Efficacy and safety of superselective trans-catheter arterial embolization of upper and lower gastrointestinal bleeding using N-butyl-2-cyanoacrylate
Efficacy and safety of superselective trans-catheter arterial embolization of upper and lower gastrointestinal bleeding using N-butyl-2-cyanoacrylate
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DOI：
10.1007/s10140-017-1552-0
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发表时间：
2018-04-01
影响因子：
2.2
通讯作者：
Han, Yoon Hee
中科院分区：
文献类型：
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作者：
Kwon, Jae Hyun;Han, Yoon Hee
目的 评价 N-丁基-2-氰基丙烯酸酯 (NBCA) 超选择性经导管动脉栓塞 (TAE) 对急性非静脉曲张上消化道和下消化道 (GI) 出血患者的疗效和安全性。方法 对 21 例急性非静脉曲张上消化道 (n = 15) 和下消化道 (n = 6) 患者（13 名男性，8 名女性，平均年龄 60.9 岁）进行 TAE。胃肠道出血。使用其他栓塞剂对 25 名患有急性非静脉曲张上消化道出血 (n = 16) 和下消化道出血 (n = 9) 的患者（13 名男性，12 名女性，平均年龄 69.1 岁）进行了 TAE。分析了技术成功、临床成功、临床失败、主要和次要并发症、出血相关的 30 天死亡率和总体院内死亡率。 结果 在 21 例接受 NBCA 的 TAE 患者中，总体技术成功率为 100%（21/21），总体临床成功率为 72.2%（13/18）。失控出血、反复出血和临床失败的比例分别为 11.1% (2/18)、16.7% (3/18) 和 27.8% (5/18)。轻微并发症发生率为16.7%（4/21），无重大并发症发生。 3 名患者所治疗的病灶出现缺血性损伤，1 名患者出现上腹疼痛。出血相关的 30 天死亡率和总体院内死亡率分别为 16.7% (3/18) 和 28.6% (6/21)。 TAE 后 30 天内，两名患者死于感染性休克，一名患者死于心肌梗塞。在 25 名接受其他药物 TAE 的患者中，总体技术成功率为 100% (25/25)，总体临床成功率为 68.2% (15/22)。未控制的出血、复发性出血、临床失败、出血相关的 30 天死亡率和总体院内死亡率分别为 0.5% (1/22)、22.7% (5/22)、31.8% (7/22)、22.7% (5/22) 和 32.0% (8/25)。下消化道出血被证明是一种技术上可行、安全且有效的治疗方式。因此，NBCA 可用作控制胃肠道出血的主要栓塞剂。
Purpose To evaluate the efficacy and safety of superselective trans-catheter arterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA) for patients with acute non-variceal upper and lower gastrointestinal (GI) bleeding.Methods TAE using NBCA was performed in 21 patients (13 males, 8 females, mean age 60.9 years) with acute non-variceal upper (n = 15) and lower (n = 6) GI bleeding. TAE using other embolic agents was performed in 25 patients (13 males, 12 females, mean age 69.1 years) with acute non-variceal upper (n = 16) and lower (n = 9) GI bleeding. Technical success, clinical success, clinical failure, major and minor complications, bleeding-related 30-day mortality, and overall in-hospital mortality were analyzed.Results In 21 patients who underwent TAE with NBCA, the overall technical success was 100% (21/21) and overall clinical success was 72.2% (13/18). Uncontrolled bleeding, recurrent bleeding, and clinical failure were seen in 11.1% (2/18), 16.7% (3/18), and 27.8% (5/18) of cases, respectively. The minor complication rate was 16.7% (4/21) and no major complications occurred. Three patients showed ischemic damage in the treated lesion and one patient showed epigastric pain. The bleeding-related 30-day mortality and overall in-hospital mortality rates were 16.7% (3/18) and 28.6% (6/21), respectively. Two patients died of septic shock and one died of myocardial infarction within 30 days after TAE. In 25 patients who underwent TAE with other agents, the overall technical success was 100% (25/25), and the overall clinical success was 68.2% (15/22). The rates of uncontrolled bleeding, recurrent bleeding, clinical failure, bleeding-related 30-day mortality, and overall in-hospital mortality were 0.5% (1/22), 22.7% (5/22), 31.8% (7/22), 22.7% (5/22), and 32.0% (8/25), respectively.Conclusion TAE with NBCA for acute non-variceal upper and lower GI bleeding proved to be a technically feasible, safe, and effective treatment modality. Thus, NBCA could be used as a primary embolic agent for controlling GI bleeding.