Comparison of outcomes with/without preoperative embolization for meningiomas with diluted N-butyl-2-cyanoacrylate.

BACKGROUND: Preoperative embolization for meningiomas is controversial regarding its effectiveness in reducing intraoperative blood loss and operative time. In contrast, some reports have documented improved surgical outcomes in large meningiomas. In this study, we retrospectively compared the outcomes of craniotomy for meningiomas with/without preoperative embolization with diluted N-butyl-2-cyanoacrylate (NBCA) primarily in a single institution. METHODS: Data (World Health Organization grade, Simpson grade, maximum tumor diameter, intraoperative bleeding, operative time, history of hypertension, and time from embolization to craniotomy) of patients with initial intracranial meningiomas were compared with or without preoperative embolization from January 2015 to April 2022. RESULTS: The embolization group consisted of 56 patients and the nonembolization group included 76 patients. Diluted NBCA (13% concentration for all patients) was used in 51 of 56 patients (91.1%) who underwent transarterial embolization. Permanent neurological complications occurred in 2 (3.6%) patients. Intraoperative bleeding was significantly lower in the embolization group for a maximum tumor diameter ≥40 mm (155 vs. 305 ml, respectively, p < 0.01). In the nonembolization group, for a maximum tumor diameter ≥30 mm, patients with hypertension had more intraoperative bleeding than non-hypertensive ones. CONCLUSIONS: Despite its limitations, the present results showed that, under certain conditions, preoperative embolization for intracranial meningiomas caused less intraoperative bleeding. The safety of treatment was comparable with that reported in the Japan Registry of NeuroEndovascular Therapy 3 (JR-NET3) with a complication rate of 3.7% for preoperative embolization of meningiomas, despite the treatment focused on the liquid embolization material.

Transcatheter arterial embolization with N-butyl cyanoacrylate for postoperative hemorrhage treatment following pancreatoduodenectomy.

PURPOSE: Postoperative hemorrhage (PPH) is a severe complication of pancreatoduodenectomy (PD) with a mortality rate of 5-20.2% and mortality due to hemorrhage of 11-58%. Transcatheter arterial embolization (TAE) has been widely recommended for PPH, however, TAE with N-butyl cyanoacrylate (NBCA) for PPH treatment has been reported rarely. Therefore, this study aimed to evaluate the safety and efficacy of TAE with NBCA for PPH treatment following PD. METHODS: This retrospective study included 14 male patients (mean age, 60.93 ± 10.97 years) with postoperative hemorrhage following PD treated with TAE using NBCA as the main embolic agent from October 2019 to February 2022. The clinical data, technical and success rate, and complications were analyzed. RESULTS: Among the 14 patients who underwent TAE, the technical and clinical success rates were 100 and 85.71%, respectively. Angiography revealed contrast extravasation in 12 cases and a pseudoaneurysm in 3 cases. One patient developed a serious infection and died 2 days after the TAE. CONCLUSION: TAE with NBCA for PPH treatment following PD, especially for massive hemorrhage caused by a pancreatic fistula, biliary fistula, or inflammatory corrosion, can result in rapid and effective hemostasis with high safety.

Bronchial artery embolization in patients with life-threatening massive hemoptysis: comparison of the efficacy and safety of particulate embolizing agents and n-2-butyl-cyanoacrylate.

