Acrylic Glue Research Articles

N-Butyl-2-cyanoacrylate Use in Intraoperative Ruptured Aneurysms as a Salvage Rescue

The use of N-butyl-2-cyanoacrylate (n-BCA) acrylic glue as a salvage rescue in procedural ruptured aneurysm should be part of the neurointerventionalist's armamentarium. Two patients, age 44 and 60 years, presented with Hunt and Hess grade 3 subarachnoid hemorrhage from aneurysmal rupture. We report 2 cases in which n-BCA was used effectively as a salvage rescue in aneurysms that ruptured during coil embolization. These 2 cases demonstrate a feasible technique for the salvage of iatrogenic aneurysm perforation during coil embolization, which, to our knowledge, has not been previously reported.

Treatment of Pseudoaneurysm of Internal Maxillary Artery: A Case Report

Pseudoaneurysms are rare lesions secondary to blunt or penetrating trauma, temporomandibular joint surgery, or orthognathic surgery. Nonsurgical interventions are the treatment of choice for pseudoaneurysms. In the case reported here, endovascular injection of acrylic glue was successful in the treatment of a pseudoaneurysm of the internal maxillary artery secondary to fracture of the zygomatic bone.

Embolization of the Internal Iliac Artery with Glubran 2 Acrylic Glue: Initial Experience with an Adjunctive Outflow Occlusive Agent

The authors describe their initial experience with the adjunctive use of Glubran 2, a cyanoacrylate glue, in the embolization of the internal iliac artery (IIA). Glubran 2 was used in five patients as an adjunct to traditional techniques in the repair of isolated IIA aneurysms and to prevent retrograde perfusion of the aneurysm sac in the endovascular repair of aortoiliac aneurysms.

Repair of vehicle radiators

Typical damage to wheeled rover radiators was studied. Repair technology using epoxy acrylate and anaerobic glue materials was described. The stability of the given glue materials to long exposure in various media was estimated.

Therapeutic management of intracranial dural arteriovenous shunts with leptomeningeal venous drainage: report of 53 consecutive patients with emphasis on transarterial embolization with acrylic glue

There is a strong correlation between the venous drainage pattern of intracranial dural arteriovenous shunts (ICDAVSs) and the affected patients' clinical presentation. The ICDAVSs that have cortical venous reflux (CVR) (retrograde leptomeningeal drainage: Borden Type 2 and 3 lesions) are very aggressive and have a poor natural history. Although the necessity of treatment remains debatable in ICDAVSs that drain exclusively into a sinus (Borden Type 1), lesions with CVR must be treated because of the negative effects of the retrograde venous drainage. Surgery, radiosurgery, and embolization have been proposed for management of these lesions, but endovascular therapy is considered the most appropriate therapeutic strategy in ICDAVSs. New embolic materials, such as Onyx, have been recently developed and are considered to represent a kind of "gold standard" for embolization of these lesions. The purpose of this study is to emphasize the importance of transarterial embolization using acrylic glue in the therapeutic management of ICDAVSs with CVR, and to compare the results the authors obtained using this treatment with those reported in the literature for Onyx treatment of the same type of dural shunts. The clinical and radiological records of 53 consecutive patients suffering from ICDAVSs with CVR (Borden Types 2 or 3) were reviewed. All cases were managed with the same angiographic and therapeutic protocol. Localization of the lesions, their clinical symptoms, their angioarchitecture, their therapeutic management, and the results were analyzed. Fourteen ICDAVSs were located at the superior sagittal sinus and/or convexity veins, 13 at the transverse and sigmoid sinuses, 10 at the tentorium, 5 in the anterior cranial fossa, 4 at the foramen magnum, 3 at the torcula, 2 at the straight sinus, and 1 at the vein of Galen. One patient presented with an infantile form of ICDAVS with multiple shunts. Hemorrhage had occurred in 36% of cases. Forty-three patients underwent transarterial embolization (42 with acrylic glue). Complete closure of the fistula was obtained in 34 patients. Suppression of the CVR with partial occlusion of the main shunt was achieved in all other cases. No mortality or permanent morbidity was observed in this series. Intracranial dural arteriovenous shunts can be safely managed by transarterial embolization, which can be considered in most instances as an effective first-intention treatment. Acrylic glue still allows a cheap, fast, and effective treatment with high rates of cures that compare favorably to those obtained with new embolic materials.

