Endovascular Embolization of Visceral Artery Pseudoaneurysms Using Modified Injection Technique with N-Butyl Cyanoacrylate Glue

Abstract

Purpose To evaluate the indications, feasibility, safety, and effectiveness of N-butyl cyanoacrylate (NBCA) with modified injection technique in embolization of visceral artery pseudoaneurysms (PSAs). Materials and Methods A retrospective evaluation was performed of 31 patients (26 men, 5 women; mean age, 32.6 y) with visceral artery PSAs that were treated with embolization using NBCA with modified sequential injection and flushing technique. The most common indication for using NBCA was preservation of a major feeding artery (n = 18), followed by difficult catheterization secondary to arterial tortuosity (n = 5), failed previous coil embolization (n = 4), and short landing zone for coils (n = 4). NBCA alone was used in 25 patients, and NBCA with coils was used in 6 patients. The patients were followed clinically until discharge and 1 and 3 months after discharge. Results The mean amount of NBCA–ethiodized oil (Lipiodol; Guerbet LLC, Villepinte, France) mixture injected was 0.24 mL (range, 0.1–1.1 mL). Embolization with NBCA was technically successful in all (100%) patients. Recurrence was seen in 3 (9.7%; 2—splenic artery; 1—left gastric artery) patients after a mean time of 16.3 days (range, 10–27 d) of initial embolization resulting in clinical success of 90.3%. All 3 patients underwent successful repeat embolization with secondary technical success rate of 100%. Minor (pain) and major (nontarget embolization in 2; microcatheter adhesion and fracture in 1) complications were seen in 3 patients each. Conclusions NBCA is a safe and effective embolization agent when injected with modified technique in treatment of visceral artery PSAs.