title: Transcatheter arterial embolization with N-butyl cyanoacrylate for acute life-threatening gastroduodenal bleeding uncontrolled by endoscopic hemostasis.
abstract: OBJECTIVE
  To investigate the feasibility, efficacy, and safety of transcatheter arterial embolization with N-butyl cyanoacrylate (NBCA) for gastroduodenal nonvariceal bleeding uncontrolled by endoscopic hemostasis.
  
  
  METHODS
  Between January 2006 and December 2011, a total of 317 patients underwent emergent endoscopic therapy for nonvariceal gastroduodenal bleeding, but hemostasis was not achieved in 20 cases. Emergent surgery was performed immediately following endoscopy in two patients. Arteriography was performed in the remaining 18 patients, and embolization with NBCA was performed in 15 patients (mean age, 71.3 y) in whom the bleeding site was detected on arteriography. For embolization, NBCA was mixed with iodized oil at a ratio of 1:1.5-1:4, and no other embolic material was used in the procedure. Technical and clinical success rates, recurrent bleeding, procedural time, complications, and clinical outcomes were determined for each procedure.
  
  
  RESULTS
  Embolization with NBCA was technically and clinically successful in all procedures, without major complications. No patient receiving embolization with NBCA experienced recurrent bleeding or required further treatment after the one-session procedure. All patients were discharged after clinical improvement. The time between puncture of the femoral artery and completion of embolization ranged from 25 to 240 minutes (mean, 66 min), and the time between the microcatheter reaching the ultimate catheter location selected for embolization and hemostasis ranged from 142 to 550 seconds (mean, 322s).
  
  
  CONCLUSIONS
  In this limited series, embolization with NBCA was found to be a safe, feasible, and effective treatment for gastroduodenal arterial bleeding when endoscopic hemostasis had failed.
authors: Department of Diagnostic Radiology, Japan Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan. hmorif@koto.kpu-m.ac.jp
authors: Hiroyuki
authors: H
authors: Morishita
authors: Takuji
authors: T
authors: Yamagami
authors: Tomohiro
authors: T
authors: Matsumoto
authors: Shunsuke
authors: S
authors: Asai
authors: Koji
authors: K
authors: Masui
authors: Hideki
authors: H
authors: Sato
authors: Atsushi
authors: A
authors: Majima
authors: Osamu
authors: O
authors: Sato
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage* / Q000009:adverse effects; D004998:Ethiodized Oil / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006490:Hemostatics / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D004998:Ethiodized Oil; D004659:Enbucrilate