Endovascular Management of Infective Intracranial Aneurysms with Acrylic Glue

Cerebral mycotic aneurysms (MAs) also called infective aneurysms, are uncommon and are usually encountered in patients with infective endocarditis. These aneurysms often present with intracranial hemorrhage. MAs may resolve on treatment with antibiotics alone. However prognosis with medical management alone is unpredictable. Good prognosis with surgery has been reported for single accessible ruptured MAs. However surgery is associated with significant morbidity. Endovascular treatment of MAs along with appropriate antibiotics is emerging as an acceptable option for these patients. We describe two cases of infective endocarditis complicated by ruptured MA treated successfully by liquid embolic glue material.

Acrylate glue injection for acutely bleeding oesophageal varices: A prospective cohort study

Acrylate glue injection is seldom performed in patients with bleeding oesophageal varices. To assess efficacy and safety of acrylate glue injection in patients with bleeding oesophageal varices, as well as the impact of this technique on subsequent variceal ligation. Prospective study on 133 consecutive cirrhotic patients treated by intravariceal injection of undiluted N-butyl-2-cyanoacrylate into the bleeding varix. Outcome measures were initial haemostasis, recurrent bleeding, complications and mortality at 6 weeks. 52 patients were actively bleeding at endoscopy and 81 showed stigmata of recent haemorrhage. Initial haemostasis was achieved in 49/52 active bleeders (94.2% [95% CI 85.1-98.5]). Overall, early recurrent bleeding occurred in 7 patients (5.2% [95% CI 2.3-10.1]). No major procedure-related complication was recorded. At 6 weeks, death occurred in 11 patients, with an overall bleeding-related mortality of 8.2% [95% CI 5.8-15.3]. Mortality was higher in active (15.4% [95% CI 6.9-28.1]) than non-active bleeders (3.7% [95% CI 0.8-10.4], OR 4.7 [95% CI 1.05-28.7], p=0.02). Of those surviving the first bleeding episode, 112 patients subsequently underwent ligation. No technical difficulties were encountered in performing the banding procedure which was successfully completed in all cases. Emergency injection of acrylate glue is safe and effective for the treatment of acute bleeding oesophageal varices and does not hamper subsequent variceal ligation.

In vivo regeneration of rat sciatic nerve in a double‐halved stitch‐less guide: A pilot‐study

It is about 20 years that tubular nerve guides have been introduced into clinical practice as a reliable alternative to autograft, in gaps not-longer-than 20 mm, bringing the advantage of avoiding donor site sacrifice and morbidity. There are limitations in the application of tubular guides. First, tubular structure in itself makes surgical implantation difficult; second, stitch sutures required to secure the guide may represent a site of unfavorable fibroblastic reaction; third, maximum length and diameter of the guide correlate with the occurrence of a poorer central vascularization of regenerated nerve. We report on the in vivo testing of a new concept of nerve-guide (named NeuroBox) which is double-halved, not-degradable, rigid, and does not require any stitch to be held in place, employing acrylate glue instead. Five male Wistar rats had the new guide implanted in a 4-mm sciatic nerve defect; two guides incorporated a surface constituted of microtrenches aligned longitudinally. Further five rats had the 4-mm gap left without repair. Contralateral intact nerves were used as controls. After 2 months, nerve regeneration occurred in all animals treated by the NeuroBox; fine blood vessels were well represented. There was no regeneration in the un-treated animals. Even if the limited number of animals does not allow to draw definitive conclusions, some result can be highlighted: an easy surgical technique was associated with the box-shaped guide and acrylate glue was easily applied; an adequate intraneural vascularization was found concurrently with the regeneration of the nerve and no adverse fibroblastic proliferation was present.

Embolization of an AVM with acrylic glue through a new microcatheter with detachable tip: an amazing experience

