Initial experience using N-butyl cyanoacrylate for embolization of lower gastrointestinal hemorrhage.
OBJECTIVE
To report initial experience using N-butyl cyanoacrylate (n-BCA) to control lower gastrointestinal hemorrhage (LGIH).


METHODS
From May 2005 to March 2009, 14 patients with LGIH underwent mesenteric angiography and transcatheter arterial embolization using n-BCA. Candidacy was primarily based on the patient's hemodynamic stability and the risk for future LGIH, determined by the presence of at least one of the following risk factors: more than one arterial feeder supplying the bleeding vessel, underlying coagulopathy, or need to resume anticoagulation after embolization. Outcome measures included technical success (immediate postembolic hemostasis confirmed with completion angiography showing no further extravasation of contrast medium), clinical success (postembolic hemostasis in the absence of complications 30 days after the procedure), and clinical failure (recurrence of LGIH necessitating repeat embolization or surgical treatment).


RESULTS
Fourteen patients with active LGIH were treated with n-BCA, with 100% technical success. Two patients had rebleeds resulting in bowel resection. One patient experienced a minor rebleed that spontaneously resolved. One patient died secondary to multiorgan failure in the setting of multiple medical problems. The remaining 10 patients had complete clinical success, experiencing no signs of rebleeding or infarction.


CONCLUSIONS
The results suggest that n-BCA can be a useful alternative embolic agent for the treatment of hemodynamically unstable patients with LGIH when standard microcoiling techniques fail or are not feasible and in patients with coagulopathy.
Department of Radiology, Hospital of St Raphael, New Haven, CT 06511, USA. aaron.frodsham@gmail.com
Aaron
A
Frodsham
Turgut
T
Berkmen
Chris
C
Ananian
Alice
A
Fung
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D041741:Lower Gastrointestinal Tract / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010865:Pilot Projects; D015641:Radiography, Interventional / Q000379:methods; D016896:Treatment Outcome
D006490:Hemostatics; D004659:Enbucrilate