Reactive lymphoid hyperplasia of the liver: Perinodular enhancement on contrast-enhanced computed tomography and magnetic resonance imaging.

We report the case of a 69-year-old woman with reactive lymphoid hyperplasia (RLH) of the liver. She underwent partial hepatectomy under a preoperative diagnosis of hepatocellular carcinoma; however, histopathological analysis revealed RLH. The liver nodule showed the imaging feature of perinodular enhancement in the arterial dominant phase on contrast-enhanced computed tomography and magnetic resonance imaging, which could be a useful clue for identifying RLH in the liver. Histologically, the perinodular enhancement was compatible with prominent sinusoidal dilatation surrounding the liver nodule.

Emergency balloon-occluded retrograde transvenous obliteration of ruptured gastric varices.

AIM: To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration (BRTO) for ruptured gastric varices. METHODS: Emergency BRTO was performed in 17 patients with gastric varices and gastrorenal or gastrocaval shunts within 24 h of hematemesis and/or tarry stool. The gastric varices were confirmed by endoscopy, and the gastrorenal or gastrocaval shunts were identified by contrast-enhanced computed tomography (CE-CT). A 6-Fr balloon catheter (Cobra type) was inserted into the gastrorenal shunt via the right internal jugular vein, or into the gastrocaval shunt via the right femoral vein, depending on the varices drainage route. The sclerosant, 5% ethanolamine oleate iopamidol, was injected into the gastric varices through the catheter during balloon occlusion. In patients with incomplete thrombosis of the varices after the first BRTO, a second BRTO was performed the following day. Patients were followed up by endoscopy and CE-CT at 1 d, 1 wk, and 1, 3 and 6 mo after the procedure, and every 6 mo thereafter. RESULTS: Complete thrombosis of the gastric varices was not achieved with the first BRTO in 7/17 patients because of large gastric varices. These patients underwent a second BRTO on the next day, and additional sclerosant was injected through the catheter. Complete thrombosis which led to disappearance of the varices was achieved in 16/17 patients, while the remaining patient had incomplete thrombosis of the varices. None of the patients experienced rebleeding or recurrence of the gastric varices after a median follow-up of 1130 d (range 8-2739 d). No major complications occurred after the procedure. However, esophageal varices worsened in 5/17 patients after a mean follow-up of 8.6 mo. CONCLUSION: Emergency BRTO is an effective and safe treatment for ruptured gastric varices.

Balloon-occluded retrograde transvenous obliteration for gastric varices via the intercostal vein.

Gastric varices are usually associated with a gastro-renal (G-R) shunt. However, the gastric varices described in this case report were not associated with a G-R shunt. The inflow vessel was the posterior gastric vein and the outflow vessels were the narrow inferior phrenic vein and the dilated cardio-phrenic vein. First, percutaneous transhepatic obliteration of the posterior gastric vein was performed, but the gastric varices remained patent. Then, micro-balloon catheterization of the subphrenic vein was carried out via the jugular vein, pericardial vein and cardio-phrenic vein, however, micro-balloon-occluded inferior phrenic venography followed by micro-coil embolization of the cardio-phrenic vein revealed no delineation of gastric varices resulting in no further treatment. Thereafter, as a gastro-subphrenic-intercostal vein shunt developed, a micro-balloon catheter was advanced to the gastric varices via the intercostal vein and balloon-occluded retrograde transvenous obliteration (BRTO) was performed resulting in the eradication of gastric varices. BRTO for gastric varices via the intercostal vein has not previously been documented.

Three benefits of microcatheters for retrograde transvenous obliteration of gastric varices.

AIM: To evaluate the usefulness of the microcatheter techniques in balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices. METHODS: Fifty-six patients with gastric varices underwent BRTOs using microcatheters. A balloon catheter was inserted into gastrorenal or gastrocaval shunts. A microcatheter was navigated close to the varices, and sclerosant was injected into the varices through the microcatheter during balloon occlusion. The next morning, thrombosis of the varices was evaluated by contrast enhanced computed tomography (CE-CT). In patients with incomplete thrombosis of the varices, a second BRTO was performed the following day. Patients were followed up with CE-CT and endoscopy. RESULTS: In all 56 patients, sclerosant was selectively injected through the microcatheter close to the varices. In 9 patients, microcoil embolization of collateral veins was performed using a microcatheter. In 12 patients with incomplete thrombosis of the varices, additional injection of sclerosant was performed through the microcatheter that remained inserted overnight. Complete thrombosis of the varices was achieved in 51 of 56 patients, and the remaining 5 patients showed incomplete thrombosis of the varices. No recurrence of the varices was found in the successful 51 patients after a median follow up time of 10.5 mo. We experienced one case of liver necrosis, and the other complications were transient. CONCLUSION: The microcatheter techniques are very effective methods for achieving a higher success rate of BRTO procedures.