Sir, We recently treated a patient with a right temporal arteriovenous malformation (AVM) by injecting acrylic glue through a new microcatheter with a detachable tip (Sonic, Balt, France)—with unexpected results. A 40-year-old male patient presented with epilepsy. Cranial computerized tomography (CT) and magnetic resonance examinations revealed a right temporal AVM that was 6×5×3 cm. Cerebral digital subtraction angiography (DSA) showed the presence of an AVM filling from the inferior truncus branches of the right middle cerebral artery and draining through multiple cortical veins. There were no arterial feeder aneurysms or venous drainage stenosis. Based on these DSA findings, we planned an embolotherapy. We first catheterized the right internal carotid artery with a guiding catheter (Envoy Cordis, Miami, FL) and then navigated the new detachable flow-directed tip plus braided microcatheter (sonic) to the AVM nidus with its own microwire (model Steel007; Balt Extrusion, Montmorency, France). The microcatheter has three markers on its distal part, with the most distal one indicating the end of the microcatheter, the middle one indicating the detachment zone and the proximal one marking the maximum permitted reflux point. To evaluate the flow dynamics of the lesion and to confirm the ideal wedge position of the microcatheter, we carried out several intranidal injections through the microcatheter. A mixture of 0.5 ml n-butyl-2 cyanoacrylate (NBCA) (Histoacryl; B. Braun, Melsungen, Germany) diluted with 3.5 ml ethiodized oil (Lipiodol; Guebert Laboratories, Aulney-sous-Bois, France) was prepared (12.5% diluted glue). This mixture was injected as a 16-min-long single injection, with several reopenings of the different portions of the nidus following waiting intervals for backflows. Repeated flushings with a 5% dextrose solution were carried out during these waiting intervals to clean the inside of the microcatheter and consequently prevent premature polymerization that would lead to blockage of the microcatheter. After the glue reflux had reached the maximum permitted point at which the distal tip could be detached, we waited for approximately 3 min to ensure that the distal tip had been fully glued. The microcatheter was then retracted; however, the detachable distal tip did not detach but was removed together with the entire microcatheter. Subsequent control cerebral angiograms showed an occlusion nearly 50% the size of the lesion without any complications, such as non-target embolization or drainage vein thrombosis. The patient was then transferred to the neurointensive care unit for monitoring. The mean arterial blood pressure was maintained at approximately 10–15% below baseline for 24 h to minimize the possibility of normal pressure breakthrough. A control cerebral CTcarried out after the procedure revealed no procedure-related hemorrhage. The embolization of brain AVMs with liquid-embolizing agents, such as cyanoacrylates derivatives or Onyx (ethylene vinyl alcohol copolymer), is a well-known and accepted treatment option [1, 2]. Cyanoacrylate derivatives are widely used to occlude the AVM nidus. However, they are far from being satisfactory embolic liquids due to the risk of gluing the catheter to the artery, which can result in serious complications [3]. It can be hypothesized that the new microcatheter with a detachable tip will solve this Neuroradiology (2008) 50:903–904 DOI 10.1007/s00234-008-0442-2

Percutaneous acrylic glue injection to control bleed in doudenal carcinoma in a case of failed endovascular embolization: case report

We present a case of locally advanced duodenal adenocarcinoma that underwent radiotherapy and chemotherapy prior to presenting with massive upper gastrointestinal bleed as well as melena. Endovascular embolization with metallic coils to occlude the gastro duodenal artery pseudoaneurysm failed to completely resolve the gastrointestinal bleed. As surgical and endoscopic interventions were not technically feasible, under computed tomography fluoroscopic guidance, a percutaneous injection of N-butyl cyanoacrylate glue was done in tumor bed to occlude the bleeding vessels.

Occupational methacrylate and acrylate allergy from glues

Glues and sealants are important causes of methacrylate and acrylate allergy. This study aimed to analyse patterns of allergic patch test reactions to acrylic monomers in relation to exposure in patients sensitized from glues. We screened the patch test files at the Finnish Institute of Occupational Health from 1994 to 2006 for allergic reactions in the 'Methacrylate series' and analysed the clinical records of sensitized patients. Only patients who had handled acrylic glues at work were included. 10 patients had allergic reactions to acrylic monomers and had been sensitized from glues at work. 9 of them had used anaerobic sealants, 3 cyanoacrylate-based instant adhesives, and 1 patient a bi-component instant adhesive. All the patients reacted to 2-hydroxyethyl methacrylate (2-HEMA) and ethyleneglycol dimethacrylate (EGDMA); reactions to 2-hydroxypropyl methacrylate, triethyleneglycol dimethacrylate, and tetrahydrofurfuryl methacrylate were also common. The first 4 methacrylates were found in the glues used by the patients. Ethyl cyanoacrylate (ECA) gave no reactions, but 1 patient reacted weakly to her own ECA-based glue. 2-HEMA and EGDMA are good screeners for contact allergy to anaerobic sealants and also detected a single case deriving from bi-component acrylic glue.

