Division of Interventional Radiology, Stanford University School of Medicine, H-3646 Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5642, USA.
Cardiovasc Intervent Radiol. 2013 Jun;36(3):690-8. doi: 10.1007/s00270-012-0490-1. Epub 2012 Oct 16.
Avoidance of nontarget microsphere deposition via hepatoenteric anastomoses is essential to the safety of yttrium-90 radioembolization (RE). The hepatic hilar arterial network may remain partially patent after coil embolization of major arteries, resulting in persistent risk. We retrospectively reviewed cases where n-butyl cyanoacrylate (n-BCA) glue embolization was used to facilitate endovascular hepatic arterial skeletonization before RE.
A total of 543 RE procedures performed between June 2004 and March 2012 were reviewed, and 10 were identified where n-BCA was used to embolize hepatoenteric anastomoses. Arterial anatomy, prior coil embolization, and technical details were recorded. Outcomes were reviewed to identify subsequent complications of n-BCA embolization or nontarget RE.
The rate of complete technical success was 80 % and partial success 20 %, with one nontarget embolization complication resulting in a minor change in treatment plan. No evidence of gastrointestinal or biliary ischemia or infarction was identified, and no microsphere-related gastroduodenal ulcerations or other evidence of nontarget RE were seen. Median volume of n-BCA used was <0.1 ml.
n-BCA glue embolization is useful to eliminate hepatoenteric networks that may result in nontarget RE, especially in those that persist after coil embolization of major vessels such as the gastroduodenal and right gastric arteries.
通过肝肠吻合避免非目标微球沉积对于钇-90 放射性栓塞治疗（RE）的安全性至关重要。在主要动脉进行线圈栓塞后，肝门动脉网络可能仍部分通畅，从而持续存在风险。我们回顾性分析了在 RE 前使用 n-丁基氰基丙烯酸酯（n-BCA）胶栓塞来促进血管内肝动脉骨骼化的病例。
共回顾了 2004 年 6 月至 2012 年 3 月期间进行的 543 例 RE 手术，其中有 10 例使用 n-BCA 栓塞肝肠吻合。记录了动脉解剖结构、之前的线圈栓塞情况和技术细节。对结果进行了回顾，以确定 n-BCA 栓塞或非目标 RE 的后续并发症。
完全技术成功的比例为 80%，部分成功的比例为 20%，有一例非目标栓塞并发症导致治疗计划略有改变。未发现胃肠道或胆道缺血或梗死的证据，也未发现与微球相关的胃十二指肠溃疡或其他非目标 RE 的证据。n-BCA 使用的中位数体积<0.1ml。
n-BCA 胶栓塞对于消除可能导致非目标 RE 的肝肠网络非常有用，尤其是在胃十二指肠和右胃动脉等主要血管进行线圈栓塞后仍然存在的情况下。
