Feasibility and Safety of Sac Embolization Using N-Butyl Cyanoacrylate in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms or Isolated Iliac Artery Aneurysms

Abstract

Purpose: To evaluate the feasibility and safety of sac embolization with N-butyl cyanoacrylate (NBCA) in emergency endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (AAA) and iliac artery aneurysm (IAA) in comparison to EVAR without sac embolization. Materials and Methods: Between February 2012 and December 2019, among 44 consecutive patients with ruptured AAA or IAA, 29 underwent EVAR. Of these, 22 patients (median age 77.5 years; 18 men) had concomitant sac embolization using NBCA; the remaining 7 patients (median age 88 years; 6 men) underwent EVAR without sac embolization and form the control group. The technical success, clinical success (hemodynamic stabilization), procedure-related complications, and mortality were compared between the groups. Results: All EVAR procedures and embolizations were successful. The clinical success rates in the NBCA and control groups were 95% (21/22) and 71% (5/7), respectively (p=0.14). There was no complication related to the procedure. Type II endoleak occurred in 4 of 21 patients (19%) in the NBCA group vs none of the control patients. One patient (5%) died in the NBCA group vs 3 (43%) in the controls (p=0.034). Conclusion: Sac embolization using NBCA in emergency EVAR appears to be feasible and safe for ruptured AAA and IAA.

Endovascular Aneurysm Sac Embolization for Treatment of Ruptured Aneurysms in the Aortoiliac Segment Using N-Butyl-Cyanoacrylate

“…Most recently, in 2020, research by Ohba et al retrospectively analyzed aneurysm sac and rupture site embolization with NBCA for aortic aneurysm rupture in 22 patients [18]. They reported a mean intervention time of 108.5 min, which is in line with our mean intervention time of 107.8 min [18].…”

“…Two patients were transferred to an ICU after the intervention simply for the purpose of continuous monitoring in the framework of aneurysm rupture, but these patients could be discharged within 3 days. Further, we report a shorter total length of hospital stay of 6.5 days in comparison to previous studies on this topic [18].…”

“…In the first study on this specific topic, Koike et al reported the use of 1 mL NBCA/lipiodol mixed in a 50/50 ratio. Later, Ohba et al reported the embolization of 4-5 mL NBCA/lipiodol with a NBCA content of 20-25% [12,18]. In comparison, we administered a higher mean amount of 10.75 mL in a similar mixing ratio, with NBCA contents ranging from 16 to 27%.…”

“…In our cohort, no early or late type 2 endoleaks were diagnosed, even though the NBCA cast was seen to almost completely dissolve over the course of follow-up. Ohba et al, however, reported four type 2 endoleaks within 6 months in 22 patients, although aneurysm sac embolization with NBCA had been performed [18]. Lastly, the efficacy of higher volumes of embolic agents for avoidance of type 2 endoleaks remains to be fully investigated in larger scale trials.…”

Percutaneous transcatheter super-selective renal arterial embolization with N-butyl cyanoacrylate for iatrogenic renal hemorrhage

“…N-butyl cyanoacrylate (NBCA), a liquid and permanent glue embolic agent, has been widely used in vascular interventions for bleeding, aneurysm, vascular malformation, and other pathophysiologies. 6 , 11 , 12 , 13 , 14 NBCA polymerizes immediately upon contacting blood and occludes the vessel regardless of the patient's coagulation status, 6 , 9 which is effective for patients with coagulopathy. Owing to its low degree of viscosity, NBCA can be delivered far distally to the delivery catheter and offers immediate occlusion of small arteries and collateral circulations.…”