Long term prognosis of osteochondritis dissecans of the knee

Although osteochondritis dissecans (OCD) of the knee has been known for a long time, we still do not fully understand why it develops. We have also known for a long time that the prognosis is better if it develops before the epiphyseal plates are closed. In the 1970s the Swedish researcher Bjarne Linden used the fact that Sweden’s third largest city, Malmo, had only one hospital and that the population around Malmo was very stable and did not move, in order to make a 33 year follow-up of OCD cases. He found that the juvenile cases had much better long term prognosis than the adult cases. In a recent study Bruns and colleagues from Hamburg, Germany, found similar results. Bruns et al. also found that retrograde drilling in cases with intact cartilage layer gives better long term results than antegrade drilling. Their worst results were found in cases where an acrylic glue had been used to attach loose bodies. They have also restudied their cases. Their first follow-up was after 10 years and now they have studied them after 20 years. As expected some results deteriorated with time but 49% of their studied patients had improved. The age of the patients and the stage of the epiphyseal plate were the most important prognostic factors. Although their material is small, it seems from their study and those of others as if it is better to try to reattach the loose fragment than to remove it. Some surgeons still operate the juvenile OCD cases although there seems to be a good chance that they heal without surgery. Unfortunately there are no randomized prospective studies on the treatment of OCD like in so many other areas of orthopaedic surgery. We need more research on as well the etiology as on the treatment of this disease.

Longitudinal long-term results of surgical treatment in patients with osteochondritis dissecans of the femoral condyles

In a longitudinal study, we performed a second follow-up examination on patients suffering from osteochondritis dissecans at the femoral condyles 10 years after a first follow-up, which had been performed 10 years after surgical treatment. Results (clinical score; radiological signs of OA) were analysed depending on the stage of the epiphyseal plate at the time of surgery, the used surgical procedure was divided into retrograde and anterograde procedures, and removal of loose bodies depending on the stage of the lesion. The analysis clearly exhibited that JOCD patients demonstrated better results than AOCD patients. The clinical score obtained after 10 years improved significantly with time, particularly for JOCD patients. Overall, when a retrograde procedure had been used in cases with an intact cartilage layer clinical results were better than those obtained in patients in whom an anterograde procedure with restoration of the joint surface or simple removal of the loose fragments had been performed. After a mean follow-up of 20 years the mean OA-stage was 0.27 in JOCD patients, whereas in AOCD patients a mean OA-stage of 1.55 was detected. Worst OA-changes were detected in patients in whom acrylic glue had been used for refixation of the loose bodies.

Transcatheter Embolization of a Large Symptomatic Pelvic Arteriovenous Malformation with Glubran 2 Acrylic Glue

A young patient affected by a pelvic arteriovenous malformation (pAVM) with recurrent episodes of hematuria following exercise, underwent transcatheter embolization using Glubran 2 acrylic glue (GEM, Viareggio, Italy). All branches of the pAVM were successfully occluded. The patient showed prompt resolution of symptoms and persistent occlusion of the pAVM at the 6 month follow-up.

Uncommon cause of early postoperative colonic fistula successfully treated with endoscopic acrylate glue injection

Uncommon cause of early postoperative colonic fistula successfully treated with endoscopic acrylate glue injection

Preferences of invasive Ponto-Caspian and native European gammarids for zebra mussel (Dreissena polymorpha, Bivalvia) shell habitat

We investigated habitat preferences of two invasive Ponto-Caspian gammarids (Dikerogammarus haemobaphes and Pontogammarus robustoides) and a native European species (Gammarus fossarum) in laboratory experiments. The habitats consisted of the following objects: (1) living zebra mussels; (2) empty mussel shells (clean or coated with nail varnish) with both valves glued together using aquarium silicone sealant to imitate a living mussel; (3) stones (clean or varnished); (4) empty plates. Ten objects of the same type were glued to a plastic plate (10 × 10 cm) with methyl acrylic glue. The plates were placed in experimental tanks in various combinations. A single gammarid was put into the tank and its position was determined after 24 h. The studied species responded differently to the presence of zebra mussels. D. haemobaphes preferred living mussels rather than their empty shells and these two habitats over stones and empty plates. It responded positively to shell shape, selecting varnished shells rather than varnished stones, and to shell surface properties, selecting clean shells rather than varnished shells. It did not respond to waterborne mussel exudates. P. robustoides did not exhibit any preferences for the above-mentioned substrata. G. fossarum was attracted by empty mussel shells (but not by living mussels). It responded only to their shape, not to surface properties. The strong affinity for zebra mussels, exhibited by D. haemobaphes, might help it survive and develop stable populations in newly invaded areas.

Transcranial puncture through the parietal and mastoid foramina for the treatment of dural fistulas

In this report the authors describe the endovascular treatment of dural arteriovenous fistulas (DAVFs) through transcranial puncture of the feeding arteries. Four patients had DAVFs that were fed by occipital arteries (OAs) that supplied blood to the intracranial meningeal arteries via the transcranial branches and coursed through the parietal and mastoid foramina. Due to the excessive tortuosity of the OA, conventional endovascular navigation had failed in all cases. Transcranial puncture of the meningeal feeding arteries was performed through the parietal or mastoid foramen, allowing navigation with a microcatheter until the level of the shunts. Complete cure of the DAVF was attained in all patients after injection of acrylic glue.

