5:18 PM, Abstract No. 85 - Use of liquid embolic agents in the treatment of aortopulmonary collaterals in pediatric patients with congenital heart disease

Abstract

Purpose: To assess the technique and clinical outcomes for pre-operative n-butyl cyanoacrylate glue embolization of pediatric head and neck venous malformations. Materials and Methods: A retrospective analysis was conducted over a 9-year period at a tertiary care pediatric hospital to identify cases of head and neck venous malformations that were embolized with n-BCA prior to resection. 24 embolizations were performed in 22 patients. 7 patients were male, and mean age was 12.4 years (range 2-25). Primary clinical symptoms included pain (65%), swelling (61%), cosmetic disfigurement (87%), and bleeding (9%). 41.7% of patients had received prior intervention including surgical resection, laser ablation therapy, or sclerotherapy. Sites treated included cheek (n1⁄47), perimandibular regions (n1⁄45), lip (n1⁄44), neck (n1⁄44), tongue (n1⁄43), periorbital regions (n1⁄42), and temporalis muscle (n1⁄41). Mean volume of n-BCA used was 2.69mL; all embolizations were performed through direct percutaneous punctures via 21 or 23 gauge needles, using a range of 1:1 to 1:5 dilutions of n-BCA in ethiodized oil. Prior to injecting the embolization mixture, biplane digital subtraction venography was performed. Same-day pre-operative glue embolization and surgical resection took place for 21 out of 22 patients. Results: All patients were transported to the OR under stable conditions. Technical success rates for both embolization and resection were 100%. One patient had clinically insignificant embolization of a small amount of glue to a subsegmental pulmonary artery. No other complications were recorded. Adjunctive sclerotherapy or further glue embolization with resection was performed in 3 out of 22 patients who had large lesions. Average hospital stay was 1.5 days, with follow up scheduled for 1 week, 1 month, and 6 months. Follow-up indicated successful alleviation of primary symptoms for all patients based on clinical findings. Conclusion: Pre-operative n-BCA glue embolization of pediatric head and neck venous malformations is a safe and effective treatment option for these lesions. Advantages include the ability to achieve a more complete resection with diminished surgical blood loss. Technical and clinical success rates in this series were 100%.