicated as a source of GI bleeding. This report describes a unique case of isolated SBV resulting in overt GI hemorrhage. CASE DESCRIPTION/METHODS: A 54-year-old female with a history of alcoholic cirrhosis decompensated by esophageal varices, hepatic encephalopathy, and abdominal ascites (MELD-Na 19) presented to the ED after multiple episodes of melena and hematochezia. The patient had previously undergone transjugular portosystemic shunting (TIPS) for recurrent variceal bleeding. The patient underwent an EGD which showed mild portal hypertensive gastropathy but no gastric or esophageal varices. Her colonoscopy was unremarkable. Given ongoing bleeding, the patient underwent a capsule endoscopy which revealed fresh blood with clots two-thirds (65%) of the way through the jejunum. A CT angiography revealed a portosystemic shunt between the superior mesenteric vein and the common femoral vein near the jejunum. Interventional radiology performed a catheter guided coil and glue embolization of the venous malformation and created a new portosystemic shunt. The patient’s melena and hematochezia ceased, and she was safely discharged home. DISCUSSION: Caused by portal hypertension, SBV are rare and infrequently implicated in significant GI hemorrhage. This case is unique in that the patient had no gastric, esophageal, or rectal varices. Isolated SBV are described anecdotally in the literature and extremely unlikely to manifest clinically. In addition, this case highlights the potential utility for inpatient video capsule endoscopy (VCE). In a patient with persistent GI bleeding with normal endoscopy and colonoscopy should certainly be considered for a deeper luminal exam. Furthermore, the definitive management of SBV is not well defined. While the mainstay of treatment is supportive care, minimally invasive vascular interventions provide an exciting option for management.

Utilizing immediate preoperative n-BCA in the resection of head and neck venous and lymphatic malformations

Purpose/objectiveTo add to the current literature on single stage excision of head and neck vascular malformations with preoperative n-butyl cyanoacrylate (n-BCA) glue. Unlike previous studies, this series includes pediatric and adult patients, highlights a single stage partial excision of a complex venous malformation, and describes the first description of using glue prior to resection of a macrocystic lymphatic malformation. Study designCase series with chart review. SettingTertiary-care adult and pediatric hospital. Subjects and resultsFour patients (3 males - 9, 13, 25 years, 1 female - 61 years) underwent same day excision of head and neck vascular malformations utilizing immediate preoperative n-BCA glue embolization performed by interventional radiology and otolaryngology, as described by Tieu et al. The indications for resection included bleeding (1/4), pain (3/4), cosmetic deformity (3/4), and discomfort with denture wear (1/4). Prior interventions included none (1/4), cautery and primary closure to control acute hemorrhage (1/4), and sclerotherapy (2/4). Treatments included complete embolization and resection of simple venous malformation (VM)s of the oral cavity/lip (2/4), partial embolization and resection of a complex hemifacial venous malformation (VM) (1/4), and complete embolization and resection of a lymphatic malformation (LM) (1/4). On average, 97 min of anesthesia time was added for the preoperative embolization procedure (range, 94–104 min). All patients had a successful embolization without need for coils. Operative time ranged from 28 to 44 min for the simple cases and was 6 h and 30 min for the complex case. There was minimal blood loss in all cases. There were no associated complications, lesion recurrences, or long-term deficits at an average follow-up of 5 months. The patient with the complex hemifacial VM demonstrated subtle lower facial weakness post-operatively, which completely resolved within two months. ConclusionsTreatment of head and neck vascular malformations with preoperative n-BCA glue and subsequent surgical excision is a viable method for both simple and complex lesions. The safety and efficacy of this technique has been demonstrated in the past in a limited number of studies. This study further supports the use of this technique to address patient concerns such as pain or discomfort and cosmetic deformity, even if the lesion is only partially resectable. In our series a lymphatic malformation refractory to sclerotherapy was treated with a similar technique of glue and resection, following aspiration of the mucoid LM fluid. Our series emphasizes that pediatric vascular malformations carry functional and cosmetic deficits into adulthood that can and should be addressed in this patient population. Therefore, same-day embolization and resection should be coordinated when possible, in order to optimize patient safety and convenience.

