title: Comparison of hemostatic durability between N-butyl cyanoacrylate and gelatin sponge particles in transcatheter arterial embolization for acute arterial hemorrhage in a coagulopathic condition in a swine model.
abstract: This study was designed to compare the efficacy of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) or gelatin sponge particles (GSP) for acute arterial bleeding in a coagulopathic condition using a swine model. Four healthy swine were divided into two coagulopathic conditions: mild and severe. Five hemorrhages were created in each swine (10 hemorrhages per coagulopathy). Mild coagulopathy was achieved by bloodletting 10% of the total circulatory whole blood and preserving activated clotting time (ACT) less than 200 s (ACT < 200 s state); severe coagulopathy was achieved by bloodletting 30% and preserving ACT > 400 s (ACT > 400-second state). For each state, of ACT < 200 s or ACT > 400 s, TAE was conducted with GSP or NBCA to control five hemorrhages arising from artificially created renal and splenic injuries. Angiography immediately after TAE with GSP or NBCA showed complete occlusion in both coagulopathic conditions. In the ACT < 200-second state, follow-up angiography at 5-30 min after TAE with GSP or NBCA showed no evidence of recurrent hemorrhage. In the ACT > 400-second state, follow-up angiography showed recurrent hemorrhage in four (80%) of the five hemorrhages embolized with GSP and in one (20%) of the five hemorrhages embolized with NBCA. Microscopically, red thrombi were observed densely surrounding GSP in mild coagulopathy but were scarce in severe coagulopathy. In a condition with severe coagulopathy, TAE with NBCA was more effective in durability to cease active arterial bleeding than with GSP.
authors.affiliation: Department of Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8510, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Yonemitsu
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kawai
authors.forename: Morio
authors.initials: M
authors.lastname: Sato
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Sonomura
authors.forename: Isao
authors.initials: I
authors.lastname: Takasaka
authors.forename: Motoki
authors.initials: M
authors.lastname: Nakai
authors.forename: Hiroki
authors.initials: H
authors.lastname: Minamiguchi
authors.forename: Shinya
authors.initials: S
authors.lastname: Sahara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Toshio
authors.initials: T
authors.lastname: Naka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shinozaki
mesh_terms: D000792:Angiography; D000818:Animals; D001778:Blood Coagulation Disorders / Q000150:complications*; D004195:Disease Models, Animal; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000494:pharmacology*; D005781:Gelatin Sponge, Absorbable / Q000494:pharmacology*; D006470:Hemorrhage / Q000628:therapy*; D006490:Hemostatics; D012077:Renal Artery / Q000293:injuries*; D013157:Splenic Artery / Q000293:injuries*; D013552:Swine
chemical_list: D006490:Hemostatics; D004659:Enbucrilate