Differentiation of pancreatic serous cystadenoma from endocrine tumor and intraductal papillary mucinous neoplasm based on washout pattern on multiphase CT.

OBJECTIVE: To evaluate the washout (WO) pattern of serous cystadenomas (SCAs) compared with endocrine tumors (ETs) and intraductal papillary mucinous neoplasm (IPMN). METHODS: Patients with serous cystadenoma (n = 12), ET (n = 29), and IPMN (n = 35) underwent 4-phase computed tomography CT. Tumors were categorized as hyperdense or hypodense. Computed tomographic values measured were unenhanced attenuation (AU), pancreatic attenuation (A12, 12 seconds), portal attenuation (A35), and equilibrium (A158). Computed tomographic parameters calculated were wash-in (WI) = A12 - AU; WO = A12 - A35; and washout ratio (WOR) = WO/WI × 100/22. RESULTS: Hyperdense SCAs had significantly higher WOR than did hyperdense ETs (P = 0.001). Among the 3 hypodense tumors, SCAs had the significantly highest WOR (P < 0.05/3). Relative to the pancreas, the WOR of SCAs were equivalent, whereas the WOR of ETs and IPMNs were significantly lower. CONCLUSIONS: Hyperdense SCAs had significantly higher WOR than did hyperdense ETs, and hypodense SCAs had the significantly highest WOR among the three.

Prospective evaluation of transcatheter arterial chemoembolization (TACE) with multiple anti-cancer drugs (epirubicin, cisplatin, mitomycin c, 5-fluorouracil) compared with TACE with epirubicin for treatment of hepatocellular carcinoma.

PURPOSE: To compare the efficacy of transcatheter arterial chemoembolization (TACE) using multiple anticancer drugs (epirubicin, cisplatin, mitomycin C, and 5-furuorouracil: Multi group) with TACE using epirubicin (EP group) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: The study design was a single-center, prospective, randomized controlled trial. Patients with unrespectable HCC confined to the liver, unsuitable for radiofrequency ablation, were assigned to the Multi group or the EP group. We assessed radiographic response as the primary endpoint; secondary endpoints were progression-free survival (PFS), safety, and hepatic branch artery abnormality (Grade I, no damage or mild vessel wall irregularity; Grade II, overt stenosis; Grade III, occlusion; Grades II and III indicated significant hepatic artery damage). A total of 51 patients were enrolled: 24 in the Multi group vs. 27 in the EP group. RESULTS: No significant difference in HCC patient background was found between the groups. Radiographic response, PFS, and 1- and 2-year overall survival of the Multi vs. EP group were 54% vs. 48%, 6.1 months vs. 8.7 months, and 95% and 65% vs. 85% and 76%, respectively, with no significant difference. Significantly greater Grade 3 transaminase elevation was found in the Multi group (p = 0.023). Hepatic artery abnormality was observed in 34% of the Multi group and in 17.1% of the EP group (p = 0.019). CONCLUSION: TACE with multiple anti-cancer drugs was tolerable but appeared not to contribute to an increase in radiographic response or PFS, and caused significantly more hepatic arterial abnormalities compared with TACE with epirubicin alone.

Usefulness of microcatheters inserted overnight for additional injection of sclerosant after initial balloon-occluded retrograde transvenous obliteration of gastric varices.

In patients with large gastric varices, dose limitation of the sclerosant can cause difficulties in achieving complete thrombosis of varices during a single balloon-occluded retrograde transvenous obliteration (BRTO) procedure. For patients with incomplete variceal thrombosis after the first BRTO, additional sclerosant must be injected in a second BRTO. We report a successful case of BRTO for large gastric varices in whom additional sclerosant was injected through a microcatheter that remained inserted overnight. To achieve complete variceal thrombosis in a patient with incomplete thrombosis of large gastric varices after a first BRTO, a retained microcatheter can be used to inject additional sclerosant in a second BRTO the next day.