OBJECTIVE: Comparing the efficacy and safety of particulate [microspheres/polyvinyl alcohol (PVA)] and non-particulate [n-butyl-2-cyanoacrylate (NBCA)] agents used as the embolic agents for bronchial artery embolization (BAE) intervention in patients experiencing massive hemoptysis. PATIENTS AND METHODS: A total of 58 individuals (47 male, 11 female, standard deviation = 53.9 ± 14.8, age range = 18-84) were recruited for a retrospective study in a single unit. Thirty (51.7%) of the patients underwent BAE intervention with NBCA, and 28 (48.3%) underwent the same procedure with a particulate embolizing agent (microspheres/PVA). The demographic distribution of the patients, the etiological factors, the technical and clinical success rates, and complications were documented, with the two groups subsequently compared. RESULTS: The technical and clinical success rates following the procedure were 100% for both groups. The average follow-up duration was 34 months in the NBCA group and 33.5 months in the particulate embolizing agent group. In comparison, the rate of recurrent hemoptysis was 3.3% in the former and 17.9% in the latter, with the presence of recurrent hemoptysis not statistically different between the two groups (p = 0.097). Major complications and procedural death did not occur in either of the samples. CONCLUSIONS: The use of NBCA in BAE presents a safe and effective method. The combination of NBCA and particulate embolizing agents (PVA/microspheres) achieved equal technical and clinical success and significantly increased the hemoptysis-free survival rates in terms of life-threatening hemoptysis. MAIN POINTS: (1) In managing massive hemoptysis, using NBCA is a safe and effective method similar to using particulate embolizing agents. (2) Although not statistically significant, recurrent hemoptysis is observed less frequently in the NBCA group. (3) Technique and clinical success were relatively high and similar in the groups where NBCA and particulate embolizing agents were used.

Prostate artery embolization using n-butyl cyanoacrylate glue for symptomatic benign prostatic hyperplasia: A six-month outcome analysis in 103 patients.

PURPOSE: The purpose of this study was to assess the feasibility, safety, and 6-month outcomes of prostate artery embolization (PAE) using N-butyl-cyanoacrylate (NBCA) glue as the only embolic agent in patients with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms. MATERIALS AND METHODS: Patients with BPH-related lower urinary tract symptoms who were treated by PAE using methacryloxysulfolane-NBCA mixed with ethiodized oil (1:8 ratio) between September 2018 and January 2023 were retrospectively included. Vascular mapping was made using cone-beam computed tomography angiography. PAEs were performed as an outpatient procedure, under local anaesthesia. Outcomes were assessed at six months using the International Prostate Symptoms Score (IPSS) and associated quality-of-life score (IPSS-QoL), prostate-specific antigen (PSA) level, prostate volume, and International Index of Erectile Function form 5 (IIEF5). RESULTS: A total of 103 men with a mean age of 68.4 ± 6 (standard deviation [SD]) years were included. Technical success rate was 100%. The mean fluoroscopy time was 26.4 ± 12.5 (SD) min and the median radiation dose was 23 980 mGy·cm (Q1, Q3: 16 770, 38 450). Compared to baseline, statistically significant improvements were observed at six months for the IPSS (8.9 ± 6.2 [SD] vs. 20.2 ± 6.5 [SD]; P = 0.01), IPSS-QoL (2.1 ± 1.4 [SD] vs. 5.1 ± 0.9 [SD]; P = 0.01), PSA level (3.6 ± 3.2 [SD] ng/mL vs. 4.8 ± 4.2 [SD] ng/mL; P = 0.0001), and prostate volume (78.6 ± 43.5 [SD] mL vs. 119.1 ± 65.7 [SD] mL; P = 0.01). Minor adverse events developed in 19/103 (18.4%) patients. No major complications occurred. Compared to baseline, the IIEF5 did not change significantly at six months (15.3 ± 6.8 [SD] vs. 15.8 ± 6.8 [SD]; P = 0.078). CONCLUSION: PAE with NBCA is a feasible and safe method that provides good outcomes at six months in patients with BPH-related lower urinary tract symptoms. This method deserves further evaluation in randomized trials with longer follow-up.

Comparison of endovenous laser ablation and cyanoacrylate embolization in the non-invasive treatment of superficial venous insufficiency in terms of patient satisfaction.

OBJECTIVE: Ablation with n-butyl cyanoacrylate is a clinically newer technique than endovenous laser ablation and other interventional techniques in the treatment of chronic venous insufficiency (CVI). The aim of this study was to compare the endovenous laser ablation (EVLA) and n-butyl cyanoacrylate (NBCA) interventional techniques in terms of benefit, effectiveness, and patient satisfaction. MATERIALS AND METHODS: The study was conducted at Yozgat City Hospital and Bozok University Research Hospital Cardiovascular Surgery clinics between November 2016 and February 2021. A total of 260 symptomatic patients with 130 randomized cases in each intervention group were included. NBCA patients constituted Group 1 and EVLA patients Group 2. The saphenous vein was evaluated by color Doppler ultrasonography (CDUS) of the lower extremity. Patients with saphenous veins over 5.5 mm in diameter and a saphenous-femoral reflux time of 2 s or longer were included in the study. The patients were asked about their satisfaction and symptoms in the first postoperative week during an outpatient clinic follow-up with CDUS investigation at the first and sixth months. RESULTS: Although vena saphenous magna (VSM) closure results were similar with the two methods, satisfaction rates were found to be higher with the NBCA procedure. CONCLUSION: Comparison of the new methods used in the treatment of CVI revealed similar VSM closure rates in the two methods, but the satisfaction rate was higher with the NBCA technique in this study.

