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Case Reports
. 2024 Aug 27;19(11):5313-5317.
doi: 10.1016/j.radcr.2024.08.024. eCollection 2024 Nov.

Resolving a sticky situation: A case report of mechanical thrombectomy of Histoacryl emboli in the right atrium and inferior vena cava

Elif Can  1 , Michael C Doppler  1 , Charlotte Wintergerst  1 , Niklas Efinger  1 , Josefina Udi  2 , Asieb Sekandarzad  2 , Wibke Uller  1 , Katharina Vogt  1 , Sebastian Grundmann  3
Affiliations
Case Reports

Resolving a sticky situation: A case report of mechanical thrombectomy of Histoacryl emboli in the right atrium and inferior vena cava

Elif Can et al. Radiol Case Rep. .

Abstract

A 68-year-old male with liver cirrhosis presented with dizziness and dyspnea two days after endoscopic Histoacryl occlusion of gastric varicses. Imaging revealed a large endovascular embolization of Histoacryl glue, spanning from porto-caval collaterals via the inferior vena cava to the right atrium, partially occluding right atrial inflow. This case report describes the successful removal of this large net-like mass of Histoacryl glue using thrombectomy devices from the inferior vena cava and the right atrium. Postprocedure imaging showed near-complete clearance with residual fragments in the superior mesenteric vein and small emboli in the pulmonary arteries. The patient was discharged in stable condition. Histoacryl glue can cause severe complications if embolized. This case highlights the potential of advanced thrombectomy devices for managing embolic complications from endovascular treatments.

Keywords: Cardiology; Gastric varices; Gastroenterology; Histoacryl embolus; Interventional radiology; Liver cirrhosis; Thrombectomy.

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Figures

Fig 1
Fig. 1
Distribution of Histoacryl (blue arrow): (A) coronal maximum intensity projection (MIP) reformations in native CT images from the referring hospital. (B) Coronal MIP reformations in pulmonary arterial contrast-enhanced CT images. C: Echocardiogram showing a large mass in the right atrium (RA) significantly affecting right ventricular filling.
Fig 2
Fig. 2
Cavography revealing a large Histoacryl mass (blue arrow) impacting the right atrium (RA) and inferior vena cava (IVC): (A) unenhanced digital subtraction angiography (DSA) highlighting the distribution of Histoacryl from fundal varices along the mesenteric vein into the IVC and extending into the right heart. (B) Contrast-enhanced images confirming these findings.
Fig 3
Fig. 3
Post-thrombectomy images: (A) unenhanced view showing the 24F FlowTriever sheath and Amplatz wire with residual Histoacryl in fundal varices. (B) Final contrast-enhanced image of the right atrium (RA) and inferior vena cava (IVC) postintervention. (C) Detailed contrast-enhanced view of pulmonary arteries and the right-to-left heart transition postprocedure. (D) Echocardiogram indicating normalized cardiac function after mass removal. (E) Successfully retrieved Histoacryl.
See this image and copyright information in PMC

References

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