Embolization of bronchial arteries with N-butyl cyanoacrylate for management of massive hemoptysis: a technical review.
ABSTRACT N-butyl cyanoacrylate (NBCA) is an adhesive material, which has been used as an embolic agent in various vascular beds. Its role in the management of patients with acute massive hemoptysis has not been reported. In this article we report our experience with 12 such patients who underwent bronchial artery embolization using NBCA and compare the results with 36 procedures using polyvinyl alcohol (PVA) particles. As compared with PVA, NBCA embolizations appear more durable, leading to fewer rebleeds. There were 12 episodes of recurrent hemoptysis after 36 procedures using PVA (33%) with 8 being due to bleeding from a previously embolized vessel. Conversely, there were only 2 of the 12 patients who were treated by NBCA who experienced rebleed (16.6%). In this article, we describe the technical nuances of NBCA embolization of bronchial arteries and review potential pitfalls.
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ABSTRACT: Hemoptysis can be a life-threatening pulmonary emergency with high mortality, is symptomatic of an underlying severe pulmonary disease and requires immediate diagnosis and treatment. Diagnostically, bronchoscopy, conventional chest x-ray and contrast-enhanced multislice computed tomography (MSCT) with CT angiography (CTA) provide information regarding the underlying pulmonary disease, bleeding site, the vascular anatomy of the bronchial arteries (BA) and extrabronchial branches, as well a basis for planning of endovascular intervention. Therapeutically, bronchial artery embolization (BAE) is a safe and effective technique in the hands of an experienced interventionist with profound knowledge of the BA anatomy and possible pitfalls as well as experience with first-line therapy of recurrent and massive hemoptysis or as an intervention prior to elective surgery. Recurrent episodes of hemoptysis are not uncommon and require a prompt repeat BAE after exclusion of extrabronchial systemic and pulmonary artery bleeding sources. This review article should give an overview of the history, anatomical and pathophysiological basics and the clinical context of hemoptysis and diagnosis, as well as a survey of management, treatment and results of BAE. Key Points: • Hemoptyses are life threatening and require urgent diagnostic and therapy.• Chest x-ray, bronchoscopy, and contrast-enhanced MSCT with CTA should be carried out before therapeutic bronchial artery embolization (BAE).• BAE for the treatment of massive and recurrent hemoptysis is safe and effective.• False embolization in spinal branches of BA are the most serious complication of a BAE.• Repeatedly BAE refractory cases should undergo elective surgery. Citation Format: • Ittrich H, Klose H, Adam G Radiologisches Management von Hämoptysen: Diagnostik und Interventionelle Bronchialarterienembolisation. Fortschr Röntgenstr 2014; DOI: 10.1055/s-0034-1385457.RöFo - Fortschritte auf dem Gebiet der R 11/2014; DOI:10.1055/s-0034-1385457 · 1.96 Impact Factor
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ABSTRACT: Uvulopalatoplasty is one of the most common surgeries for snoring and obstructive sleep apnea. The usual way of approximating the edges of the soft palate is the use of sutures, which influences the quality of healing and the severity of postoperative pain. To present our experience in using the tissue glue “N-butyl-2-cyanoacrylate (Glubran 2)” in uvulopalatoplasty and its effect on the operative technique and postoperative results. Between January 2009 and February 2011, 54 patients fitting certain preoperative criteria were treated with this technique and with a minimum follow-up period of 6 months. N-butyl-2-cyanoacrylate was used in uvulopalatoplasty for the treatment of snoring. The main outcome measures were the stability of soft palatal tissues to which the glue was applied, the degree of postoperative pain in comparison with the use of sutures, the morphology of the newly formed soft palate, and postoperative side effects and complications. The technique for the use of surgical glue is described in detail. Fifty-four patients completed the study. Complete healing of the edge of the newly formed soft palate without displacement or delayed postoperative palatal fibrosis was achieved with the use of N-butyl-2-cyanoacrylate. Postoperative pain was significantly reduced with the use of surgical glue. N-butyl-2-cyanoacrylate (Glubran 2) is an effective alternative for surgical sutures in uvulopalatoplasty. As compared to sutures, this tissue glue had the advantages of achieving better surgical outcomes.Operative Techniques in Otolaryngology-Head and Neck Surgery 09/2013; 24(3):184–189. DOI:10.1016/j.otot.2013.04.009
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ABSTRACT: Cyanoacrylates are a group of fast-acting adhesives. They form low viscosity liquids in the monomer state and instantly polymerize to become adhesive upon contact with ionic substances. Since the 1950s, they have been used around the world for industrial and household purposes. N-butyl cyanoacrylate (NBCA) is a cyanoacrylate that is commonly used for medical care, and the closure of skin wounds with NBCA has been found to promote hemostasis. However, in Japan, the intravascular injection of NBCA is considered to be off-label use, except during the treatment of gastric varices under endoscopy. The use of NBCA in embolotherapy is considered when the target vessels cannot be cannulated superselectively, for vascular diseases that require long segments of the target vessel to be embolized, or for patients in a hypocoagulable state. NBCA-based embolotherapy can be used to treat vascular malformations, acute hemorrhaging, tumors, and venous disease. The complications associated with NBCA-based embolotherapy include tissue ischemia, hemorrhaging, systemic or local reactions, and catheter adhesion to blood vessels. NBCA is mixed with Lipiodol to make it radiopaque and to adjust its polymerization time. Since there are various technical aspects to performing NBCA-based embolotherapy safely, it should be carried out by, or with the assistance of, proficient interventional radiologists.Japanese journal of radiology 06/2014; 32(8). DOI:10.1007/s11604-014-0328-7 · 0.74 Impact Factor