N-Butyl Cyanoacrylate Embolisation for Acute Arterial Haemorrhage and Pseudoaneurysms in Extracranial Locations
KK Cheng, SCH Lam, DHY Cho, S Lau
Hong Kong J Radiol 2015;18:187-96
DOI: 10.12809/hkjr1514290
Objective: To review the technical feasibility and effectiveness of N-butyl cyanoacrylate (NBCA; Histoacryl, B. Braun, Melsungen, Germany) embolisation to control acute arterial haemorrhage and embolisation of pseudoaneurysms in extracranial locations.
Methods: A retrospective study was performed on 17 patients who underwent NBCA embolisation for haemorrhage control over a 5-year period. All showed angiographic evidence of active contrast extravasation, pseudoaneurysm, or both. NBCA alone was used in nine patients. NBCA together with other embolic agents (coils and particulate agents) were used in eight patients. Causes of the acute haemorrhage or pseudoaneurysm included recent operation or procedure, over-warfarinisation, recurrent tongue base carcinoma, pulmonary tuberculosis, cavitary lung mass, duodenal ulcer, and trauma. The sites embolised included the kidney, abdominal or chest wall, hepatopancreaticobiliary system, gastrointestinal tract, pulmonary system, head and neck, spleen, and lower limb.
Results: Immediate angiographic success was achieved in all patients (100%). Of 17 patients, NBCA embolisation was beneficial in 13 (76.5%), with no clinical or radiological evidence of recurrent bleeding. In the remaining four (23.5%) patients, one was confirmed to have recurrent bleeding during subsequent re-operation. Recurrent bleeding was suspected clinically in two. One patient died within 24 hours of the procedure due to multi-organ failure. There were no major complications directly related to NBCA embolisation.
Conclusion: NBCA embolisation with or without another embolic agent is technically feasible, effective, and safe to control acute arterial haemorrhage and to embolise pseudoaneurysms due to various causes and at various anatomic sites.
中文摘要
NBCA栓塞術治療顱外急性動脈出血和假性動脈瘤
鄭加勁、林卓恆、曹慶恩、柳洵
目的：回顧研究N-氰基丙烯酸正丁酯（NBCA）栓塞術控制顱外急性動脈出血和假性動脈瘤栓塞的技術可行性和有效性 。
方法：回顧分析5年內接受NBCA栓塞術以控制出血的17例病人。全部病例發現有急性顯影劑外滲，或假性動脈瘤的血管造影術證據，或兩者並存。9例單用NBCA，另8例合併使用NBCA膠和其他栓塞劑（線圈和微粒）。急性出血或假性動脈瘤的病因包括近期手術、華法林過量、復發性舌根癌、肺結核、空洞性肺腫塊、十二指腸潰瘍和創傷。栓塞部位包括腎、腹壁或胸壁、肝膽胰系統、胃腸道、肺部、頭和頸、脾和下肢。
結果：術後即時血管造影術成功率為100%。17例病人中，13例（76.5%）沒有臨床或放射學證據顯示出血復發，證實NBCA栓塞術有效。餘下4例（23.5%）病人中，1例於隨後二次手術過程中證實出血復發；2例臨床懷疑出血復發；1例因多器官衰竭於術後24小時內死亡。並沒有與NBCA栓塞術直接相關的嚴重併發症。
結論：NBCA單用或聯合其他栓塞劑用於控制顱外急性動脈出血，及栓塞各種誘因和解剖位置的假性動脈瘤是技術上可行，且臨床有效和安全的。