Glue. Lessons Learned. GEST 2016 Session IX Masterclass & Materials: Liquid Material. Yasuaki Arai, M.D. FSIR National Cancer Center, Japan
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1 GEST 2016 Session IX Masterclass & Materials: Liquid Material Lessons Learned Glue Yasuaki Arai, M.D. FSIR, Japan
2 Yasuaki Arai, M.D. Speakers Bureau: Toshiba Medical Systems Intellectual Property/Patents: Sumitomo Bakelite, Co., Ltd.
3 Acrylic glue Specific properties Specific indications Tips and tricks
4 Cyanoacrylates Ethyl cyanoacrylate Liquid glue CH 2 = C CH 2 = C CN COOCH 2 - CH Isobutyl-2-cyanoacrylate (IBCA) Polymerize contacting with ionic substances CN such as bio-tissue, CH 2 = C blood, saline, COOCH 2 - CH CH 3 etc. CH 3 Not N-butyl-2-cyanoacrylate polymerize mixing (NBCA) with non-ionic agents such as Lipiodol. CN COOCH 2 CH 2 CH 2 CH 3
5 Polymerization time (sec) NBCA-Lipiodol mixture - Correlation between concentration and polymerization time - NBCA is used as mixture with Lipiodol to visualize under X-ray images and to control polymerization time. (Ishiguchi T, 2013) Concentration of NBCA (vol%)
6 Control of depth by dilution rate High Low concentration (10-20%) (40-50%) (NBCA/NBCA+Lipiodol)
7 The specific properties of acrylic glue 1. Liquid embolic material 2. Changes to solid by polymerization contacting with ionic substances. 3. The depth of embolization can be controlled by dilution rate with lipiodol. (polymerization time and viscosity) 4. Able to embolize in case of coagulopathy.
8 Acrylic glue Specific properties Specific indications Tips and tricks
9 Unable to insert M.C. into deeper portion 30 50% Glue
10 Embolization of p-aneurysm of rgepa
11 Embolization of p-aneurysm of rgepa 33% Glue
12 Too far to the target point 10 15% Glue
13 Bleeding from gastrostomy tract 15% Glue
14 Bleeding from gastrostomy tract
15 Artery with many branches and communications
16 Embolization of rt-ipa 10% Glue
17 With unstable catheter (High risk of kick-back)
18 Embolization of BA with unstable cath.
19 Embolization of BA with unstable cath. 15% Glue
20 Embolization in coagulopathy - Hepatic hilar cancer - Rt-3 - Shock segmentectomy vital and with almost biliary DIC reconstruction - Massive - Quick hemorrhage procedure at 10th must POD be needed.
21 Embolization in coagulopathy Glue (40%NBCA) 3mm/2cm coil x 4
22 The specific indication of acrylic glue 1. M.C. cannot reach the adequate point. 2. Vessels with too many branches and communications. 3. Unstable catheter position for coiling. 4. Coagulopathy.
23 Acrylic glue Specific properties Specific indications Tips and tricks
24 Key issues for handling 1) Make it just before use. Use new syringes and needles. 2) Use microcatheter. 3) Wash out all contrast before Glue injection 4) Immediately remove catheter after injection
25 Control of embolizing area Using protection coils
26 Pre-operative embolization
27 Pre-operative embolization
28 Pre-operative embolization 10% Glue
29 Pre-operative embolization 10% Glue injection with protection coils
30 Pre-operative embolization
31 Injection during pulling-back catheter
32 Injection during pulling-back catheter Embolization of IPA (10%Glue)
33 Re-use of M.C.
34 Re-use of M.C. Possible to re-use a MC by washing with Lipiodol and dextrose. (if carefully used)
35 My experienced trouble shooting
36 My experienced trouble shooting
37 Acrylic glue Acrylic glue is the most powerful Specific properties embolic material, if we understand its specific Specific indications properties and proficient its handling. Tips and tricks Thank you!
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