Bildgesteuerte Schmerztherapie – Interventional Radiology in pain Treatment under CT-Guidance – Which technique for what disease?

Radiologists at present are performing on routine basis biopsies, abscess drainage and other procedures under imaging guidance. These skills can be easily used in techniques for pain management. Recently for both diagnosis and pain treatment, a great number of interventional techniques have been elaborated including: greater occipital nerve, pudental nerve and superior hypogastric plexus infiltration, periradicular infiltration, stellate, spheno-palatine ganglion, thoracic and lumbar, splanchnic nerves and celiac plexus neurolysis, presacral, bone metastasis alcoholization and RF ablations, acrylic glue injections and combined techniques. For the efficiency and safety of these procedures and particularly for the more elaborated ones, CT-guidance becomes mandatory.

Angiolymphoid hyperplasia with eosinophilia induced by trauma

A 48-year-old Hispanic man presented to our clinic with multiple, bright red, firm nodules limited to the right side of the scalp (Fig. 1). The patient had first noted a lesion 6 months previously, and complained of mild associated pruritus and ease of bleeding. The first lesion developed at the exact site at which the patient had accidentally hit his head against a filing cabinet 2 years previously. The trauma had been associated with significant bleeding, which required more sutures than expected. In a magnetic resonance image, the initial nodule was visualized and, because of its firm consistency, the diagnosis of a lipoma was made. Surgical excision of the tumor was attempted, but was complicated by significant bleeding, which required extensive electrocoagulation. Shortly thereafter, multiple new lesions slowly began to develop around the original nodule. In addition, the patient complained of new-onset migraine headaches. Figure 1Open in figure viewerPowerPoint Linear arrangement of erythematous nodules on the scalp On physical examination, the right side of the patient's scalp showed multiple, erythematous, firm papules and nodules measuring 0.5–2.5 cm in diameter. These were slightly alopecic, and the largest and earliest tumor was pulsatile. There was no associated lymphadenopathy or peripheral eosinophilia. On angiography, an arteriovenous malformation was detected. Specifically, branches from the occipital arteries bilaterally appeared to feed the malformation (Fig. 2). Skin biopsy of one of the nodules revealed lobular proliferations of capillary-sized vessels around larger central vessels, with a mild perivascular infiltrate of lymphocytes and eosinophils in the dermis. The larger vessels were lined by characteristic “hobnail” endothelial cells, which protruded into the lumen (Fig. 3). As this vascular anomaly was thought to underlie his skin lesion, the patient was treated with embolization using polyvinyl alcohol particles and fiber coils, which resulted in increased pallor of the lesions, a greater than 50% decrease in size, decreased pulsatility, and resolution of his migraine headaches. Six months after this successful procedure, no new lesions had developed. Presently, the patient is opting to defer further treatment in the hope that the lesions will resolve entirely. A second endovascular treatment with polyvinyl alcohol particles and acrylic glue is pending based on the course of his disease. Figure 2Open in figure viewerPowerPoint Dilated and tortuous branches from the right occipital artery feed into an arteriovenous malformation (AVM), with the resultant scalp lesions visible on angiogram (lateral view) Figure 3Open in figure viewerPowerPoint Vascular proliferation with well-formed lumens and cells protruding into them in a hobnail-like fashion, together with a mixed-cell inflammatory infiltrate (hematoxylin and eosin, ×200)

CYANOACRYLIC GLUE: A MINIMALLY INVASIVE NONSURGICAL FIRST LINE APPROACH FOR THE TREATMENT OF SOME URINARY FISTULAS

We evaluated the adaptability and the efficacy of a cyanoacrylic glue for the conservative treatment of urinary fistulas of different etiologies using an endoscopic, percutaneous or endovaginal approach. From May 1998 to July 2004, 13 patients with long lasting iatrogenic and/or inflammatory urinary fistulas were treated conservatively with endoscopic, percutaneous or endovaginal application of 1 to 3 cc of cyanoacrylic glue. The complication rate in this cohort of 13 patients was low. Occlusion therapy failed in 2 genitourinary fistulas which were wider (diameter greater than 1 cm) and short. In the remaining 11 cases urinary fistulas were successfully sealed and at a median followup of 35 months no relapses were observed. Cyanoacrylic glue is suitable for endoscopic, percutaneous and endovaginal use. This occlusion therapy represents a safe and minimally invasive approach that might be offered as a first line option for the treatment of urinary fistulas, especially narrow and long tract fistulas.