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Abstract Background Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established therapeutic option for the management of variceal hemorrhage in patients with cirrhosis. The simultaneous migration of the coil and n-butyl-2-cyanoacrylate (NBCA) is an extremely rare but significant complication after TIPS. Because of its rare presentation, there are currently no definitive recommendations for the management of this condition. Case presentation A 46-year-old man with hepatitis B cirrhosis underwent TIPS placement for uncontrolled gastroesophageal varix (GEV) bleeding secondary to portal hypertension in August 2018. During the procedure, large GEVs were embolized using a coil and NBCA. After a year, coil and NBCA migration into the stomach was observed. Attempts to remove the coil using biopsy forceps during esophagogastroduodenoscopy failed. The patient refused further intervention on the coil to prevent further complications and received conservative therapy instead. Close surveillance with endoscopy is recommended for detecting coils and varices. Conclusions The present case reports an extremely rare but significant complication after TIPS, which highlights the management and follow-up recommendation for such rare complications. Our experience may provide guidance for the management of future similar cases and stimulate discussion about treatment methods of similar patients.

Abstract An 84‐year‐old man underwent right basal segmentectomy for primary lung cancer and developed empyema accompanied by a bronchopleural fistula (BPF). Emergency open‐window thoracotomy was performed. Although the general and nutritional conditions improved, the fistula did not close naturally, and we planned to close it 6 months after surgery. In this report, we describe, for the first time, a novel method for closing BPF using an endobronchial Watanabe spigot (EWS), polyglycolic acid (PGA) sheet and N‐butyl‐2‐cyanoacrylate (NBCA). We named this method the“sandwich method.”

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established therapeutic option for the management of variceal hemorrhage in patients with cirrhosis. The simultaneous migration of the coil and n-butyl-2-cyanoacrylate (NBCA) is an extremely rare but significant complication after TIPS. Because of its rare presentation, there are currently no definitive recommendations for the management of this condition. Case presentation: A 46-year-old man with hepatitis B cirrhosis underwent TIPS placement for uncontrolled gastroesophageal varix (GEV) bleeding secondary to portal hypertension in August 2018. During the procedure, large GEVs were embolized using a coil and NBCA. After a year, coil and NBCA migration into the stomach was observed. Attempts to remove the coil using biopsy forceps during esophagogastroduodenoscopy failed. The patient refused further intervention on the coil to prevent further complications and received conservative therapy instead. Close surveillance with endoscopy is recommended for detecting coils and varices. Conclusions: The present case reports an extremely rare but significant complication after TIPS, which highlights the management and follow-up recommendation for such rare complications. Our experience may provide guidance for the management of future similar cases and stimulate discussion about treatment methods of similar patients. [ABSTRACT FROM AUTHOR]

An 84‐year‐old man underwent right basal segmentectomy for primary lung cancer and developed empyema accompanied by a bronchopleural fistula (BPF). Emergency open‐window thoracotomy was performed. Although the general and nutritional conditions improved, the fistula did not close naturally, and we planned to close it 6 months after surgery. In this report, we describe, for the first time, a novel method for closing BPF using an endobronchial Watanabe spigot (EWS), polyglycolic acid (PGA) sheet and N‐butyl‐2‐cyanoacrylate (NBCA). We named this method the"sandwich method." [ABSTRACT FROM AUTHOR]

Transcatheter arterial embolization (TAE) has long been reported to be safe, effective, and to have a high clinical and technical success rate for vulvovaginal hematoma. We used a permanent embolic material, diluted N-butyl-2-cyanoacrylate (NBCA), for the first choice intervention for six cases of vulvovaginal hematoma, in order to confirm the effectiveness of NBCA. Regarding post-embolization adverse events, we did not observe any fever nor necrosis or pain in the vaginal wall or vulva, in all cases. The use of NBCA as a first-line treatment for TAE of vulvovaginal hematoma is considered to be effective, in the following two ways: First, hemostasis can be achieved by adjusting the mixing ratio of NBCA and lipiodol, according to the distance between the tip of the catheter and the site of injury. Second, NBCA does not cause complications such as pain, necrosis, or infection, and it can be used safely. There are no reports clearly recommending NBCA as the first choice in the treatment of TAE for vulvovaginal hematoma. This is the first report to examine the efficacy and safety of NBCA as the first-line intervention for such cases. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID‐19) causes pneumothorax or mediastinal emphysema in approximately 1% of patients. According to the British Thoracic Society guidelines, the next treatment option for patients with persistent pneumothorax despite chest drainage is pleurodesis or surgery. In fact, there are reports of autologous blood pleurodesis or surgery for the treatment of pneumothorax caused by COVID‐19. However, elderly patients or patients in poor general condition may not be able to tolerate surgical invasion. In this report, we present two patients who did not respond to chest drainage or pleurodesis and who were not suitable for surgery because of their poor general condition. These patients were successfully treated with an endobronchial Watanabe spigot and N‐butyl‐2‐cyanoacrylate. This method may be an option for the treatment of refractory pneumothorax in COVID‐19. [ABSTRACT FROM AUTHOR]