Endoscopic Ultrasound-Guided Angiotherapy for Gastric Varices—A Small Retrospective Study

Abstract Introduction Conventional n-butyl-cyanoacrylate (CYA) recommended for secondary prophylaxis of gastric varices (GV) is associated with significant rebleeding and glue embolism. Limited data are available on more successful and less risky endoscopic ultrasound-guided coils and CYA (EUS-Coils-CYA) injection in GV. Methods We present a retrospective case series of 12 patients with GV bleeding managed successfully with EUS-Coils-CYA injection leading to variceal eradication in 11 patients. Results From January 2018 to June 2019, 12 cases of GV, which were either bleeding or bled recently, were included. Complete obliteration was achieved in 91.6% of patients with 100% technical success. Mean number of deployed coils and volume of injected CYA glue were 1.16 and 1.58 mL, respectively. Conclusions EUS-guided angiotherapy is an effective and safe intervention for managing GV bleeding with high technical success rate.

Glue Embolization of Lymphopseudoaneurysm for Chylous Ascites after Retroperitoneal Surgery

ObjectiveTo assess the safety and efficacy of lymphopseudoaneurysm (LPA) glue (n-butyl cyanoacrylate [NBCA]) embolization in the management of chylous ascites after retroperitoneal surgery.Materials and MethodsA retrospective analysis from January 2014 to October 2018 was performed in six patients (4 females and 2 males; mean age, 45.3 ± 14.2 years; range, 26–61 years) who underwent LPA embolization for chylous ascites developing after retroperitoneal surgery involving the perirenal space (four donor nephrectomies, one partial nephrectomy, and one retroperitoneal lymphadenectomy). After placing a percutaneous drainage catheter into the LPA or adjacent lymphocele, embolization was performed by filling the LPA itself with a mixture of glue and Lipiodol (Guerbet).ResultsDaily drainage from percutaneously placed drains exceeded 300 mL/day despite medical and surgical treatment (volume: mean, 1173 ± 1098 mL; range, 305–2800 mL). Intranodal lymphangiography was performed in four of the six patients and revealed leakage in 2 patients. Percutaneous embolization of the LPA was successful in all patients using an NBCA and Lipiodol mixture in a ratio of 1:1–1:2 (volume: mean, 4.3 ± 1.1 mL; range, 3–6 mL). Chylous ascites was resolved and the drainage catheter was removed in all patients within 4 days after the procedure (mean, 2.0 ± 1.8 days; range, 0–4 days). No procedure-related complications or recurrence of chylous ascites occurred during a mean follow-up period of 37.3 months (range, 21.1–48.4 months).ConclusionGlue embolization of LPA has the potential to be a feasible and effective treatment method for the management of chylous ascites after retroperitoneal surgery.

Adrenal and renal abscesses following glue embolization of gastric varices: a case description.

Adrenal and renal abscesses following glue embolization of gastric varices: a case description.

Ultrasound-Guided Percutaneous Antegrade Varicocele Embolization with Cyanoacrylate Glue as an Alternative to the Standard Retrograde Approach.

We report a case of a 29-year-old male referred to our hospital for endovascular treatment of a left-sided painful varicocele. Standard retrograde embolization via the left renal vein was not possible because of the presence of a left circum-aortic renal vein making the catheterization of the testicular vein not feasible. The patient was successfully treated via ultrasound-guided percutaneous antegrade access of the testicular vein at the inguinal level with subsequent cyanoacrylate glue embolization as a minimally invasive alternative to surgical therapy. This is a new approach to varicocele embolization when the left renal vein does not feed the varicocele.

A Single-Center Experience With Percutaneous Interventional Management of Refractory Chylous Ascites.