A cyanoacrylate/triethyl citrate/nanosilica-based closure glue with wet-adhesion capability for treatment of superficial varicose veins.

Varicose veins in legs are common in clinics. Currently, medical adhesive-based, minimally invasive endovenous occlusion is used to treat them. However, the most common cyanoacrylate medical adhesives do not perform well when used under blood/wet conditions. In particular, poor adhesion, short curing time, and high heat release greatly limit their clinical use. In this paper, we demonstrate the use of a composite system composed of butyl-cyanoacrylate, triethyl citrate, and nanosilica that exhibits a blood/wet-adhesion capability to serve as a new sealing glue. Hydrophobic triethyl citrate groups displace boundary waters while also protecting cyanoacrylate monomers from undergoing rapid polymerization. Nanosilica increases viscosity, which contributes to in situ extrusion molding and retention. An optimal formulation, FAL-006, exhibited good physical and chemical properties in vitro. The performed additional safety assays indicated that FAL-006 has good biocompatibility. The closure efficiency of FAL-006 in vivo was evaluated in both a rat abdominal aortic closure model and in a sheep lower limb venous closure model. Taken together, these results indicate that FAL-006 exhibits promising potential for use in clinical applications. Furthermore, this study provides a new strategy for designing underwater adhesive agents for additional clinical applications, and a strategy for constructing other biomaterials needed for use under wet conditions.

Embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate in patients with hemoptysis: A retrospective single-center study.

OBJECTIVES: To evaluate the safety and efficacy of the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate (NBCA) in patients with hemoptysis. METHODS: We analyzed a total of 55 consecutive patients with hemoptysis (14 mild, 31 moderate, and 10 massive) treated with the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate between November 2013 and January 2020. The main variables analyzed were the rates of technical success, of clinical success, of recurrence, and of complications. Statistics included a descriptive analysis and Kaplan-Meier survival curves. RESULTS: Embolization was a technical success in 55 (100%) and a clinical success in 54 (98.2%). During follow-up (mean, 23.8 months; interquartile range, 9.7-38.2 months), hemoptysis recurred in 5 (9.3%) patients. The nonrecurrence rate was 91.9% one year after the initial procedure and 88.7% two years and four years after the initial procedure. Minor complications related with the procedure occurred in 6 (10.9%); no major complications occurred. CONCLUSIONS: The embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate is safe and efficacious for controlling hemoptysis, resulting in low recurrence rates.

Preoperative n-BCA embolization in the resection of submandibular lymphatic malformations refractory to sclerotherapy treatment: A pilot case series.

OBJECTIVE: Lymphatic malformations in the submandibular neck pose unique challenges to treatment that elevate their risk of recurrence. This case series provides a review of five patients, previously treated with sclerotherapy or with a history of multiple infections, who were treated in a novel fashion: single-stage resection using preoperative n-butyl cyanoacrylate (n-BCA) glue embolization. METHODS: We performed a retrospective medical record review of five patients who underwent single-stage n-BCA embolization by Interventional Radiology followed by surgical resection by Otolaryngology, including a review of their symptoms, previous treatments, and post-treatment surveillance, with follow-up ranging from 4 to 24 months after the treatment of interest. RESULTS: All study subjects had unremarkable perioperative courses, and four patients did not demonstrate any evidence of disease recurrence or persistence during the follow-up period. One patient was found to have a small area of persistent disease on post-treatment imaging, but has remained symptom free. CONCLUSIONS: Treatment of submandibular lymphatic malformations with n-BCA embolization followed by surgical resection can be performed in a single stage. This case series demonstrates that this approach can yield durable relief of symptoms, even in patients whose lesions were refractory to previous treatments.

