Abstract No. 405 Safety and efficacy of N-butyl cyanoacrylate in the treatment of life threatening hemoptysis in the presence of non-bronchial systemic to pulmonary and broncho-pulmonary shunts

Abstract

The purpose of this study is to evaluate the safety and efficacy of N-butyl cyanoacrylate (NBCA) in treatment of patients with life threatening hemoptysis in the presence of non-bronchial systemic to pulmonary shunts (NBSPS) and broncho-pulmonary shunts (BPS). We performed a retrospective analysis of 91 patients (77 males and 14 females, age range, 42-92 years) who underwent embolization for massive hemoptysis between January 2014 and March 2019. The study was approved by the institutional review board. Angiographically demonstrable large volume NBPS and BPS was seen in 19 patients. The underlying etiology was tuberculosis and its sequelae in all 19 patients. Two patients had aspergillomas. Five patients had undergone at least two sessions of ipsilateral Bronchial artery embolization (BAE) for hemoptysis during the same admission. Three patients had embolization of the ipsilateral internal mammary artery (IMA) in addition to BAE. Target vessels were embolized based on CTA findings (when available) and selective catheter angiography. Coaxial technique using microcatheter was used to cannulate the target vessel. In our practice, 1 part NBCA was mixed with 3-4 parts of lipiodol depending on the blood flow dynamics. Devascularization of the abnormal target vessels and exclusion of the shunts were achieved in 18 patients using NBCA (95% technical success). No recurrence was noted in 11 patents for up to 2 years of follow-up (58%). Recurrence of hemoptysis occurred in 2 patients at 2 and 3 months from different vascular territory to previous embolization. Serious non target embolization to central nervous system (CNS) was seen in 2 patients. Five patients died during the follow-up. The presence of large volume non-bronchial systemic and bronchopulmonary shunts precludes the use of particulate embolic agents in order to prevent non-target embolization. NBCA may be the most suitable and effective embolic agent in these patients and is known to reduce recurrence. The operator and patients should however be aware of rare but unforgiving consequences of non-target embolization to the central nervous system.