Effect of interval between transcatheter hepatic arterial embolization and radiofrequency ablation on ablated lesion size in a swine model.

PURPOSE: The aim of the study was to clarify the effect of the interval between transcatheter hepatic arterial embolization (TAE) with Lipiodol plus gelatin sponge particles and radiofrequency (RF) ablation on the extent of ablation. MATERIALS AND METHODS: Eight healthy swine were divided into four groups: RF ablation (ablation only), RF ablation immediately after TAE (immediate ablation), RF ablation 3 days after TAE (3-day ablation), and RF ablation 6 days after TAE (6-day ablation). Five ablated lesions were created in each swine (10 per group). A 2-cm expandable LeVeen needle electrode was used for RF ablation. Ablated lesions are composed of an outer reddish zone and an inner whitish zone. RESULTS: The average longest length of the major, intermediate, and minor axes and the volume in the immediate ablation, 3-day ablation, and 6-day ablation groups were significant longer and greater (1.52 and 1.52, 1.46 and 1.50, and 1.37 and 1.35 times greater in the red zone and the whitish area, respectively) than those in the ablation-only group (P < 0.05/3). Accumulation of Lipiodol was still noted in the hepatic sinusoids in the 3-day and 6-day ablation groups. CONCLUSION: RF ablation delayed to 6 days following TAE produced larger ablation volumes than did RF ablation alone.

Pathologic evaluation of damage to bronchial artery, bronchial wall, and pulmonary parenchyma after bronchial artery embolization with N-butyl cyanoacrylate for massive hemoptysis.

Histologic evidence of safety after bronchial arterial embolization (BAE) with N-butyl cyanoacrylate (NBCA) should be assured. The present report describes a 78-year-old man with massive hemoptysis from lung cancer who underwent surgical lobectomy 23 days after hemostasis had been achieved via BAE with NBCA. Pathologic examination revealed that NBCA filled the lumen of bronchial branch arteries 143-1,094 µm in diameter from the lobar bronchus to subsegmental bronchus but was not seen in the lumen of the pulmonary artery or pulmonary vein. NBCA induced occlusion of bronchial branch arteries but no necrosis of the bronchial wall or pulmonary parenchyma.

Interlocking detachable coil embolization by technique of dumbbell-shaped framing and filling and bridge formation under balloon dilatation for huge conglomerate pulmonary arteriovenous malformation.

A 60-year-old woman presented with a conglomerate pulmonary arteriovenous malformation (PAVM) size 8.2 × 7.2 cm on chest X-ray. Feeding arteries were A(a)(7) and A(b)(7) , A(8), and A(10). The diameter and length of the A(b)(7) neck were 15.5 and 16 mm, respectively. After percutaneous transcatheter embolization of A(8) and A(10), PTE of A(a)(7) and A(b)(7) was conducted under balloon occlusion with interlocking detachable coils using a technique of dumbbell-shaped framing and filling, making a bridge from A(b)(7) to the trunk of A(9) and A(10)across A(7). Follow-up computed tomography 10 months after treatment showed marked shrinkage of the PAVM.

Balloon occlusion retrograde transvenous obliteration for inferior mesenteric vein-systemic shunt.

Two cases of portosystemic encephalopathy caused by an inferior mesenteric vein (IMV)-internal iliac vein shunt and an IMV-renal vein shunt are presented. IMV and systemic varicosity consisted of a first functional segment, a stagnant segment, and a second functional segment. Both patients underwent balloon occlusion retrograde transvenous obliteration (BRTO), using a microcatheter, to occlude the stagnant segment selectively. Although transient portal vein thrombosis was observed in case 1 and aggravation of esophageal varices was observed in case 2, these complications were tolerable. Following BRTO, the portosystemic encephalopathy in both cases resolved, and serum ammonia levels, although elevated, remained within the normal range.

Bone marrow nails created by percutaneous osteoplasty for long bone fracture: comparisons among acrylic cement alone, acrylic-cement-filled bare metallic stent, and acrylic-cement-filled covered metallic stent.