Management of chylous ascites is poorly understood with no management guidelines. We retrospectively reviewed patients treated for chylous ascites at our institution to evaluate efficacy and safety of lipiodol lymphangiography and embolization. Seven patients underwent percutaneous interventional management of chylous ascites (average age 52.5 years, 3 female, 6 post-surgical, 1 pancreatitis) from 2012. All patients underwent lipiodol inguinal lymph node injection. Adjunctive glue embolization was performed if a leak was identified. Data were collected on the cause of chylous ascites, conservative management strategies, procedural details, and success. All patients had chylous ascites refractory to conservative management. Preprocedure lymphoscintigraphy identified a retroperitoneal leak in 6 patients. Seven patients underwent 12 lymphangiogram procedures; 8 were performed at our institution. Lymphangiography identified a leak in 5 patients (71%). Success was achieved in 2 patients (28%) treated at our institution after glue embolization following cannulation of the leaking lymphatic channels and 1 patient (14%) after lymphangiography alone for an overall success rate of 43% (3/7). Two patients (29%) were successfully treated after one procedure. Two patients (29%) unsuccessfully treated at our institution were referred to a specialized center in the United States. No 30 day post procedural complications. In our experience, lymphangiography and embolization was a safe, relatively effective and minimally invasive method for treating medically refractory chylous ascites. Complex cases required referral to a specialized institution with resources unavailable at our tertiary care center.

Embolization using warmed glue via the triaxial microballoon occlusion system for various vascular disorders.

We aimed to illustrate the benefits of using warmed glue for viscosity reduction via the triaxial microballoon system for the treatment of various vascular disorders. Seven patients who underwent 10 treatment sessions for hemoptysis, type II endoleak, post-pancreatic surgical bleeding, spontaneous retroperitoneal bleeding, or ovarian tumor bleeding were evaluated based on technical and clinical outcomes. In the procedure, the triaxial system, consisting of a 4.5-Fr guiding catheter, a 2.8-Fr microballoon catheter, and a 1.9-Fr no-taper microcatheter, was advanced into the target lesion. Glue (33% n-butyl cyanoacrylate mixed with Lipiodol) warmed to 40°C was injected under balloon occlusion. The common hepatic, right bronchial, intercostals, internal mammary, costocervical, lateral thoracic, superior thoracic, thoracoacromial, inferior thyroid, iliolumbar, lumbar, internal pudendal arteries, and branch of the inferior mesenteric artery were successfully embolized; 100% technical success and 100% clinical success were obtained after each session. Our modified balloon-occluded glue embolization may lead to better handling with more distal glue penetration capability.

Bleeding after Microwave Ablation in Hepatocellular Carcinoma: Successful Treatment with Percutaneous Ultrasound-Guided Cyanoacrylate Glue Embolization.

Bleeding after Microwave Ablation in Hepatocellular Carcinoma: Successful Treatment with Percutaneous Ultrasound-Guided Cyanoacrylate Glue Embolization.

Abstract No. 385 Emergent uncontrolled bleeding in patients with thrombocytopenia and/or coagulopathy: embolization with glue significantly less likely to require repeat intervention than other embolic agents

Traditional coil embolization slows blood flow to enable hemostasis. Sufficient platelet activation and intact coagulation cascade are required for hemostasis. Past studies have found that thrombocytopenia and/or coagulopathy are factors associated with failure of embolization to stop bleeding. Glue embolization is thought to not be affected by such factors to stop bleeding. To evaluate the efficacy of glue embolization to other forms of embolization, we retrospectively reviewed all emergent embolizations performed for bleeding. We reviewed imaging and medical charts for all embolizations for bleeding performed by interventional radiology at a large academic institution for 4 years. Patient demographics, labs, indication, procedure time, embolization site, embolic agent(s) used, procedures and clinical course were reviewed. For statistical significance, Wilcoxon test is used to test continuous variables and Fisher’s exact for categorical variables. A total of 42 embolization procedures were performed on patients who had INR of at least 1.5 or higher and/or platelets 100 or less. Eight patients had embolizations performed using glue as one of the agents and 34 patients had embolizations using any agent or combination of agents exclusive of glue. In non-glue cases (34 cases), coils were used 82% of the time, followed by gel foam (32%), particles (6%) and plugs (6%). Gel foam was almost always concurrently used with coils (72% of the time); only 3 cases used gel foam as the only agent. The most common target organ was bowel (48% of the cases), followed by solid organs (liver, spleen, kidney; 29%) and muscle (24%). No glue cases required repeat intervention versus 18 of the non-glue cases (43%, P < 0.05). The INR and platelet levels were not significantly different between the groups. The mean procedure time was lower for glue cases (95 minutes for glue versus 106 minutes for non-glue cases) but was not statistically different between the groups. Embolization with glue was found to be significantly more durable than with embolization with other agents in patients with thrombocytopenia and/or coagulopathy.

