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BackTable / VI / Podcast / Episode #216

Stick It: Glue Embo

with Dr. Ziv Haskal

In this episode, host Dr. Aparna Baheti interviews interventional radiologist Dr. Ziv Haskal about the use of glue in peripheral applications. They discuss how to prepare and inject glue for portal vein embolization, type 2 endoleaks, and Dr. Haskal’s glue bullet technique.

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Stick It: Glue Embo with Dr. Ziv Haskal on the BackTable VI Podcast)
Ep 216 Stick It: Glue Embo with Dr. Ziv Haskal
00:00 / 01:04

BackTable, LLC (Producer). (2022, June 13). Ep. 216 – Stick It: Glue Embo [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Ziv Haskal discusses Stick It: Glue Embo on the BackTable 216 Podcast

Dr. Ziv Haskal

Dr. Ziv Haskal is an interventional radiologist, tenured professor, and vice chair of career development at the University of Virginia.

Dr. Aparna Baheti discusses Stick It: Glue Embo on the BackTable 216 Podcast

Dr. Aparna Baheti

Dr. Aparna Baheti is a practicing Interventional Radiologist in Tacoma, Washington.

Synopsis

Dr. Ziv Haskal talks us through the use of glue in peripheral applications. He discusses how to prepare and inject glue for portal vein embolization, how to do the same for type 2 endoleaks, and also shares his glue bullet technique.

Glue is only approved for neurointerventional procedures in the US, though there are many off-label uses where glue is the superior embolic. The benefit of glue is the power it gives to the operator. By manipulating the oil to glue ratio and thus the viscosity, the operator has control of how far the glue will travel when injected which makes it a very versatile liquid embolic. Dr. Haskal commonly uses glue for portal vein, bronchial, lumbar and intercostal embolizations as well as in coagulopathic patients.

Dr. Haskal advises that one of the easiest places to start using glue is portal vein embolization. To prepare glue for a procedure, Dr. Haskal separates it from the rest of the back table, and always uses new gloves and a separate set of equipment. For a portal vein embolization, Dr. Haskal runs a microcatheter paraxially alongside the safety wire and makes U-turns into portal vein branches that he is targeting. For treating renal pseudoaneurysm or for finishing a coil embolization, Dr. Haskal uses the glue bullet method, which involves loading a syringe with dextrose and only a tiny amount of glue at the top of the syringe.

Regarding complications of glue, Dr. Haskal says that though many fear the glue solidifying and causing the catheter to get stuck in a vessel, the likelihood of this is near zero because the glue does not harden fast enough for this to happen. The most common complication is over embolization and downstream spillage, which can be problematic in end organ supply vessels. Finally, Dr. Haskel explains his technique for when the glue starts solidifying around the catheter which creates a glue tail catheter is drawn back.

Resources

Glue for Type 2 Endoleak:
https://www.jvir.org/article/S1051-0443(18)30849-2/fulltext

Global Embolization and Symposium Technologies (GEST):
https://www.gestweb.org

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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