Analysis of the time course of changes in imaging findings of small arteries embolized with the N-Butyl cyanoacrylate-lipiodol mixture

Abstract

Background: There are no reports analyzing imaging findings of arteries embolized with N-butyl cyanoacrylate (NBCA)-Lipiodol. To evaluate the time course of changes in the imaging findings of small arteries embolized with NBCA-Lipiodol. Materials and Methods: Selective transcatheter arterial embolization procedures via the inferior phrenic artery (right IPA, n = 25; left IPA, n = 5) were performed in 30 patients (25 males, 5 females; mean age 63 years, range: 45–78) at our institution. The NBCA-Lipiodol mixture was used as an embolic agent. The ratio of NBCA to Lipiodol was 1:4 (Group-A, n = 16) or 1:8 (Group-B, n = 14).We retrospectively reviewed the computed tomography (CT) findings and outcomes of small arteries embolized with the NBCA-Lipiodol mixture. The residual lipiodol was compared between Group-A and Group-B. The Student’s t-test and Chi-square test were used for statistical analyses. In addition, the residual lipiodol rate was calculated using the Kaplan–Meier method and compared using the log-rank test. Results: The mean observation period was 264 ± 84 days (range: 104–425). Lipiodol completely disappeared in 20 arteries (66%) during follow-up. Recanalization of arterial flow was not seen in CT images, even when Lipiodol disappeared. Group-B showed a shorter period of progression to disappearance of Lipiodol than Group-A (P < 0.05). On follow up, the rate of residual Lipiodol in Group-A was higher than that in Group-B (P < 0.05). Conclusion: Residual Lipiodol was expected to gradually disappear. Lipiodol disappeared early when the density of NBCA was low in the NBCA-Lipiodol mixture. Further evaluations of various arteries and ratios of NBCA to Lipiodol are needed.

Keywords

Embolization - lipiodol - N-butyl cyanoacrylate - recanalization

Publication History

Article published online:
26 July 2021

• References

• 1 Takeuchi Y, Morishita H, Sato Y, Hamaguchi S, Sakamoto N, Tokue H. et al. Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition. Jpn J Radiol 2014; 32: 500-17
• 2 The n-BCA Trial Investigators. N-butyl cyanoacrylate embolization of cerebral arteriovenous malformations: Results of a prospective, randomized, multi-center trial. Am J Neuroradiol 2002; 23: 748-55
• 3 McConnell KA, Tjoumakaris SI, Allen J, Shapiro M, Bescke T, Jabbour PM. et al. Neuroendovascular management of dural arteriovenous malformations. Neurosurg Clin N Am 2009; 20: 431-9
• 4 Turner Jr WW, Ellman BA. Transhepatic embolization in patients with acute variceal hemorrhage. Am J Surg 1981; 142: 731-4
• 5 Pollak JS, White Jr. RI. The use of cyanoacrylate adhesives in peripheral embolization. J Vasc Interv Radiol 2001; 12: 907-13
• 6 Yamagami T, Kato T, Iida S, Tanaka O, Nishimura T. Value of transcatheter arterial embolization with coils and n-butyl cyanoacrylate for long-term hepatic arterial infusion chemotherapy. Radiology 2004; 230: 792-802
• 7 Matsumoto K, Ushijima Y, Tajima T, Nishie A, Hirakawa M, Ishigami K. et al. Recanalization of splenic artery aneurysm after transcatheter arterial embolization using N-butyl cyanoacrylate. Cardiovasc Intervent Radiol 2010; 33: 187-90
• 8 Ishikawa M, Kakizawa H, Yamasaki W, Date S, Hieda M, Kajiwara K. et al. Recanalization after successful occlusion by transcatheter arterial embolization with N-butyl cyanoacrylate for traumatic splenic artery injury. Hiroshima J Med Sci 2011; 60: 87-90
• 9 Stoesslein F, Ditscherlein G, Romaniuk PA. Experimentalstudies on new liquid embolization mixtures (histoacryl-lipiodol, histoacryl-panthopaque). Cardiovasc Intervent Radiol 1982; 5: 264-7
• 10 Gruber A, Mazal PR, Bavinzski G, Killer M, Budka H, Richling B. Repermeation of partially embolized cerebral arteriovenous malformations: A clinical, radiologic, and histologic study. Am J Neuroradiol 1996; 17: 1323-31