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Usefulness of N-butyl cyanoacrylate embolization versus coil embolization for control of massive hemorrhage in patients with pelvic fracture
Zenjiro Sekikawa1, Izumi Torimoto1, Shigeo Takebayashi1, Hiroshi Manaka2, Kyota Nakamura3, Naoto Morimura3
1The Departments of Diagnostic Radiology, Yokohama City University Medical Center.
2The Neurosurgery, Yokohama City University Medical Center.
3The Critical Care and Emergency Center (KN, NM), Yokohama City University Medical Center.

Article ID: 100003R02ZS2016
doi:10.5348/R02-2016-3-OA-1

Address correspondence to:
Izumi Torimoto
PhD, Department of Diagnostic Radiology
Yokohama City University Medical Center, 4-57
Urafune-cho, Minami-ku, Yokohama, 232-0024
Japan

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How to cite this article
Sekikawa Z, Torimoto I, Takebayashi S, Manaka H, Nakamura K, Morimura N. Usefulness of N-butyl cyanoacrylate embolization versus coil embolization for control of massive hemorrhage in patients with pelvic fracture. Edorium J Radiol 2016;2:1–11.


Abstract
Aims: To evaluate the usefulness of N-butyl cyanoacrylate (NBCA) in transarterial embolization (TAE) in patients with pelvic fracture and massive hemorrhage.
Methods: We retrospectively reviewed 91 patients with pelvic fracture and massive hemorrhage requiring a >2 L of blood transfusion and TAE at a single institution from July 2008 to September 2015. The backgrounds and outcomes were compared between the NBCA group, which consisted of 46 patients treated by TEA including NBCA-Lipiodol embolization beginning in 2012, and the remaining 46 patients (non-NBCA group). Statistical analyses were performed to compare various factors among the two groups and to determine factors associated with mortality.
Results: Between the NBCA group and the non-NBCA group, there were no significant differences in the backgrounds, the mean number of embolized arteries (4.22 ± 2.26 versus 4.24 ± 1.75), the mean time required for TAE (73.4 minutes ± 31.0 versus 74.3 minutes ± 29.2), or the mean cost of devices for TAE ($1535.7 ± 809.0 versus $1682.1 ± 914.3). The success rate of hemostasis by TAE and the mortality rate at 2 days or 30 days for the NBCA group and the non-NBCA group were 86.7%, 11.1%, 15.6% and 56.5%, 41.3%, 47.8%, respectively. Transarterial embolization without NBCA was a significant factor associated with 2-day and 30-day mortality.
Conclusion: Transarterial embolization with NBCA could be used in resuscitative strategies for patients with pelvic fracture and massive hemorrhage because it is effective for improving early hemorrhage control and prognosis without increasing the cost of devices for TAE.

Keywords: Cost-effectiveness, Cyanoacrylate, Embolization, Hemorrhage, Pelvis, Trauma


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Author Contributions
Zenjiro Sekikawa – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Izumi Torimoto – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Shigeo Takebayashi – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Hiroshi Manaka – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Kyota Nakamura – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Naoto Morimura – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Zenjiro Sekikawa et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.