ARTERIAL EMBOLIZATION

GLUBRAN

Introduction

Last updated: may 11, 2025

Liquid embolic agents are injected and guided to vascular malformations via catheters under X-ray imaging. Once delivered, they solidify in place through mechanisms like polymerization, precipitation, or cross-linking triggered by ionic or thermal changes. Their properties—such as viscosity and solidification time—are critical to successful delivery through narrow, long catheters and effective vessel occlusion. Visibility during injection is essential for safety and is enhanced by radiopaque additives or solvents.

 

Presentation

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Indications

  • Buttock AVM
  • Uterine AVM
  • Cardiac hyperflow related dyspnea
  • Endoleak type II
  • False aneurysm
  • Kidney false aneurysm
  • Angiomyolipoma
  • Pre-op in hypervascular processes
  • Pseudoaneurysm
  • Humeral bone metastasis
  • Tibial bone metastasis
  • Gastrointestinal bleeding
  • Prostatic embolization
  • Varicocele
  • Pelvic Congestion Syndrome (PCS)
  • Portal vein
  • False aneurysm at the common femoral artery
  • Non-vascular
    • Needle track
    • Enterocutaneous leaks
    • Biliary tract

 

Pre procedural

 

Materials

Essentials

  • 6F sheath
  • Stiff Terumo
  • 0.018" catheter (Progreat)
  • Glubran
  • Lipiodol
  • Glucose 5% or 10%
  • Metal bowl for mixture
  • Standard polyester Luer Lock-syringes (BD)
    • NOT polycarbonate which reacts with Glubran

Non-Essentials

 

Positioning the patient

  • Depending on the procedure

 

The procedure in steps

Preparation Steps

  • Adjust the Glubran® 2 to Ethiodized Oil ratio based on the target's distance—more distal targets require slower polymerization (higher oil content)
  • Use two separate syringes to combine the glue and oil through the stopcock
  • Mix slowly in 4–5 incremental steps to prevent premature polymerization
  • Monitor the mixture’s color—whitening indicates early polymerization, which should be avoided
  • Depending on the dilution, use a catheter or needle gauge compatible with the viscosity of the final mixture
Administration
  • Place a microcatheter inside a standard 4–5 French catheter to improve maneuverability and provide additional safety during the procedure
  • Ensure a stable secure position
  • Make a detailed angiography
  • Flush the catheter system with a 5% dextrose solution to prepare for embolic agent delivery
  • Take a 5 ml syringe of dextrose solution and flush the dead space first, then
  • Take another 5 ml syringe filled with the Glubran® 2 - Ethiodized Oil mixture
  • Start injecting slowly and continuously. Looking at the tip of the microcatheter, you will eventually see the mixture going distally, followed by a moment of stasis
  • Your endpoint will be marked by some reflux
  • Remove the microcatheter with your right hand by the 5 ml syringe itself

 

Tips and tricks

Select Appropriate Equipment

  • Use a 5 ml Luer-Lock syringe and a plastic 3-way stopcock
  • Avoid polycarbonate materials, as Ethiodized Oil can degrade them
Ensure Secure Setup
  • The Luer-Lock system ensures a tight syringe connection and also allows easy catheter removal by pulling back on the syringe
Choose the Correct Gauge
  • Depending on the dilution, use a catheter or needle gauge compatible with the viscosity of the final mixture
Assess Microcatheter Reusability
  • In many cases, the microcatheter must be discarded after use due to adhesion of embolic material. For simpler procedures like portal vein embolization or varicocele treatment, the catheter may be reused if the next catheterization is straightforward
Avoid Re-entry
  • If embolization is properly performed, typically only a small amount of glue is needed, eliminating the need for a second catheterization
Size of the catheter:
  • A 2.8 Progreat ® catheter and a 5 ml syringe offer a good balance between fluidity and resistance. A smaller microcatheter such as a 2.0, for instance, would benefiut from a 3 ml syringe. A 1 ml syringes is not advisable as the injection may feel too easy and lack the proper resistance
AVM
  • In case of venous drainage in arms or legs, apply compression to stop the process.
Uterine AVM
  • While copolymers are useful in many indications, they cause immediate reflux, which forces us to wait for the cast along the microcatheter to harden, in order to be able to push again.
  • When in doubt do a test with Ethiodized Oil alone first.
  • Abundantly flush using about 10 ml of dextrose solution
  • reflux to reach the other branches and complete the embolization.
GI bleed
  • Advisory to put coils in the right gastroepiploic artery (GEA) to protect it and prevent distal embolization by liquids.
Varicocele
  • In case of reflux at the tip, make sure you do not immediately remove the microcatheter, but wait for polymerization to start and withdraw the microcatheter after about 5 minutes
PCS
  • First put one or two coils at the proximal port, go through the coils with the microcatheter, inject the glue from the distal port, and ask the patient for Valsalva while removing the catheter until we reach the coils.
Femoral false aneurysm
  • It is mandatory to place a balloon in front of the neck in order to prevent reflux that would be seriously difficult to handle. We wait about 5 minutes before deflating the balloon.