PURPOSE: This study was designed to compare the strength among bone marrow nails created to treat long bone fractures using interventional procedures. METHODS: Twelve resected intact tibiae of healthy swine were used. A circumferential bone fracture was made in nine tibiae and restored with the following created bone marrow nails: acrylic cement alone (ACA) (n=3), acrylic-cement-filled bare metallic stent (AC-FBMS) (n=3), and acrylic-cement-filled covered metallic (AC-FCMS) stent (n=3). The remaining intact tibiae (n=3) were used as controls. RESULTS: A bone marrow nail was successfully achieved within 30 min in all swine. The maximum injection volume of acrylic cement for creating ACA, AC-FBMS, and AC-FCMS was 1.7±0.3, 3.2±0.4, and 2.9±0.4 mL, respectively. The thickness of bone marrow nail created in the ACA, AC-FBMS, and AC-FCMS groups was 3.6±1.0, 10.3±0.26, and 9.6±0.32 mm, respectively (AC-FBMS group versus AC-FCMS group, p=0.038), probably because of leakage of acrylic cement surrounding the interstices. The maximum bending power (kilonewton) and bending strength (newton/mm2) in the normal long bone, ACA, AC-FBMS, and AC-FCMS groups were: 1.70±0.25 and 79.2±16.1; 0.21±0.11 and 8.8±2.8; 0.46±0.06 and 18.2±1.6; and 0.18±0.04 and 7.8±2.7, respectively. CONCLUSIONS: Although the maximum bending power and bending strength of AC-FBMS were not satisfactory, it was the most robust of the three marrow nails for restoring fractured long bone.

Distribution of functional liver volume in hepatocellular carcinoma patients with portal vein tumor thrombus in the 1st branch and main trunk using single photon emission computed tomography-application to radiation therapy.

PURPOSE: To analyze the distribution of functional liver volume (FLV) in the margin volume (MV) surrounding hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) before radiation therapy (RT) and to verify the safety of single photon emission computed tomography-based three-dimensional conformal radiotherapy (SPECT-B3DCRT) by exploring the relation of FLV in MV to radiation-induced liver disease (RILD). METHODS AND MATERIALS: Clinical target volume (CTV) included main tumor and PVTT, and planning target volume (PTV) included CTV with a 10 mm margin. MV was defined as PTV-CTV. FLV ratio in MV was calculated as FLV in MV/MV × 100 (%). The two high-dose beams were planned to irradiate FLV as little as possible. Fifty-seven cases of HCC (26/57, 46%; Child-Pugh grade B) with PVTT underwent SPECT-B3DCRT which targeted the CTV to a total dose of 45 Gy/18 fractions. The destructive ratio was defined as radiation induced dysfunctional volume/FLV × 100 (%). RESULTS: We observed a significant negative correlation between FLV ratio in MV and CTV (p < 0.001). Three cases with CTVs of 287, 587 and 1184 cm3 experienced transient RILD. The FLV ratio in MV was highest in patients with RILD: nine patients with CTV of 200-300 cm3, three with CTV of 500-600 cm3, and two with CTV of 1100-1200 cm3. The destructive ratio yielded a mean value of 24.2 ± 1.5%. CONCLUSIONS: Radiation planning that takes into account the distribution of FLV appears to result in the least possible RILD.

Percutaneous osteoplasty with a bone marrow nail for fractures of long bones: experimental study.

PURPOSE: To develop percutaneous osteoplasty with the use of a bone marrow nail for fixation of long-bone fractures, and to evaluate its feasibility and safety in vivo and in vitro. MATERIALS AND METHODS: Six long bones in three healthy swine were used in the in vivo study. Acrylic cement was injected through an 11-gauge bone biopsy needle and a catheter into a covered metallic stent placed within the long bone, creating a bone marrow nail. In the in vitro study, we determined the bending, tug, and compression strengths of the acrylic cement nails 9 cm long and 8 mm in diameter (N = 10). The bending strength of the artificially fractured bones (N = 6) restored with the bone marrow nail and cement augmentation was then compared with that of normal long bones (N = 6). RESULTS: Percutaneous osteoplasty with a bone marrow nail was successfully achieved within 1 hour for all swine. After osteoplasty, all swine regained the ability to run until they were euthanized. Blood tests and pathologic findings showed no adverse effects. The mean bending, tug, and compression strengths of the nail were 91.4 N/mm(2) (range, 75.0-114.1 N/mm(2)), 20.9 N/mm(2) (range, 6.6-30.4 N/mm(2)), and 103.0 N/mm(2) (range, 96.3-110.0 N/mm(2)), respectively. The bending strength ratio of artificially fractured bones restored with bone marrow nail and cement augmentation to normal long bone was 0.32. CONCLUSIONS: Percutaneous osteoplasty with use of a bone marrow nail and cement augmentation appears to have potential in treating fractures of non-weight-bearing long bones.

