title: Transcatheter arterial embolization with N-butyl cyanoacrylate for nonvariceal upper gastrointestinal bleeding in hemodynamically unstable patients: results and predictors of clinical outcomes.
abstract: OBJECTIVE
  To assess the safety, efficacy, clinical outcomes, and prognostic factors associated with transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal (GI) hemorrhage in hemodynamically unstable patients.
  
  
  METHODS
  Between January 2008 and December 2012, 49 hemodynamically unstable patients (systolic blood pressure < 90 mm Hg and ongoing transfusion requirement) underwent emergency TAE with NBCA for nonvariceal upper GI bleeding and were included in the study. The technical (cessation of extravasation) and clinical (no residual bleeding within 7 d) success rates, incidence of ischemic complications, and clinical and technical predictors of recurrent bleeding within 30 days were analyzed.
  
  
  RESULTS
  The technical and clinical success rates were 98% and 71%, respectively. There were no ischemic bowel complications; one patient experienced hepatic infarction with elevated liver enzymes. The incidence of major complications was 2%. The incidence of rebleeding within 30 days was 39%. Hematologic malignancies (P = .017), coagulopathy (P = .003), steroid pulse therapy (P = .025), and the absence of NBCA in the target lesions (P = .003) were associated with recurrent bleeding.
  
  
  CONCLUSIONS
  NBCA embolization can be safely performed in hemodynamically unstable patients with active nonvariceal upper GI bleeding. The clinical factors associated with rebleeding might influence the clinical outcome.
authors.affiliation: Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei; Department of Medical Imaging, National Taiwan University Hospital and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei 100, Taiwan; Department of Medical Imaging, National Taiwan University Hospital Yun Lin Branch, Yun-Lin, Taiwan.
authors.forename: Yu-Sen
authors.initials: YS
authors.lastname: Huang
authors.affiliation: Department of Medical Imaging, National Taiwan University Hospital and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei 100, Taiwan.
authors.forename: Chin-Chen
authors.initials: CC
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei 100, Taiwan.
authors.forename: Jyh-Ming
authors.initials: JM
authors.lastname: Liou
authors.affiliation: Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei.
authors.forename: Fu-Shan
authors.initials: FS
authors.lastname: Jaw
authors.affiliation: Department of Medical Imaging, National Taiwan University Hospital and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei 100, Taiwan. Electronic address: lkl@ntu.edu.tw.
authors.forename: Kao-Lang
authors.initials: KL
authors.lastname: Liu
mesh_terms: D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000150:complications*; D008297:Male; D016896:Treatment Outcome
chemical_list: D004659:Enbucrilate