A 64-year-old man was scheduled to undergo endovascular aneurysm repair for an abdominal aortic aneurysm (AAA). Since preoperative computed tomography showed an AAA with common iliac artery and internal iliac artery (IIA) aneurysms, IIA embolization was scheduled. Embolization using a coil was supposed to be performed; however, the lateral sacral artery could not be selected. For this reason, IIA embolization using N-butyl-2-cyanoacrylate (NBCA) was undertaken. During embolization, the median sacral artery was unexpectedly embolized through the lateral sacral artery. The patient complained of drop foot just after embolization; he was diagnosed with iatrogenic common peroneal nerve palsy. We have learned that sciatic nerve palsy can occur in cases of embolization with a liquid NBCA-Lipiodol mixture to the lateral or sacral median artery. [ABSTRACT FROM AUTHOR]

Background: Surgical therapy for symptomatic polycystic liver disease (PLD) is effective but has substantial mortality and morbidity. Minimally invasive options such as laparoscopic fenestration, percutaneous cyst aspiration with or without injection of a sclerosing solution have had disappointing results. Because the hepatic cysts in autosomal dominant polycystic kidney disease (ADPKD) patients are mostly supplied from hepatic arteries but not from portal veins, therefore, transcatheter arterial embolization (TAE) of the hepatic artery branches that supply major hepatic cysts can lead to shrinkage of the cyst and liver size. Aim: The purpose of this study was to evaluate the safety and effectiveness of TAE using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil for massive PLD in ADPKD patients. Methods: From February 2007 to March 2011, a total of 21 patients with symptomatic PLD underwent super-selective hepatic TAE with the mixture of NBCA and iodized oil. The patients consisted of 17 women and 4 men (age range 36-64 years, average age 48.8 years). All patients underwent contrast-enhanced computed tomography (CT) of the liver before TAE, and at every 3 months for the first year after TAE and at 6-monthly intervals thereafter. Laboratory data, including routine blood tests and liver enzymes, were collected before and 1, 3, 7, and 14 days, 1, 3, 6, and 12 months after TAE. Results: Technical success was achieved in all cases. No serious complications were experienced. The mean follow-up period was 34 ± 20 months (range 12-60 months). At follow-up of 6-12 months, symptoms notably improved in 18 (85.7%) of 21 patients, and these patients experienced further relief of the symptoms during the follow-up period. TAE failed to benefit in 3 patients (14.3%). No patient complained of worsening of the symptoms after the procedure. At follow-up CT, the total liver volume and total intra-hepatic cyst volume decreased significantly ( p < 0.001) compared with pre-TAE in 18 (85.7%) of 21 patients at 12 months after TAE. The total liver volume decreased from 8270 ± 3016 to 6120 ± 2680 cm and the total intra-hepatic cyst volume decreased from 7120 ± 3070 to 4530 ± 2600 cm. Mild elevation of the liver enzymes was shown in patients at 1-14 days after TAE but returned to the normal range within 1 month. Conclusion: The mixture of NBCA and iodized oil is an acceptable embolic agent for embolization of the hepatic artery branches that supply the hepatic cysts in ADPKD patients. This technique is an option for patient with highly symptomatic PLD who are not candidates for surgical treatment. [ABSTRACT FROM AUTHOR]

Bronchopleural fistula (BPF) is a severe complication following lung resection. We present the case of a patient with a history of advanced lung cancer, who had undergone induction chemoradiotherapy followed by right middle and lower lobectomy, and who developed BPF after completion right pneumonectomy. Although we had covered the bronchial stump with an omental pedicled flap, BPF was found on postoperative day 19. We covered the fistula with n-butyl-2-cyanoacrylate (NBCA) using bronchoscopy. Although we had to repeat the NBCA treatment, we ultimately cured the patient's BPF and no recurrence was observed up to 15.2 months after surgery., Competing Interests: No potential conflict of interest relevant to this article was reported.

The middle meningeal artery (MMA) is suggested to play an important role in the recurrence of chronic subdural hematomas (CSDHs). However, the exact mechanisms involved in the recurrence of CSDHs still remain unknown. For recurring CSDHs, MMA embolization is performed using low-concentration n -butyl-2-cyanoacrylate (NBCA) at our hospital. We report new findings and a discussion related to the mechanism of CSDH recurrence based on the imaging findings after MMA embolization, and cases that required craniotomy due to recurrence. The study included eight patients with recurrent CSDH, defined as ipsilateral hematoma re-enlargement within 3 months, and treated with MMA embolization. MMA embolization was performed successfully in all eight patients with no complications. Of the eight patients treated, one patient required craniotomy for the evacuation of CSDHs due to hematoma re-enlargement. NBCA casts were observed in the inner membrane of CSDHs in five of the eight patients by postoperative computed tomography scans. In the case that required craniotomy, the formation of neovasculatures was observed in the inner membrane of the CSDH. Our results suggested that angiogenesis also occurs in the septum and inner membrane through the MMA and the outer membrane of the CSDH. Additionally, these neovascular vessels may be involved in the recurrence of CSDH after MMA embolization. In a future larger study, it is necessary to elucidate in detail the vascular architecture of the CSDH membrane associated with the hematoma re-enlargement, and the effectiveness of MMA embolization that embolized to these peripheral neovascular vessels., Competing Interests: Conflicts of Interest Disclosure All authors have no conflicts of interest to disclose., (© 2019 The Japan Neurosurgical Society.)