A Transcatheter Arterial Embolization Technique Utilizing n-butyl 2-Cyanoacrilate for Progressive Maxillary Carcinoma in a Very Elderly Person
Transcatheter arterial embolization (TAE) is commonly used for preoperative treatment of progressive carcinoma or to improve of the QOL of patients with end stage oral cancer. Some of these patients are very elderly or suffer of cognitive impairment. These cases often present difficulties where choice of treatment method is concerned due to their refusal of treatment. We here present one case that shows TAE with n-butyl 2-cyanoacrylate can be an effective and lowly invasive procedure for such patients with progressive carcinoma.
The patient was a 93-year-old woman. In May 2013 we confirmed a 50mm x 50mm tumor on her maxillary gingiva with bleeding that impaired her eating. The family refused our suggestion to resect the tumor, citing the patient’s advanced age and cognitive impairment. We then suggested just palliative care consisting of TAE to address the patient’s complaint regarding discomfort. TAE was subsequently carried out in August 2013 under intravenous sedation.
materials and methods
・Superficial temporal artery (STA) exposure
The STA was first exposed through an approximately 4 cm preauricular skin incision.
After tensioning the exposed vessel we punctured it in order to insert the guide wire.
・Selective insertion using a fluoroscopic imaging system
We inserted the guide wire to the maxillary artery branch under a fluoroscope.
We then fed the guide wire into the maxillary artery and passed the microcatheter along the guide wire.
By injecting contrast medium we could now confirm the path of the maxillary artery and visualize on screen the vessels related to the tumour.
・ Arterial embolization
After filling the microcatheter with 5% glucose solution we injected 0.2 ml of embolus material prepared by mixing 2.5 ml lipiodol and 0.5 ml n-butyl 2-cyanoacrylate. We confirmed occlusion by fluoroscope, and if it was insufficient repeatedly injected additional embolus material 0.1 ml at a time until embolization was achieved.
methods of data analysis
General examination and CT were utilized.
results
It was found that necrotic tissue began shedding 3 days after TAE. After 6 days the complaints by the patient and her family regarding discomfort had disappeared. In 15 days after TAE the size of the mass had been reduced to 20 mm x 25 mm.
conclusions
This experience suggests the possibility that TAE with n-butyl 2-cyanoacrylate may inhibit cancer cell hyperproliferation and mass bleeding, and may be useful for improve patients’ QOL. It is a fast and simple procedure that we believe to warrant additional research.
references
1) H. Feifel, E. Volle, et. al., Superselective embolization in an errosive haemorrhage of a carcinoma in the parotid gland. Int.J.Oral Maxillofac.surg. 20:369-370, 1991
2)Yasuto Yoshihama, Akiyoshi Nishiyama, et. al., Three cases of arterial embolization for bleeding in terminal oral cancer patients. Kokushuyo(Japanese) 15:13-19, 2003