Clinical Applications of Lipiodol® in Vascular Anomalies Embolization
1. Portal vein embolization using a NBCA/ Lipiodol® mixture before right liver resection(1)
Portal vein were embolized with a mixture of Histoacryl/Lipiodol® mean dilution ratio 1:4
LIPIODOL® & NBCA – FOR TREATMENT OF GASTRIC VARICES
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«Placement of a pigtail catheter in the main portal branch after CT-guided puncture of the left portal vein.»Portal vein were embolized with a mixture of Histoacryl/Lipiodol® mean dilution ratio 1:4 LIPIODOL® & NBCA – FOR TREATMENT OF GASTRIC VARICES |
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«Catheterization of a right-sided portal branch via a microcatheter system.»Portal vein were embolized with a mixture of Histoacryl/Lipiodol® mean dilution ratio 1:4 LIPIODOL® & NBCA – FOR TREATMENT OF GASTRIC VARICES |
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«Visualization of the entire embolized area of the right-sided portal branches.»Portal vein were embolized with a mixture of Histoacryl/Lipiodol® mean dilution ratio 1:4 LIPIODOL® & NBCA – FOR TREATMENT OF GASTRIC VARICES |
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«Visualization of the entire embolized area of the right-sided portal branches.»Portal vein were embolized with a mixture of Histoacryl/Lipiodol® mean dilution ratio 1:4 LIPIODOL® & NBCA – FOR TREATMENT OF GASTRIC VARICES |
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«Total occlusion of the right-sided portal venous system 30 days after embolization with Histoacryl/Lipiodol®.»Portal vein were embolized with a mixture of Histoacryl/Lipiodol® mean dilution ratio 1:4 LIPIODOL® & NBCA – FOR TREATMENT OF GASTRIC VARICES |
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«The same patient 9 months after right-sided hemihepatectomy shows a massive hypertrophy of the residual liver.»Portal vein were embolized with a mixture of Histoacryl/Lipiodol® mean dilution ratio 1:4 LIPIODOL® & NBCA – FOR TREATMENT OF GASTRIC VARICES |
2. Cyanoacrylate therapy for the treatment of gastric varices: a new method(2)
Patients with bleeding large gastric varices – Cyanoacrylate/Lipiodol® Dilution ratio 1:1
LIPIODOL® & NBCA – FOR TREATMENT OF GASTRIC VARICES
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«Endoscopic view of fundal varix (gastroesophageal varices type 1) with active bleeding before treated with cyanoacrylate.» |
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«Endoscopic view of gastroesophageal varices 1 after cyanoacrylate therapy, showing stoppage of bleeding.» |
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«Abdominal X-ray examination showing a large amount of Lipiodol®-mixed cyanoacrylate remaining at the site of large fundal varix.» |
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«Computed tomography scan of thorax after Lipiodol®-diluted cyanoacrylate, showing normal pulmonary vessels.» |
3. Clinical efficacy of transcatheter embolization of visceral artery pseudoaneurysms using NBCA(3)
Patient with a pseudoaneurysm in the proximal jejunum NBCA/Lipiodol® dilution ratio 1:3
LIPIODOL® & NBCA – FOR EMBOLIZATION OF PSEUDOANEURYSMS
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«26-year-old male patient with a pseudoaneurysm in the proximal jejunum: superior mesenteric arteriography showed focal contrast media collection in the proximal jejunum, indicating a pseudoaneurysm.» |
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«The microcatheter was advanced within the jejunal branch, and the pseudoaneurysm was confirmed. The 25% glue solution (histoacryl blue with Lipiodol®) was retained and confined within the jejunal branch.» |
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«After embolization, follow-up arteriography through the outer catheter confirmed a completely occluded pseudoaneurysm and preservation of the adjacent vessels.» |
4. Endovascular embolization of a muscular symptomatic arteriovenous malformation (AVM) with NBCA(4)
Patient with muscular symptomatic arteriovenous malformation Glubran 2/Lipiodol® dilution ratio 1:2.5
LIPIODOL® & NBCA – FOR AVM TREATMENT
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«Arteriogram showing the mAVM, which is fed by multiple perforanting branches of the profunda femoris artery.» |
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«Embolization of the feeding branches with Glubran 2 and Lipiodol® after selective catheterization using a microcatheter.» |
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«Post-embolization arteriogram shows the occlusion of all embolized branches with complete devascularization and thrombosis of the nidus.» |
5. Interventional treatment of pulmonary lymphatic anomalies(5)
« […] Percutaneous embolization of these abnormal pulmonary lymphatic vessels has been proven to be successful treatment
of these conditions with minimal complication rate […] »
Patient with neonatal chylothorax – NBCA/Lipiodol® ratio 1:2
LIPIODOL® & NBCA – FOR PULMONARY LYMPHATIC ANOMALIES
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«DCMRL of the patient with neonatal chylothorax, demonstrating abnormal pulmonary lymphatic flow toward lung parenchyma (white arrows).» |
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«Fluoroscopy image of the chest again demonstrating abnormal flow of the Lipiodol® injected through groin lymph nodes toward lung parenchyma (black arrows).»
