Clinical study
Transcatheter N-butyl Cyanoacrylate Embolization of Pseudoaneurysms

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Purpose

To report clinical experience with N-butyl cyanoacrylate (NBCA) for embolization of pseudoaneurysms at various locations.

Materials and Methods

Retrospective study of patients with pseudoaneurysms treated with NBCA over a 4-year period was conducted. Seventeen consecutive patients were evaluated, including three women and 14 men ranging in age from 25 to 77 years (mean, 60.6 y). NBCA was the only embolic agent used in 15 patients; in two patients, a liquid coil and a microcoil were placed before administration of NBCA. NBCA was mixed with iodized oil in a 1:3 ratio to control its polymerization time and to make it radiopaque. Diagnostic angiography and embolization were performed at the same session. Embolized sites included gastrointestinal tract (n = 6), spleen (n = 5), liver (n = 2), kidney (n = 1), chest (n = 1), oral cavity (n = 1), and buttock (n = 1).

Results

NBCA embolization was successful in 16 of 17 patients (94%), with complete occlusion of pseudoaneurysms. In one patient with a gastroduodenal artery stump pseudoaneurysm, NBCA embolization failed, and a stent-graft (8 mm/40 mm) was placed in the hepatic artery, excluding the pseudoaneurysm and preserving the hepatic artery. No major complications occurred, and there were no recurrences of pseudoaneurysms.

Conclusions

NBCA embolization was an effective method for the treatment of pseudoaneurysms.

Section snippets

Patients

The institutional review board approved this retrospective study, and the need for informed consent for study inclusion was waived. Informed consent for angiography and embolization was obtained from each patient or the patient's family. From October 2004 to November 2008, 39 patients with bleeding episodes or pseudoaneurysms detected on computed tomography (CT) were referred to the interventional radiology department for angiography and possible embolization. Of 39 patients, 17 consecutive

Results

Angiographic success of NBCA embolization was achieved in 16 of 17 patients (94%), with complete exclusion of pseudoaneurysms from the circulation (Fig 1). In one patient (Fig 2), who had a gastroduodenal artery stump pseudoaneurysm with a short neck after periampullary carcinoma resection, embolization with NBCA directly into the pseudoaneurysm neck failed to occlude the pseudoaneurysm; the pseudoaneurysm ruptured, and a small amount of NBCA refluxed and embolized distal branches of hepatic

Discussion

The present study demonstrates that endovascular embolization with the use of NBCA as the primary embolic agent is a feasible and effective method for treatment of pseudoaneurysms at various locations and related to various causes. NBCA occludes the embolized artery definitively, with neither recanalization nor recurrent bleeding occurring during the follow-up period. Even when the microcatheter could not be positioned at the ideal location in the pseudoaneurysm neck as a result of tortuosity

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Copyright © 2010 SIR. Published by Elsevier Inc. All rights reserved.