Adherence of cyanoacrylate which leaked from gastric varices to the left renal vein during endoscopic injection sclerotherapy: A histopathologic study

We report a case involving leakage of cyanoacrylate (CA) to the inferior ve na cava (IVC) through a gastrorenal shunt and left renal vein. A 72-year-ol d man with liver cirrhosis was admitted to our hospital to undergo emergenc y treatment for massive hemorrhage of gastric varices, Endoscopic injection sclerotherapy (EIS) using CA was performed on the varices, Radiographic fl uoroscopy revealed that most of the injected CA had adhered firmly to the g astric varices, but a cel-tain portion of the CA had flowed to the IVC thro ugh the gastrorenal shunt and left renal vein. At that point, the patient d id not complain of any symptoms. However, 6 months later, he died of hepati c failure and an autopsy was performed. Histopathologic examination of the wall of the IVC and renal vein, to which CA had adhered, revealed that the CA was covered with endothelial cells of the vessel and no nearby thrombus was present. Long-term anticoagulant therapy may not be indicated in cases of leakage of CA from the gastric varices to other veins, since the leaked CA may be readily covered with endothelium without thrombus formation as in our patient, It is possible for CA to flow to the IVC and have a fatal imp act. Our patient was fortunate, and for safe EIS it is important that these complications are prevented.