Percutaneous Direct Needle Puncture and Transcatheter N-butyl Cyanoacrylate Injection Techniques for the Embolization of Pseudoaneurysms and Aneurysms of Arteries Supplying the Hepato-pancreato-biliary System and Gastrointestinal Tract

Abstract

Aims:The aim of this study was to evaluate the safety and clinical efficacy of percutaneous direct needle puncture and transcatheter N-butyl cyanoacrylate (NBCA) injection techniques for the embolization of pseudoaneurysms and aneurysms of arteries supplying the hepato-pancreato-biliary (HPB) system and gastrointestinal (GI) tract.Subjects and Methods:A hospital-based cross-sectional retrospective study was conducted, where the study group comprised 11 patients with pseudoaneurysms/aneurysms of arteries supplying the HPB system and GI tract presenting to a tertiary care center from January 2015 to June 2016. Four patients (36.4%) underwent percutaneous direct needle puncture of pseudoaneurysms with NBCA injection, 3 patients (27.3%) underwent transcatheter embolization with NBCA as sole embolic agent, and in 4 patients (36.4%), transcatheter NBCA injection was done along with coil embolization.Results:This retrospective study comprised 11 patients (8 males and 3 females) with mean age of 35.8 years ± 1.6 (standard deviation [SD]). The mean volume of NBCA: ethiodized oil (lipiodol) mixture injected by percutaneous direct needle puncture was 0.62 ml ± 0.25 (SD) (range = 0.5–1 ml), and by transcatheter injection, it was 0.62 ml ± 0.37 (SD) (range = 0.3–1.4 ml). Embolization with NBCA was technically and clinically successful in all patients (100%). No recurrence of bleeding or recurrence of pseudoaneurysm/aneurysm was noted in our study.Conclusions:Percutaneous direct needle puncture of visceral artery pseudoaneurysms and NBCA glue injection and transcatheter NBCA injection for embolization of visceral artery pseudoaneurysms and aneurysms are cost-effective techniques that can be used when coil embolization is not feasible or has failed.

Glue Embolization of Adrenal Artery Pseudoaneurysm: Case Series with Review of Literature

“…Hence, it is imperative that the right concentration, volume, and rate of injection of NBCA mixture are pre-decided by taking adequate check angiograms to avoid non target embolization. [3] A success rate of 79-100% with mortality of 12-33% has been reported with angiographic embolization methods, thus describing the importance of interventional radiological methods in salvaging the patients with PSAs. [10]…”

“…In scenarios, where the accessibility to the distal part of the artery is not possible due to small caliber of arteries (as in our Case 1), liquid embolizing agents can be used. [3] NBCA polymerizes when it comes in contact with the anions in blood and immediately occludes the vessel. It is mixed with Lipiodol to confer radio-opacity.…”

“…e formation of PSA has diverse etiologies such as trauma, inflammation (pancreatitis and cholecystitis), infection (abscess), vasculitis, and malignancy. [3] Most common inflammatory causes of PSAs is pancreatitis. emergent computed tomography angiography (CTA) was performed on a 64-slice multi-detector CT scanner (Philips Ingenuity, Philips Healthcare, Cleveland, Ohio, USA) with 90 ml of 300 mg/ml of intravenous non-ionic contrast medium (Omnipaque, GE Healthcare, Marlborough, USA) with automated exposure control.…”

When the Conventional Treatment Fails: A Rare Approach to Superior Mesenteric Arterial Embolization

“…A number of case reports describe percutaneous thrombin injections of splanchnic or splenic artery aneurysms and direct needle puncture with transcatheter N-butyl cyanoacrylate injections of aneurysms of the hepatobiliary system and gastrointestinal (GI) tract. [4][5][6] Injection of thrombin into pseudoaneurysms in the groin (usually a complication of femoral arterial punctures) is commonly performed because visualization with ultrasound is possible. In this case, the pseudoaneurysm was visualized as the lesion could be opacified and therefore targeted fluoroscopically.…”

Direct Percutaneous Puncture and Embolization of Visceral Pseudoaneurysm: Safety and Clinical Efficacy

“…The largest case series included 21 patients. [7][8][9][10][11][12][13][14][15][16][17][18][19] Previous studies are limited by small size of the study population and lack of durable follow-up. In this study, we would like to assess the safety and clinical effectiveness of the percutaneous embolization in the management of visceral artery pseudoaneurysms in a large group of patients.…”