 

Complications

  • Non-target embolisation
  • Catheter fixation
  • Ischaemia in GI bleed
    • Preferably beyond the vasa recta
    • Bowel wall ischemia is unlikely 3 or fewer vasa recta: not risky / - 4 or more vasa recta: risky

 

Post-op

 

Report

 

Literature

File NameTypePermissionsChanged DateDateSize

  1. J. Mark Ryan, MD, S. M. Key, Siobhan A. Dumbleton, MD, and Tony P. Smith, MD Nonlocalized Lower Gastrointestinal Bleeding: Provocative Bleeding Studies with Intraarterial tPA, Heparin, and Tolazoline J Vasc Interv Radiol 2001 Nov;12(11):1273-7

  2. Baum ST. Arteriographic diagnosis and treatment of gastrointestinal bleeding. In Baum ST, Pentecost MJ, eds. Abrams' angiography interventional radiology. 2nd ed. Philadelphia, Pa:Lippincott, Williams & Wilkins, 2006:488.

  4. Poultsides GA, Kim CJ, Orlando R 3rd, et al. Angiographic embolization for gastroduodenal hemorrhage: safety, efficacy, and predictors of outcome. Arch Surg. 2008;143:457-461.

  5. Eriksson LG, Sundbom M, Gustavsson S, Nyman R. Endoscopic marking with a metallic clip facilitates transcatheter arterial embolization in upper peptic ulcer bleeding. J Vasc Interv Radiol. 2006;17:959-964.

  6. Dixon S, Chan V, Shrivastava V et al. Is there a role for empiric gastroduodenal artery embolization in the management of patients with active upper GI hemorrhage? Cardiovasc Intervent Radiol. 2013 Aug;36(4):970-7.

  7. Shin JH. Recent update of embolization of upper gastrointestinal tract bleeding. Korean J Radiol 2012;13 Suppl 1:S31-S39.

  9. van Leerdam ME. Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 2008;22(2):209-24.

  10. Sildiroglu O, Muasher J, Arslan B, Sabri SS, Saad WE, Angle JF, Matsumoto AH, Turba UC. Outcomes of patients with acute upper gastrointestinal nonvariceal hemorrhage referred to interventional radiology for potential embolotherapy. J Clin Gastroenterol. 2014;48(8):687-92.

  11. Strate LL, Gralnek IM. ACG Clinical Guideline: Management of Patients With Acute Lower Gastrointestinal Bleeding. Am J Gastroenterol. 2016 Apr;111(4):459-74.

  13. van Dam J, Brugge WR. Endoscopy of the upper gastrointestinal tract. N Engl J Med. 1999;341(23):1738-48.

  15. Lefkovitz Z, Cappell MS, Lookstein R, Mitty HA, Gerard PS. Radiologic diagnosis and treatment of gastrointestinal hemorrhage and ischemia. Med Clin North Am. 2002 Nov;86(6):1357-99.

  16. Lee EW, Laberge JM. Differential diagnosis of gastrointestinal bleeding. Tech Vasc Interv Radiol 2004; 7: 112-22

  18. Strate LL, Gralnek IM. ACG Clinical Guideline: Management of Patients With Acute Lower Gastrointestinal Bleeding. Am J Gastroenterol. 2016 Apr;111(4):459-74.

  19. Chaudhry V, Hyser MJ, Gracias VH, Gau FC. Colonoscopy: the initial test for acute lower gastrointestinal bleeding. Am Surg. 1998 Aug;64(8):723-8.

  20. Cummings CL. Value of early capsular endoscopy for severe gastrointestinal bleeding. J Natl Med Assoc. 2004;96(12):1653-6.

  21. Appleyard M, Glukhovsky A, Swain P. Wireless-capsule diagnostic endoscopy for recurrent small-bowel bleeding. N Engl J Med. 2001;344(3):232-3.

  24. Lim JK, Ahmed A. Endoscopic approach to the treatment of gastrointestinal bleeding. Tech Vasc Interv Radiol. 2004 Sep;7(3):123-9.

  25. Nicholson AA, Ettles DF, Hartley JE, et al. Transcatheter coil embolotherapy: a safe and effective option for major colonic haemorrhage. Gut 1998; 43:79–84.

  26. Zuckier LS. Acute gastrointestinal bleeding. Semin Nucl Med. 2003 Oct;33(4):297-311.

  27. Imbembo AL, Diverticular disease of the colon. In: Sabiston D, Editor. Textbook of Surgery (14th edn). Philadelphia, PA:WB Saunders, 1992:910.

