The use of cyanoacrylate in the treatment of angiodysplasias: A safe and cheap alternative to coils

Abstract

Gastrointestinal angiodysplasia (GIAD) represents one of the most frequent causes of recurrent lower gastrointestinal bleeding in the elder population. Clinical manifestations are highly variable, diagnosis is done with colonoscopy or CT and management consists of either endoscopic or, more conservatively, endovascular approach. Trans-arterial embolization (TAE) reduces blood flow into the lesion and may complicate with perforation, dissection, vasospasm and bowel ischaemia. To date, coils and Gelfoam represent the most employed embolizing agents, followed by PVA and onyx. We report the successful embolization of GIADs in four patients with n-butyl 2-cyanoacrylate (NBCA) and Lipiodol Ultra-Fluid (LUF): despite the reported higher risk of bowel infarction when compared with the other agents, no major complication or short-term recurrence occurred in our series.

Figure 1.

a 79 years old male presenting with recurrent melena, abdominal pain and anaemia. Contrast-enhanced CT scans of the abdomen show an active extravasation of contrast medium within duodenal lumen, incrementing from the arterial (A-B) to the venous phase of the study (C-D; red circles). DSA is thus performed: the presence of an active bleeding from a branch of the gastro-duodenal artery is confirmed (E; red circle) and successful TAE with 2 ml Glubran 60% is performed (F).

Figure 2.

a 73 years old female presenting with melena and anaemia. CT-angiography of the abdomen does not show any sign of active or recent bleeding. DSA demonstrates the presence of an active bleeding from jejunal branches of the superior mesenteric artery (A; red arrow) and successful TAE with 2 ml Glubran 40% is performed (B; the radiopacity within the feeding artery represents Glubran-Lipiodol mixture [the second being iodine-rich], which has stopped blood flow into the “vascular tufts” [no longer opacified]).

Figure 3.

a 72 years old female presenting with rettorrhagy and anaemia. Pre (A) and post-contrast CT scans of the abdomen (B) show clots and active extravasation of contrast medium within transverse colic lumen, respectively (red arrows). DSA is thus performed: the presence of an active bleeding from a branch of the middle colic artery is confirmed (C; red arrow) and successful TAE with 2 ml Glubran 30% is performed (D).