Histoacryl

N. N-butyl-2-cyanoacrylate (Histoacryl) plus sclerotherapy versus sclerotherapy alone in the treatment of bleeding esophageal varices a randomized prospective study. Endoscopy 1995 27 355—357... 

Cyanoacrylate (Histoacryl) is a tissue adhesive used in duraplasty. The sites at which it is used should be carefully chosen. Cyanoacrylates are also in use for embolization of arteriovenous malformations in the brain. The risk of this procedure is the creation of pulmonary emboli after acrylate glue injection, particularly when delivery systems without flow arrest are used in high-flow vascular brain lesions. Techniques using acetic acid to delay polymerization time and sandwich techniques, in which glue is pushed with dextrose, appear to be more likely to cause this complication (1). 

Another tissue adhesive that has been reported is enbucrylate (Histoacryl B. Braun, Tuttlingen, Germany). It can be used when multiple collaterals are seen that are too small to be selectively catheterized [26]. 

The technique of intranidal embolization with Histoacryl requires tremendous experience on the part of the operator, because the injection is fast (from a few seconds to 1-2 min) and clinical consequences or improper gluing are disastrous. 

Prior to injection of glue, the dead space of the catheter and hub must be filled with 5% dextrose solution to avoid polymerization of the glue within the catheter. In some cases, however, this unexplained rapid polymerization may happen. The main reason is probably poor quality control of Histoacryl or Lipiodol. The operator should always push the glue slowly through the microcatheter and follow its progression at the level of its distal tip. If the glue does not exit the tip of the catheter, and even if there is no increased resistance to pressure on the syringe, the operator should never increase the injection pressure. The major risk is catheter rupture and major artery occlusion or embolization of distal normal arteries. 

A 36-year-old man had a pulmonary embolus after percutaneous embolization of a varicocele with enbucrilate (Histoacryl ) -I- lipiodol [26 ]. 

A 77-year-old woman had an injection of a 50/ 50 mixture of enbucrilate (Histoacryl ) and hpiodol for esophageal varices, and immediately developed epigastric pain and fever associated with portal-vein thrombosis [36 ]. 

A 60-year-old man had a gastric varix injected with a 50/50 mixture of enbucrilate (Histoacryl ) and hpiodol and within 1 week developed acute hepatic failure associated with multiple emboli in the portal vein and its branch [38 ]. 

A 62-year-old man had bleeding gastric varices injected with enbucrilate (Histoacryl ) and 4 weeks later developed hepatic impairment associated with cyanoacrylate in the aorta and iliac arteries [39 ]. He then developed a diffuse ascending spondylodiscitis, with osteolysis of the fifth lumbar vertebra, probably as a result of septic emboli and died 10 months later. 

Thijs WJ, de Groot EH, Hofstra LS. Portal and splenic vein occlusion complicating Histoacryl injection therapy in bleeding gastric varices. Endoscopy 2008 40(Suppl 2) E187. 

Prytula A, Veereman-Wauters G, Duval EL. Pulmonary embolism due to injection of Histoacryl and Lipiodol during endoscopic sclerotherapy of fundic varices. Acta Gastroenterol Belg 2008 71(4) 387-9. 

Barclay S, Cameron I, Stewart I, Forrest E. Massive hemorrhage from a pulmonary vein-esophageal ftstula a late complication of Histoacryl glue injection. Gastrointest Endosc 2009 70(5) 1037-8. 

Neumann H, Scheidbach H, Monkemtiller K, Pech M, Malfertheiner P. Multiple cyanoacrylate (Histoacryl) emboli after injection therapy of cardia varices. Gastrointest Endosc 2009 70(5) 1025-6. 

Histoacryl is a biological product that undergoes polymerization on contact with an ionic substance, inducing then a permanent occlusion. Mostly used as a pre-surgical step, it was reported for the treatment of venous malformations of the orbit [38]. Delay in healing up may be due to the extrusion of the Histoacryl when left in place. 

Cyanoacrylate Histoacryl, 0.5 ml vials (B. Braun) Lipiodol Ultrafluide, 10 ml (Guerbet)... 

Fig. 13.3. Liver histopathology of the resected parenchyma 4 weeks after portal embolization with Histoacryl. Portal branch (P) filled with cyanoacrylate (C). Bile duct (B) presenting a massive periductal fibrosis (arrows)...

Gelatin foam / Gelfoam Gelatin sponge / Gelaspon Gelfoam prepared with BCG Histoacryl... 

StSsslein [147] 1988 Detachable balloons Histoacryl Ivalon Combinations 147 100 47... 

The embolizing agents are the same as those used for adults. The gelatin sponge particles (Surgifoam, Ethicon, Johnson Johnson Co., Somerville, New Jersey) are used for a temporary occlusion, and the polyvinyl alcohol particles (Contour, Boston Scientific Corp., Fremont, CA) for a permanent occlusion. Tissue adhesive N-butyl-2-cyanoacry-late (Indermil, Tyco, Norwalk, USA) or enbucrilate (Histoacryl, Braun, Aesculap) opacified with oily contrast media and alcohol can also used in pediatrics. 

Trade Names. Indermil, Loctite Corporation and Histoacryl, B. Braun, Aesculap, B.B.D. (based on cyanacrylic butyl ester) Dertnabond, Closure Medical Corporation, (based on cyanacrylic octyl ester). 

Butyl cyanoacrylate is an intermediate-length CA (Fig. 14.1) adhesive, and was the first product broadly used for closing cutaneous wounds. This compound has been approved for use in Europe and Canada as Histoacryl Blue (trademark of Aesculap, Inc) and GluStitch (trademark of GluStitch Inc.) for nearly 40 years. It was not, however, approved by the US FDA for use in the United States for a long time. In Europe, Canada, and Japan, it has been used for middle ear procedures to close cerebrospinal leaks, to repair incisions and lacerations, and to affix skin since the... 

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