Prospective comparison of transcatheter arterial chemoembolization with Lipiodol-epirubicin and Lipiodol-cisplatin for treatment of recurrent hepatocellular carcinoma.

PURPOSE: The aim of this study was to compare the safety and short-term efficacy of transcatheter arterial chemoembolization (TACE) using cisplatin-Lipiodol suspension (CP/Lp) with that using epirubicin-Lipiodol emulsion (EP/Lp) in patients with recurrent hepatocellular carcinoma (HCC). MATERIALS AND METHODS: A total of 28 HCC patients were enrolled prospectively and assigned to the CP/Lp group or EP/Lp group. Adverse effects related to TACE were graded; and the treatment effect (TE) on HCC nodules at 3 months and overall tumor response at 6 months were assessed as the endpoint. RESULTS: No significant difference was observed between the groups regarding the frequency of adverse effects of grade 3 or less. The TE rates for 100% necrosis plus >50% necrosis in 62 HCC nodules in the CP/Lp group and 75 HCC nodules in the EP/Lp group were 72.6% and 66.7%, respectively (P = 0.894). Overall tumor response revealed that six patients (50.0%) in the CP/Lp group and six patients (37.5%) in the EP/Lp group had a partial response plus a complete response, with no significant difference (P = 0.615). TACE-free control curves for both groups revealed no significant difference (P = 0.513). CONCLUSION: No significant difference was found with regard to adverse effects, the treatment effect on HCC nodules, or overall tumor response between the CP/Lp and EP/Lp groups.

Comparison of hemostatic durability between N-butyl cyanoacrylate and gelatin sponge particles in transcatheter arterial embolization for acute arterial hemorrhage in a coagulopathic condition in a swine model.

This study was designed to compare the efficacy of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) or gelatin sponge particles (GSP) for acute arterial bleeding in a coagulopathic condition using a swine model. Four healthy swine were divided into two coagulopathic conditions: mild and severe. Five hemorrhages were created in each swine (10 hemorrhages per coagulopathy). Mild coagulopathy was achieved by bloodletting 10% of the total circulatory whole blood and preserving activated clotting time (ACT) less than 200 s (ACT < 200 s state); severe coagulopathy was achieved by bloodletting 30% and preserving ACT > 400 s (ACT > 400-second state). For each state, of ACT < 200 s or ACT > 400 s, TAE was conducted with GSP or NBCA to control five hemorrhages arising from artificially created renal and splenic injuries. Angiography immediately after TAE with GSP or NBCA showed complete occlusion in both coagulopathic conditions. In the ACT < 200-second state, follow-up angiography at 5-30 min after TAE with GSP or NBCA showed no evidence of recurrent hemorrhage. In the ACT > 400-second state, follow-up angiography showed recurrent hemorrhage in four (80%) of the five hemorrhages embolized with GSP and in one (20%) of the five hemorrhages embolized with NBCA. Microscopically, red thrombi were observed densely surrounding GSP in mild coagulopathy but were scarce in severe coagulopathy. In a condition with severe coagulopathy, TAE with NBCA was more effective in durability to cease active arterial bleeding than with GSP.

A new soluble gelatin sponge for transcatheter hepatic arterial embolization.

To prepare a soluble gelatin sponge (GS) and to explore the GS particles (GSPs) that inhibit development of collateral pathways when transcatheter hepatic arterial embolization is performed. The approval of the Institutional Committee on Research Animal Care of our institution was obtained. By means of 50 and 100 kDa of regenerative medicine-gelatin (RM-G), RM-G sponges were prepared by freeze-drying and heating to temperatures of 110-150°C for cross-linkage. The soluble times of RM-GSPs were measured in vitro. Eight swine for transcatheter hepatic arterial embolization were assigned into two groups: six received 135°C/50RM-GSPs, 125°C/100RM-GSPs, and 138°C/50RM-GSPs, with soluble time of 48 h or more in vitro; two swine received Gelpart GSPs (G-GSPs) with insoluble time of 14 days as a control. Transarterial chemoembolization was performed on two branches of the hepatic artery per swine. RM-GSPs heated at temperatures of 110-138°C were soluble. Mean soluble times of the RM-GSPs increased with higher temperature. Hepatic branches embolized with G-GSP remained occluded after 6 days, and development of collateral pathways was observed after 3 days. Hepatic branches embolized with 135°C/50RM-GSP and 125°C/100RM-GSP remained occluded for 4 h, and recanalization was observed after 1 day. Hepatic branches embolized with 138°C/50RM-GS remained occluded for 1 day, and recanalization was observed after 2 days with no development of collateral pathways. In RM-GSs with various soluble times that were prepared by modulating the heating temperature, 138°C/50RM-GSP was the soluble GSP with the longest occlusion time without inducing development of collateral pathways.