Endoscopic N-butyl-2-cyanoacrylate and ethanolamine oleate injection is equivalent to balloon-occluded retrograde transvenous obliteration for preventing gastric variceal bleeding.

OBJECTIVES: Endoscopic injection sclerotherapy (EIS) is effective for temporary hemostasis, but EIS and balloon-occluded retrograde transvenous obliteration (BRTO) have been reported as effective for secondary prophylaxis of gastric varices (GV) bleeding. This study retrospectively compared EIS and BRTO in patients with GV in terms of the efficacy for secondary prevention of GV bleeding and effects on liver function. METHODS: From our database of patients with GV who underwent EIS or BRTO between February 2011 and April 2020, a total of 42 patients with GV were retrospectively enrolled. The primary endpoint was the bleeding rate from GV, which was compared between EIS and BRTO groups. Secondary endpoints were liver function after treatment and rebleeding rate from EV, compared between EIS and BRTO groups. Rebleeding rates from GV and EV and liver function after treatment were also compared between EIS-ethanolamine oleate (EO)/histoacryl (HA) and EIS-HA groups. RESULTS: Technical success was achieved for all EIS cases, but two cases were unsuccessful in the BRTO group and underwent additional EIS. No significant differences in bleeding rates or endoscopic findings for GV improvement were seen between EIS and BRTO groups. Liver function also showed no significant difference in the amount of change after treatment between groups. CONCLUSION: EIS therapy appears effective for GV in terms of preventing GV rebleeding and effects on liver function after treatment. EIS appears to represent an effective treatment for GV.

Embolización de arterias bronquiales y arterias sistémicas no bronquiales con n-butil-cianoacrilato en pacientes con hemoptisis: un estudio monocéntrico y retrospectivo / Embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate in patients with hemoptysis: a retrospective single-center study

Objetivos Evaluar la seguridad y la eficacia de la embolización de arterias bronquiales y arterias sistémicas no bronquiales con n-butil-cianoacrilato en pacientes con hemoptisis. Métodos Se han analizado un total de 55 pacientes consecutivos con hemoptisis (14 leves, 31 moderadas y 10 masivas) tratados mediante embolización de arterias bronquiales y arterias sistémicas no bronquiales con n-butil- cianoacrilato entre noviembre de 2013 y enero de 2020. Las variables principales estudiadas son tasa de éxito técnico, tasa de éxito clínico, tasas de recurrencia y complicaciones. Se ha realizado un análisis estadístico descriptivo y un análisis de supervivencia mediante el método de Kaplan-Meier. Resultados En 55 (100%) pacientes se ha realizado la embolización con éxito técnico y en 54 (98,2%), con éxito clínico. Durante el seguimiento (media, 23,8 meses; rango intercuartílico, 9,7-38,2) ha recurrido en 5 de los 54 (9,3%) pacientes. La tasa de no recurrencia al año ha sido del 91,9%, y a los 2 y 4 años, del 88,7% después del procedimiento inicial. Ha habido 6 (10,9%) complicaciones menores relacionadas con el procedimiento y ninguna mayor. Conclusiones La embolización de arterias bronquiales y arterias sistémicas no bronquiales con n-butil-cianoacrilato es segura y eficaz para controlar la hemoptisis con tasas de recurrencia bajas (AU)

Objectives To evaluate the safety and efficacy of the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate (NBCA) in patients with hemoptysis. Methods We analyzed a total of 55 consecutive patients with hemoptysis (14 mild, 31 moderate, and 10 massive) treated with the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate between November 2013 and January 2020. The main variables analyzed were the rates of technical success, of clinical success, of recurrence, and of complications. Statistics included a descriptive analysis and Kaplan-Meier survival curves. Result Embolization was a technical success in 55 (100%) and a clinical success in 54 (98.2%). During follow-up (mean, 23.8 months; interquartile range, 9.7 – 38.2 months), hemoptysis recurred in 5 (9.3%) patients. The nonrecurrence rate was 91.9% one year after the initial procedure and 88.7% two years and four years after the initial procedure. Minor complications related with the procedure occurred in 6 (10.9%); no major complications occurred. Conclusions The embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate is safe and efficacious for controlling hemoptysis, resulting in low recurrence rates (AU)

Liver regeneration after portal vein embolization: comparison between absolute ethanol and N-butyl-cyanoacrylate in an in vivo rat model.

