Multiple delayed-onset metachronous ileal stenoses after transcatheter arterial embolization using N-butyl-2-cyanoacrylate for upper gastrointestinal bleeding: factors of complication and importance of plain CT evaluations

A 63-year-old man underwent transcatheter arterial embolization (TAE) using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil to treat acute gastrointestinal (GI) bleeding. The procedure was initially successful; however, the patient developed ileus >1 month later and subsequently underwent several surgeries to treat the multiple metachronous ileal stenoses. The flux of a small amount of off-target glue was the primary cause of these complications. As the patient had few symptoms in the first month post-TAE, however, affirming the diagnosis took time. A detailed review of plain CT scans was a decisive factor in achieving the final diagnosis. This case demonstrates that TAE using an NBCA-iodized oil mixture effectively treats acute GI bleeding. However, a complication such as off-target embolization is likelier to occur because of a combination of certain factors such as vascular anatomy, complexity of the procedure, and NBCA dilution. Close observation using plain CT should be performed for the identification of off-target embolization occurrence even in cases of successful TAE.