Ischemic effects of transcatheter arterial embolization with N-butyl cyanoacrylate-lipiodol on the colon in a Swine model.

This study was designed to assess the safety of transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate-lipiodol (NBCA-Lp) for the large bowel and to investigate the vital response to NBCA-Lp in a swine model. In nine swine, nine arteries nourishing the colon were embolized with NBCA-Lp (1 ml of NBCA mixed with 4 ml of lipiodol): sigmoid-rectal branch artery in six swine, right colic branch artery in two, and middle colic branch artery in one. The amount of NBCA-Lp was 0.1-0.4 ml. Sacrifice was conducted 3 days after TAE to identify histological infarction. Classification was conducted retrospectively: group A, vasa recta without NBCA-Lp embolization despite TAE; group B, three or fewer vasa recta with NBCA-Lp embolization; and group C, five or more vasa recta with NBCA-Lp embolization. In one swine in group A, no necrotic focus was observed. In group B, three of four swine experienced no ischemic damage. The remaining one swine experienced necrosis of mucosal and submucosal layers in one-fourth of the circumference. In group C, all four swine with marginal artery and five vasa recta or more embolized experienced total necrosis of mucosa, submucosa, and smooth muscle layers of the whole colonic circumference. Significant difference on the extent of ischemic damage was observed between groups B and C (P < 0.05). Microscopically, NBCA-Lp induced acute vasculitis. Embolization of three or fewer vasa recta with NBCA-Lp induced no ischemic damage or limited necrosis, whereas embolization of five or more vasa recta with NBCA-Lp induced extensive necrosis.

Triple-phase computed tomography during arterial portography with bolus tracking for hepatic tumors.

PURPOSE: The purpose of this study was to assess the usefulness of triple-phase computed tomography during arterial portography (CTAP) using a bolus-tracking technique. MATERIAL AND METHODS: The subjects were 60 patients with hepatic tumors: 20 patients with metastatic liver tumors with a normal liver and 40 with hypervascular hepatocellular carcinoma (HCC) with liver cirrhosis. The region of interest was set in the portal vein, and CTAP was automatically started after the triggering threshold (180 HU) was reached. Three scans were performed: early phase (E), hepatic parenchymal phase (HP), and late phase (L). The scan start time of E-CTAP was measured. The detection rates of the HCC nodules were evaluated during each CTAP phase. RESULTS: CTAP was performed by bolus tracking without failure in any of the patients. The mean scan start times in the normal liver group and liver cirrhosis group were 14.3 +/- 1.34 s and 18.5 +/- 2.46 s, respectively, which were significantly different from each other. The detection rates of HCC nodules for E-CTAP, HP-CTAP, and L-CTAP were 29.6%, 100%, and 83.3%, respectively. CONCLUSION: The bolus-tracking technique enabled us to perform CTAP with optimal timing regardless of the portal blood flow dynamics.

Repair of traumatic abdominal aortic pseudoaneurysm using N-butyl-2-cyano-acrylate embolization.

Embolization using N-butyl-2-cyano-acrylate (NBCA) has been highly regarded for treating pseudoaneurysm, arteriovenous malformation, and hemorrhage of the visceral arteries. We report the case of a patient who fell from a cliff and sustained hemorrhagic shock with blunt abdominal aortic rupture and who underwent embolization using NBCA. This treatment achieved immediate hemostasis and stabilization of vital signs. Although the long-term durability of NBCA is unknown, it appears that certain types of acute aortic hemorrhage with narrow-necked pseudoaneurysm can be controlled by embolization using NBCA.