PURPOSE: To compare the effects of absolute ethanol (ethanol) and N-butyl-cyanoacrylate (NBCA) on non-embolized liver lobe regeneration in a rat model. METHODS: Twenty-seven Sprague-Dawley rats underwent portal vein embolization (PVE) using ethanol:lipiodol, 1:1 (ethanol group, n = 11, 40.74%), NBCA:lipiodol, 1:1 (NBCA group, n = 11, 40.74%), or sham treatment (sham group, n = 5, 18.52%). The non-embolized and embolized lobe-to-whole liver weight ratios 14 days after PVE were compared among the groups (n = 5, 18.52%). The expressions of CD68 and Ki-67 and embolized-lobe necrotic area percentages one day after PVE were compared between the ethanol (n = 3, 11.11%) and NBCA (n = 3, 11.11%) groups. RESULTS: The non-embolized lobe-to-whole liver weight ratio after PVE was significantly higher in the NBCA group (n = 5, 33.33%) than in the ethanol group (n = 5, 33.33%) (84.28% ± 1.53% vs. 76.88% ± 4.12%, P = 0.029). The embolized lobe-to-whole liver weight ratio after PVE was significantly lower in the NBCA group than in the ethanol group (15.72% ± 1.53% vs. 23.12% ± 4.12%, P = 0.029). The proportions of CD68- and Ki-67-positive cells in the non-embolized lobe after PVE were significantly higher in the NBCA group (n = 30, 50%) than in the ethanol group (n = 30, 50%) [60 (48-79) vs. 55 (37-70), P = 0.003; 1 (0-2) vs. 1 (0-2), P = 0.004]. The embolized-lobe necrotic area percentage after PVE was significantly larger in the NBCA group (n = 30, 50%) than in the ethanol group (n = 30, 50%) [29.46 (12.56-83.90%) vs. 16.34 (3.22-32.0%), P < 0.001]. CONCLUSION: PVE with NBCA induced a larger necrotic area in the embolized lobe and promoted greater non-embolized liver lobe regeneration compared with PVE with ethanol.

Two Cases of Management of Coronary Artery Perforation During Percutaneous Coronary Intervention Using Injection of Combined Histoacryl (n-Butyl-2-Cyanoacrylate) and Lipiodol (Ethiodized Oil).

BACKGROUND Coronary artery perforation is a rare complication of percutaneous coronary intervention for coronary artery occlusion. This report is of 2 cases of coronary artery perforation during percutaneous coronary intervention that were managed successfully using injection of combined Histoacryl (n-Butyl-2-Cyanoacrylate) and Lipiodol (ethiodized oil). CASE REPORT Case 1 was a 51-year-old man with a past medical history of hypertension, dyslipidemia, and multivessel coronary disease. He was admitted to our hospital with inferior wall myocardial infarction, and a stent was placed in the proximal right coronary artery. He also had chronic total occlusion (CTO) of the left anterior descending artery (LAD). The planned LAD CTO intervention was complicated by balloon-induced coronary perforation and was managed successfully with intracoronary injection of Histoacryl-Lipiodol mixtures via microcatheter. He was discharged in stable condition without any serious consequences. Case 2 was a 72-year-old man with underlying hypertension who was admitted to the hospital with diagnosis of unstable angina. The diagnostic angiography showed occlusion of the LAD, CTO of the left circumflex artery, and minor atherosclerosis in right coronary artery. A stent was placed in the mid-LAD without any complications. Subsequently, a planned left circumflex artery CTO intervention was complicated by wire-induced coronary perforation, which was treated successfully with injection of Histoacryl-Lipiodol mixture. The patient was discharged in good condition. CONCLUSIONS Histoacryl and Lipiodol injection was a rapid and effective management method in 2 rare cases of coronary artery perforation during percutaneous coronary intervention.

Feasibility of gel-like radiopaque embolic material using gelatin sponge and contrast agent for tract embolization after percutaneous treatment.

