Successful Embolization of Bleeding Ileal Varices with N-butyl Cyanoacrylate via a Recanalized Paraumbilical Vein

Cardiovasc Intervent Radiol. 2018 Aug;41(8):1291-1294. doi: 10.1007/s00270-018-1970-8. Epub 2018 Apr 23.

Abstract

A 48-year-old woman with alcoholic liver cirrhosis was admitted to our hospital because of hematochezia and severe anemia. She had been hospitalized many times over the past year for hematochezia of unknown etiology. Contrast-enhanced CT demonstrated ileal varices, which were fed by several ileal veins. These feeding veins were selectively embolized with N-butyl cyanoacrylate (NBCA) via a recanalized paraumbilical vein. The paraumbilical vein instead of the portal vein was punctured to decrease the risk of bleeding complications because she had coagulopathy and ascites. We consider antegrade embolization of ileal varices with NBCA to be a feasible and effective treatment. Access via a paraumbilical vein is an alternative to the transhepatic approach.Level of Evidence Level V, case report.

Keywords: Ectopic varices; Embolization; N-butyl cyanoacrylate; Paraumbilical vein; Portal hypertension.

Publication types

  • Case Reports

MeSH terms

  • Contrast Media
  • Embolization, Therapeutic / methods*
  • Enbucrilate / therapeutic use*
  • Female
  • Gastrointestinal Hemorrhage / complications
  • Gastrointestinal Hemorrhage / physiopathology
  • Gastrointestinal Hemorrhage / therapy*
  • Humans
  • Ileum / diagnostic imaging
  • Ileum / physiopathology*
  • Liver Cirrhosis, Alcoholic / complications*
  • Middle Aged
  • Radiographic Image Enhancement / methods
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome
  • Umbilical Veins / diagnostic imaging
  • Varicose Veins / complications
  • Varicose Veins / physiopathology
  • Varicose Veins / therapy*

Substances

  • Contrast Media
  • Enbucrilate