Background and Study Aims: Though many gastric varices are treated endoscopically with n-butyl-2-cyanoacrylate, its behavior in varices is not known precisely.
Materials and Methods: We created a varix model. A volume of 0.7 ml or 1.4 ml of 71.4 % n-butyl-2-cyanoacrylate, a tissue adhesive, was injected into vinyl tubes of 0.4, 0.6, 0.9, and 1.2 cm in diameter, which were filled with still blood or flowing blood. The tissue adhesive was also injected into the inferior vena cava or femoral vein of dogs.
Results: N-butyl-2-cyanoacrylate was similarly polymerized in the vinyl tubes and the animal veins. A volume of 0.7 ml of the tissue adhesive could block all tubes up to 0.6 cm in diameter. A double quantity of the tissue adhesive could block tubes 0.9 and 1.2 cm in diameter, with flow velocities up to 10 cm/s and up to 5 cm/s, respectively. Some polymer masses were fragmented.
Conclusions: One rapid shot of the tissue adhesive can block a vessel 0.6 cm or less in diameter with fast flow velocity, and a vessel up to 1.2 cm in diameter with slow flow velocity. Fast blood flows in a larger diameter vessel and slow injection of the tissue adhesive may result in fragmentation. This model of the varix was useful for assessing the effect of tissue adhesive used to treat gastric varices.
References
-
1
Soehendra N, Grimm H, Nam V C, Berger B.
N-butyl-2-cyanoacrylate: a supplement to endoscopic sclerotherapy.
Endoscopy.
1987;
19
221-224
-
2
D’Imperio N, Piemontese A, Baroncini D, et al.
Evaluation of undiluted n-butyl-2-cyanoacrylate in the endoscopic treatment of upper gastrointestinal tract varices.
Endoscopy.
1996;
28
239-243
-
3
Huang Y H, Yeh H Z, Chen G H, et al.
Endoscopic treatment of bleeding gastric varices by n-butyl-2-cyanoacrylate (Histoacryl) injection: long-term efficacy and safety.
Gastrointest Endosc.
2000;
52
160-167
-
4
Hujiki K, Ohkusa T, Tamura Y, et al.
Evaluation of the effects of esophageal varicosclerosants on local vascular occlusion and systemic blood coagulation.
Gastrointest Endosc.
1995;
41
212-217
-
5
Brothers M F, Kaufmann J CE, Fox A J, Deveikis J P.
N-butyl-2-cyanoacrylate - substitute for IBCA in interventional neuroradiology: histopathologic and polymerization time studies.
AJNR.
1989;
10
777-786
-
6
Ishii H, Matsutani S, Mizumoto H, et al.
Portal hemodynamics in patients with fundic gastric varices: analysis of percutaneous transhepatic portography and Doppler ultrasonography. (In Japanese with English abstract).
Acta Hepatol Jpn.
1994;
35
645-651
-
7
Ohnishi K, Nakata H, Terabayashi H, et al.
The effects of endoscopic sclerotherapy combined with transhepatic variceal obliteration on portal hemodynamics.
Am J Gastroenterol.
1987;
82
1138-1142
-
8
lwase H, Suga S, Morise K, et al.
Color Doppler endoscopic ultrasonography for the evaluation of gastric varices and endoscopic obliteration with cyanoacrylate glue.
Gastrointest Endosc.
1995;
41
150-154
-
9
Obara K, Irisawa A, Kojima T, et al.
Endoscopic injection sclerotherapy for isolated gastric varices - a newly developed technique using alpha cyanoacrylate monomer and evaluation of its therapeutic effects. (In Japanese with English abstract).
Endosc Dig.
1995;
7
43-53
T. Suga, M.D.
Second Dept. of Internal Medicine · Shinsu University School of Medicine
3-1-1 Asahi · Matsumoto-shi · Nagano, 390-8621 · Japan
Fax: + 81-263-329412
Email: cqj04573@nifty.ne.jp