  29. Loffroy R, Rao P, Ota S, De Lin M, Kwak BK, Geschwind JF. Embolization of acute nonvariceal upper gastrointestinal hemorrhage resistant to endoscopic treatment: results and predictors of recurrent bleeding. Cardiovasc Intervent Radiol. 2010 Dec;33(6):1088-100. doi: 10.1007/s00270-010-9829-7. Epub 2010 Mar 16.

  31. Eriksson LG, Sundbom M, Gustavsson S, Nyman R. Endoscopic marking with a metallic clip facilitates transcatheter arterial embolization in upper peptic ulcer bleeding. J Vasc Interv Radiol. 2006 Jun;17(6):959-64.

  32. Anthony S, Milburn S, Uberoi R. Multi-detector CT: review of its use in acute GI haemorrhage. Clin Radiol. 2007 Oct;62(10):938-49.

  33. Ernst O, Bulois P, Saint-Drenant S, Leroy C, Paris JC, Sergent G. Helical CT in acute lower gastrointestinal bleeding. Eur Radiol. 2003;13(1):114-7

  34. Mirsadraee S, Tirukonda P, Nicholson A, Everett SM, McPherson SJ. Embolization for non-variceal upper gastrointestinal tract haemorrhage: a systematic review. Clin Radiol 2011;66:500-509.

  35. Loffroy R, Guiu B, D'Athis P, Mezzetta L, Gagnaire A, Jouve JL, Ortega-Deballon P, Cheynel N, Cercueil JP, Krausé D. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrhage: predictors of early rebleeding. Clin Gastroenterol Hepatol. 2009 May;7(5):515-23.

  36. Aina R, Oliva VL, Therasse E, et al. Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol 2001;12:195-200.

  37. Mirsadraee S, Tirukonda P, Nicholson A, Everett SM, McPherson SJ. Embolization for non-variceal upper gastrointestinal tract haemorrhage: a systematic review. Clin Radiol 2011;66:500-509.

  38. Loffroy R, Guiu B, Cercueil JP, Lepage C, Latournerie M, Hillon P, Rat P, Ricolfi F, Krausé D. Refractory bleeding from gastroduodenal ulcers: arterial embolization in high-operative-risk patients. J Clin Gastroenterol. 2008 Apr;42(4):361-7.

  39. Loffroy R, Guiu B, D'Athis P, Mezzetta L, Gagnaire A, Jouve JL, Ortega-Deballon P, Cheynel N, Cercueil JP, Krausé D. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrhage: predictors of early rebleeding. Clin Gastroenterol Hepatol. 2009 May;7(5):515-23.

  40. Poultsides GA, Kim CJ, Orlando R 3rd, Peros G, Hallisey MJ, Vignati PV. Angiographic embolization for gastroduodenal hemorrhage: safety, efficacy, and predictors of outcome. Arch Surg 2008;143:457-461.

  42. Gordon RL, Ahl KL, Kerlan RK, Wilson MW, LaBerge JM, Sandhu JS, Ring EJ, Welton ML. Selective arterial embolization for the control of lower gastrointestinal bleeding. Am J Surg. 1997;174(1):24-8.

  43. Funaki B, Kostelic JK, Lorenz J, Ha TV, Yip DL, Rosenblum JD, et al. Superselective microcoil embolization of colonic hemorrhage. AJR Am J Roentgenol 2001;177:829-836 7.

  44. Bandi R, Shetty PC, Sharma RP, Burke TH, Burke MW, Kastan D. Superselective arterial embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 2001;12:1399-1405.

  45. Maleux G, Roeflaer F, Heye S, Vandersmissen J, Vliegen AS, Demedts I, et al. Long-term outcome of transcatheter embolotherapy for acute lower gastrointestinal hemorrhage. Am J Gastroenterol 2009;104:2042-2046

  46. Leitman IM, Paull DE, Shires GT 3rd. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg 1989;209:175-180

  47. Rosenkrantz H, Bookstein JJ, Rosen RJ, Goff WB 2nd, Healy JF. Postembolic colonic infarction. Radiology 1982;142:47-51.

  48. Koh DC, Luchtefeld MA, Kim DG, Knox MF, Fedeson BC, Vanerp JS, et al. Efficacy of transarterial embolization as definitive treatment in lower gastrointestinal bleeding. Colorectal Dis 2009;11:53-59

  49. Lipof T, Sardella WV, Bartus CM, Johnson KH, Vignati PV, Cohen JL. The efficacy and durability of super-selective embolization in the treatment of lower gastrointestinal bleeding. Dis Colon Rectum 2008;51:301-305

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The information contained herein has been obtained from sources believed to be reliable. However, no warranty as to the accuracy, completeness or adequacy of such information is implied. No liability is accepted for errors, omissions or inadequacies in the information contained herein or for interpretations thereof. The reader assumes sole responsibility for the selection of these materials to achieve its intended results. The opinions expressed herein are subject to change without notice.

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