Abstract No. 613 Interventional radiology management of chylous ascites

Unresolving chylous ascites is fatal with up to 90% mortality at one year. Interventional management of chylous ascites is poorly understood and there are no guidelines for management. We retrospectively reviewed patients treated for chylous ascites at our institution to evaluate efficacy and safety of lymphangiography and embolization. This is a retrospective review from January 2010 to August 31, 2019 of 7 patients with chylous ascites (average age 52.5 years, 4 female, 6 post surgical, 1 pancreatitis). All patients underwent inguinal lymph node injection. Adjunctive glue embolization was performed if a leak was identified. Data was collected on cause of chylous ascites, conservative management strategies, technical details and success of the procedure. Seven patients had chylous ascites. Six patients (88%) were treated with total parenteral nutrition; one patient treated with diet. Five patients received octreotide. Conservative care failed in all patients. Six patients had pre procedure lymphoscintigraphy that identified a retroperitoneal leak. Seven patients underwent 12 lymphangiogram procedures; seven were performed our institution. Lymphangiogram identified a leak in five patients (83%). Success was achieved in two (33%) patients treated at our institution after glue embolization following fluoroscopic-guided cannulation of the leaking lymphatic channels and one (17%) patient after lymphangiography alone. Two (33%) patients were successfully treated after one procedure. Three (43%) patients unsuccessfully treated at our institution underwent further treatment at a specialized institution in the U.S; all three patients were successfully treated by retroperitoneal nodal glue injection with one patients also requiring surgery. No postprocedural related complications were noted over 30 days. Lymphangiography and embolization is a safe, effective and minimally invasive method for treating chylous ascites. Lymphangiography successfully identified a leak in 83% of patients and successfully treated 50% of patients at our institution. Complex cases were referred to a specialized institute with an overall success rate of 71% from embolization.

3:00 PM Abstract No. 364 Clinical outcomes of patients with acute gastrointestinal tract bleeding treated with N-butyl-2-cyanoacrylate glue embolization

To assess clinical outcomes of patients with acute arterial gastrointestinal (GI) tract bleeding treated with N-butyl-2-cyanoacrylate (NBCA) We reviewed procedural and clinical information in 106 patients who underwent GI embolization between September 2016 and June 2019 at a single center. Embolization with exclusively NBCA was performed in 41 patients (17 female, mean age, 67.8 years) with acute upper GI (n = 22), lower GI (n = 17), rectal (n = 2) bleeding. The most common etiology of bleed was diverticular (n = 9), ulcer (n = 7), angiodysplasia (n = 7), and GI anastomosis (n = 4). Embolization was performed using 1:3 to 1:5 mixtures of NBCA and iodized oil. Four patients had empirically treated bleeding, without active contrast extravasation see on angiogram. Coagulopathy (defined as platelet count <80, INR >1.5, or PTT >45 seconds) was present in 39% (16/41) of patients. Technical success (defined as the disappearance of angiographic findings of hemorrhage on completion), early recurrent bleeding (defined as clinical signs of rebleeding requiring medical, radiologic, endoscopic, or surgical treatment at the treated focus within 30 days of embolization) and complications were recorded. The technical success rate was 97.5%. In 1/41 patients there was persistent contrast extravasation after embolization of a third order branch of the right colic artery, thought to be likely arising from a collateral, that was unable to be accessed from a retrograde approach. Early recurrent rebleeding occurred in 4/41 (9.7%) patients, of which 2 patients had empirically treated bleeds. 3/41 (7.3%) patients presented with clinical signs/symptoms of bowel ischemia postprocedurally; two patients had complete resolution with medical management, and one patient had bowel ischemia complicated by intestinal perforation. Surgical management was recommended, but patient declined. Findings in this large cohort adds to the growing body of evidence that NBCA is a durable agent for GI tract embolization with low recurrent bleed rates.