OBJECTIVES: Tract embolization has been performed to prevent bleeding after trans-organ puncture. This study evaluated clinical outcomes of tract embolization using a gel-like radiopaque material comprising two sheets of gelatin sponge and 3 mL of contrast agent, and experimentally confirmed its viscosity and hemostatic efficacy. METHODS: Three study phases were planned. In a clinical setting, 57 consecutive patients who underwent tract embolization after transhepatic puncture were retrospectively analyzed. Clinical success was evaluated as absence of bleeding complications for 30 days after the procedure. In a basic experiment, viscosity of the material was analyzed. In an animal experiment, rabbit kidney puncture site was embolized via a 7-Fr sheath using this material, coils, or N-butyl-2-cyanoacrylate glue or received no embolization while removing the sheath. Amounts of tract bleeding were measured for 1 min and compared between groups. RESULTS: Embolization was successfully completed in all clinical cases. No postoperative bleeding requiring intervention was encountered. The basic experiment revealed the material was highly viscous. In the animal experiment, mean weights of bleeding in the control, gel-like embolic material, coil, and N-butyl-2-cyanoacrylate glue groups were 1.04±0.32 g, 0.080±0.056 g, 0.20±0.17 g and 0.11±0.10 g, respectively. No significant differences were seen among embolization groups, while the control group showed significantly more bleeding than any embolization group. CONCLUSION: Tract embolization with this gel-like radiopaque embolic material appears safe and feasible. ADVANCES IN KNOWLEDGE: Tract embolization using this embolic material with two sheets of gelatin sponge and 3 mL of contrast agent offers a safe, feasible, and economical procedure after trans-organ puncture, because the material offers the following characteristics: visibility under X-ray; viscosity facilitating retention in the tract; ability to allow repeated puncture via the same route; and low cost.

[Treatment of orbital vascular malformations with intralesional bleomycin injection and N-butyl-2-cyanoacrylate glue embolization].

Objective: To evaluate the clinical efficacy of bleomycin lavage combined with N-butyl-2-cyanoacrylate glue embolization and resection in the treatment of orbital vascular malformations. Methods: It was a retrospective case series study. Patients with orbital vascular malformations diagnosed at the Ophthalmology Division of Chinese PLA General Hospital from January 2018 to October 2021 were included and divided into exophthalmos group and non-exophthalmos group based on whether the patients had postural exophthalmos. Intralesional bleomycin injection and N-butyl-2-cyanoacrylate glue embolization were performed. The preoperative and postoperative visual acuity, the dosages of bleomycin and isobutyl cyanoacrylate glue, pathological results, imaging findings and remission rate were recorded and analyzed. The Chi-square test, Wilcoxon signed rank analysis and Mann-Whitney U test were used for statistical analysis. Results: A total of 58 patients (58 eyes)were included, and there were 22 males (37.9%)　and 36 females (62.1%). Nineteen (32.8%) patients had postural exophthalmos, and 39 (67.2%) patients did not suffer postural exophthalmos. The patient's age of the two groups was 39.0 (28.0, 54.5) years vs. 14.0 (5.7, 26.5) years, with a statistically significant difference (Z=-3.96, P<0.001). There was no significant difference in gender, eye laterality, follow-up time and the disease course between the two groups (all P>0.05). During the operation, the dosage of bleomycin was 15 000 (13 500, 15 000) U in the exophthalmos group, and 15 000 (9 000, 16 500) U in the non-exophthalmos group (Z=-0.70, P=0.944). The dosages of N-butyl-2-cyanoacrylate glue were 2.8 (1.0, 3.0) ml and 1.7 (1.0, 2.2) ml, respectively, in the two groups, with no significant difference (Z=-1.11, P=0.268). There was no visual impairment in both groups, while the visual acuity in 5 patients without postural exophthalmos was improved postoperatively. The imaging examination results showed no difference in the malformed vascular area before and after the treatment in the exophthalmos group [384.0 (329.0, 458.0) mm2 vs. 330.5 (271.6, 356.7) mm2; Z=-1.26, P=0.208], but a significantly decreased area after the treatment in the non-exophthalmos group [960.8 (822.1, 1058.3) mm2 vs. 311.6 (164.6, 361.6) mm2; Z=-2.67, P=0.008]. All patients had no obvious local or systemic adverse reactions during the follow-up. The pathology reports showed vascular malformations in all 15 specimens obtained from the exophthalmos group, as well as vascular malformations in 41.0% (16/39) of specimens and venous lymphatic malformations in 59.0% (23/39) of specimens from the non-exophthalmos group. Thirty-nine patients had complete remission (67.2%), 19 patients had partial remission (32.8%), and the effective treatment rate was 100%. Conclusion: Bleomycin lavage combined with N-butyl-2-cyanoacrylate glue embolization can achieve good therapeutic effects on orbital vascular malformations.