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6. Infiltrated embolization of meningioma with dilute cyanoacrylate glue(6)
« […] a 13% n-butyl-cyanoacrylate (NBCA)-Lipiodol® mixture is injected extremely slowly from the middle meningeal artery (MMA) […] »
Patient with left convexity meningioma
LIPIODOL® & NBCA – FOR MENINGIOMA EMBOLIZATION
7. Varicocele embolization with N-butyl cyanoacrylate: experience in 41 patients(7)
« […] The mixture with Lipiodol® also modulates the polymerization rate. We have at all times used a Lipiodol®-N2BCA ratio of 1:1 […] »
« Color Doppler US examination. Pre-treatment (A, B) and 12 months post-embolization (C, D). At rest (A, C) and during Valsalva (B, D). Pampiniform plexus color Doppler signal during valsalva (B) that is no longer appreciated after the embolization (D). »
Patients with a diagnosis of varicocele – NBCA/Lipiodol® ratio 1:1
LIPIODOL® & NBCA – FOR VARICOCELE
8. Transcatheter Embolization of a Large Symptomatic Pelvic Arteriovenous Malformation with Glubran 2 Acrylic Glue(8)
« […] The glue needs to be mixed with lipiodol before use to enable its fluoroscopic visualization […] »
Patient with pelvic arteriovenous malformation Glubran 2 acrylic glue / Lipiodol® ratio 1:2.5
LIPIODOL® & GLUBRAN 2 ACRYLIC GLUE – FOR PELVIC ARTORIOVENOUS MALFORMATION
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The preoperative angio-VCT demonstrates a large pAVM involving the urinary bladder and the distal part of the left ureter. |
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The postembolization angio-VCT shows the complete devascularization of the pAVM. |
9. Emergency case – Arterial Embolotherapy for Endoscopically Unmanageable Acute Gastroduodenal Hemorrhage: Predictors of Early Rebleeding(9)
« […] The glue needs to be mixed with lipiodol before use to enable its fluoroscopic visualization […] »
LIPIODOL® & GLUBRAN – FOR CONTROLLING BLEEDING FROM GASTRODUODENAL ULCERS
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Bleeding Dieulafoy lesion in a 76-yearold man. (A and B) Extravasation of contrast medium from the left gastric artery at the celiac trunk (arrows) and selective angiography indicates continuing bleeding. |
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Bleeding Dieulafoy lesion in a 76-yearold man. (A and B) Extravasation of contrast medium from the left gastric artery at the celiac trunk (arrows) and selective angiography indicates continuing bleeding. |
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After arterial microcatheterization, bleeding was controlled after embolization of the left gastric artery using a Glubran/ Lipiodol® (E-Z-EM) mixture (1:3) (arrows). |
10. Emergency case – Postpartum Hemorrhage in Coagulopathic Patients: Preliminary Experience with Uterine Arterial Embolization with N-Butyl Cyanoacrylate(10)
Images of primary PPH caused by uterine atony after caesarean section in a 33-year-old woman.
LIPIODOL® & NBCA – FOR EMERGENT POSTPARTUM HEMORRHAGE
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Right internal iliac arteriogram shows a beaded, dilated ascending branch of the uterine artery (arrow). |
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Delayed-phase right internal iliac arteriogram shows contrast agent extravasation (arrow) in the uterine body. |
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« After embolization, follow-up arteriography through the outer catheter confirmed a completely occluded pseudoaneurysm and preservation of the adjacent vessels. » |
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Right internal iliac arteriogram obtained to confirm treatment outcome 5 minutes after UAE shows a recanalized uterine artery (arrow) and recurrent extravasation (arrowhead) in the uterine body during the delayed phase. |
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Right internal iliac arteriogram obtained immediately after embolization of the ascending branch of the right uterine artery with a 0.5-mL bolus of a 1:1 mixture of NBCA and Lipiodol shows retained Lipiodol® (arrow) and no extravasation. |
References
1.Bellemann N. et al., Portal vein embolization using a Histoacryl / Lipiodol mixture before right liver resection, Dig. Surg., 2012; 29:236-242.
2.Singh V. et al., Cyanoacrylate therapy for the treatment of gastric varices: a new method, Journal of Digestive Diseases, 2016;17: 392–398.
3.Won Y. et al., Clinical efficacy of transcatheter embolization of visceral artery pseudoaneurysms using N-butyl cyanoacrylate (NBCA), Diagnostic and Interventional Imaging, 2015;96: 563–569.
4.San Norberto E.M. et al., Endovascular embolization of a muscular symptomatic arteriovenous malformation with Glubran 2 acrylic glue, Vascular, 2015; 23, 4, 432–435.
5.Maxim Itkin, Interventional Treatment of Pulmonary Lymphatic Anomalies, Techniques in Vascular and Interventional Radiology, 2006;19:299-304.
6.Ohnishi H. et al., Infiltrated Embolization of Meningioma with Dilute Cyanoacrylate Glue, Neurol. Med. Chir. (Tokyo), 2017; 57:44–50.
7.Urbano J. et al., Sclerosis and varicocele embolization with N-butyl cyanoacrylate: experience in 41 patients, Acta Radiol., 2014; 55(2):179-185.
8.Gandini R. et al., Transcatheter Embolization of a Large Symptomatic Pelvic Arteriovenous Malformation with Glubran 2 Acrylic Glue, Cardiovasc. Intervent. Radiol. 2008; 31:1030-1033.
9.Loffroy R. et al., Arterial Embolotherapy for Endoscopically Unmanageable Acute Gastroduodenal Hemorrhage: Predictors of Early Rebleeding, Clin. Gastroenterol. Hepatol, 2009;7:515– 523.
10.Kanematsu M. et al., Postpartum Hemorrhage in Coagulopathic Patients: Preliminary Experience with Uterine Arterial Embolization with N-Butyl Cyanoacrylate, J. Vasc. Interv. Radiol, 2011; 22:1773-1776.