Type II endoleak model creation and intraoperative aneurysmal sac embolization with n-butyl cyanoacrylate-lipiodol-ethanol mixture (NLE) in swine

Abstract

Background: The purpose of this study was to evaluate the feasibility of type II endoleak model creation and efficacy of intraoperative aneurysmal sac embolization using n-butyl-2-cyanoacrylate-lipiodol-ethanol mixture (NLE) for type II endoleak in swine. Methods: In six swine (mean body weight 53.5 kg), abdominal aortic aneurysm (AAA) was created and then end-to-side anastomosis between the left renal artery and AAA sac was performed. And then, endovascular abdominal aortic aneurysm repair (EVAR) was performed, leading to creation of a type II endoleak model. As control group, EVAR without sac embolization was performed in two swine. In four swine, AAA sac was embolized using NLE immediately after EVAR via the microcatheter placed in AAA sac (NLE embolization group). Follow-up aortography was performed immediately and three days after the procedure, and then the aneurysms were extracted. Results: The AAA sac and type II endoleak model were successfully created in all cases. In control group, type II endoleak persisted three days after the procedure. In NLE embolization group, endoleak disappeared immediately and three days after the procedure. In NLE embolization group, AAA sac was occupied with thrombus and embolic material. Inflammatory changes were recognized in aneurysmal sac wall in NLE embolization group. Conclusions: This experimental study suggests that creation of a type II endoleak model in swine is feasible and that intraoperative AAA sac embolization with NLE during EVAR might reduce the occurrence of type II endoleak.

Effects of temperature alteration on viscosity, polymerization, and in-vivo arterial distribution of N-butyl cyanoacrylate-iodized oil mixtures

“…We presume that these would be helpful for lesions requiring peripheral delivery and/or slow injection to fill the tortuous feeder and the wide volume target simultaneously with the mixture, in a situation where pinpoint-access up to the target is not available, but the target needs a large amount of the NBCA-iodized oil mixtures. For example, a type II endoleak after an endovascular aortic repair frequently requires an approach to the aneurysm via complicated collaterals [ 8 ], some types of peripheral arteriovenous malformations have multiple culprit feeders into a huge venous sac [ 4 ], and hemoptysis due to chronic lung inflammation is occasionally caused by meandering and wide vasculature [ 6 , 7 ]. In addition to the mixture ratio, as per their preferences, operators may be able to adjust viscosity and polymerization time by referring to our data.…”

“…N -butyl cyanoacrylate (NBCA) provides secure vessel occlusion due to its strong adhesive property [ 1 – 3 ]. The mixture of NBCA and iodized oil, which imparts radiopacity and viscosity, has been used in endovascular embolization for various vascular disorders, including cerebral or peripheral arteriovenous malformations [ 1 , 2 , 4 ], traumatic and other sources of idiopathic bleeding [ 3 , 5 – 7 ], and aortic intervention-related embolization [ 3 , 8 ]. Meanwhile, inadequate distribution of the mixture can cause unexpected organ damage [ 1 – 3 , 5 – 7 , 9 , 10 ].…”

“…The blood flow control method using a microballoon catheter, an instrumental technique, is known to efficiently control the extent of the mixture [ 3 , 7 , 9 ]. Further, mixing NBCA with glacial acetic acid or ethanol, a preparation technique, modified the adhesive property of the material and achieved a slow and high amount of infusion [ 2 , 8 , 12 ]. Studies regarding temperature alteration addressed its effect on the mixture viscosity and the polymerization time [ 3 , 13 , 14 ], though the previously evaluated temperature range was limited and a more detailed study may help in better handling of the NBCA-iodized oil mixtures for lesions requiring peripheral delivery.…”

A preliminary animal study of thermal rheology fluid as a new temperature-dependent liquid intravascular embolic material

“…In fact, TR fluid did not occlude the microcatheter. Nakai et al reported that NBCA-lipiodol-ethanol (NLE) has multiple advantages for embolization over NBCA, such as fewer adhesive properties to the catheter and less damage features to the vascular wall [21][22][23][24]. TR fluid and NLE appear to have similar advantages for embolization, although they have different embolic mechanisms.…”

In Vivo Experimental Endovascular Uses of Cyanoacrylate in Non-Modified Arteries: A Systematic Review

“…Thus, rete mirabile embolization through the ascending pharyngeal artery in swine serves as a model for the treatment of AVMs [ 3 ]. Aneurysms, including aortic aneurysms, have been created in rabbits and swine and in arteriovenous fistulas in dogs [ 4 , 5 , 6 , 7 , 8 ]. However, to our knowledge, no review of cyanoacrylate injection into non-modified arteries in animal models is available.…”