Comparison of Polyvinyl Alcohol Versus Combination of Lipiodol-Bleomycin Emulsion and NBCA-Lipiodol Emulsion for Renal Angiomyolipoma Embolization: A Prospective Randomized Study.

BACKGROUND. Consensus is lacking regarding optimal embolic agents for transcatheter arterial embolization (TAE) of renal angiomyolipomas (AMLs). OBJECTIVE. The purpose of our study was to compare the safety and efficacy of TAE with polyvinyl alcohol (PVA) and TAE with a combination of ethiodized oil (Lipiodol)-bleomycin emulsion and N-butyl cyanoacrylate (NBCA)-Lipiodol emulsion for the treatment of patients with large or symptomatic AMLs. METHODS. This prospective study enrolled patients referred for TAE of a large (> 4 cm) or symptomatic renal AML from July 2007 to December 2018. Patients were randomized to undergo TAE using PVA particles or a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion. Patients underwent serial clinical follow-up visits and follow-up CT or MRI examinations after TAE. Outcomes were compared between groups. RESULTS. Seventy-eight patients were enrolled. After exclusions, the analysis included 72 patients (15 men, 57 women; mean age, 35.0 years; 51 patients with hematuria, 66 patients with flank pain): 35 patients were randomized to treatment by PVA and 37 were randomized to treatment by a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion. Complete occlusion of all angiographically visible arterial supply was achieved in all patients. No major adverse event occurred in any patient. The mean follow-up after TAE was 77 ± 45 (SD) months (range, 37-180 months). The frequency of resolution of hematuria after initial TAE without recurrence was greater after treatment by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (100.0% vs 80.0%, respectively; p = .03). At 12-month follow-up, the frequency of complete resolution of flank pain was higher after treatment by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (100.0% vs 75.0%, p = .03). Mean reduction in AML volume at 36 months or longer after TAE versus at baseline was greater in patients treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than in those treated by PVA (98.0% vs 85.7%, respectively; p = .04). The frequency of complete response by modified RECIST (mRECIST) criteria at 36 months or longer after TAE was greater in patients treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (94.6% vs 74.3%, p = .04). The rate of repeat TAE was higher among patients treated by PVA than among those treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion (25.7% vs 8.1%, p = .04). CONCLUSION. Superior outcomes after TAE of AML were achieved using Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than using PVA. CLINICAL IMPACT. TAE using a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion is a safe and effective treatment option for large or symptomatic AMLs. TRIAL REGISTRATION. Chinese Clinical Trial Registry ChiCTR2100053296.

Migration of lipiodol into lateral ventricles after embolization of cerebral arteriovenous malformation: a case report.

N-butyl cyanoacrylate (NBCA) has been used to embolise brain arteriovenous malformations (AVMs) for over 30 years. It is a mixed with lipiodol in varying proportions. We report a 22-year-old male with intraventricular hemorrhage from a ruptured intranidal AVM aneurysm in the left temporal lobe. The intranidal aneurysm and the nidus were successfully embolized using a 20% NBCA and lipiodol mixture without any complications according to computed tomography (CT) immediately after treatment. Scattered high-density spots were observed in both lateral ventricles on CT 5 days after embolization, suggesting migration of lipiodol. We speculated that the aneurysm was a pseudoaneurysm whose wall protruded into the inferior horn of the left lateral ventricle, and the lipiodol in the NBCA migrated into the ventricles after the thin part of the wall ruptured. The patient developed pyrexia due to chemical meningitis, which responded to steroid treatment for one month.