Cyanoacrylate Glue Embolization Research Articles

Early Outcomes of Prostatic Artery Embolization using n-Butyl Cyanoacrylate Liquid Embolic Agent: A Safety and Feasibility Study

This retrospective study evaluated the feasibility, safety, and short-term effectiveness of prostatic artery embolization (PAE) using n-butyl cyanoacrylate (nBCA) glue embolization in 244 patients from June 2022 through May 2024. Technical success, defined as bilateral glue embolization, was achieved in 95% of cases. The median fluoroscopy time was 22.2 minutes (interquartile range [IQR], 17.1–30.0 minutes), and the median air kerma was 753 mGy (IQR, 417–1,559 mGy). Compared with baseline, statistically significant improvements were observed at 7.1 weeks for the International Prostate Symptom Score (9.5 [SD ± 6.0] vs 20.5 [SD ± 6.7]; P < .01), quality of life (1.8 [SD ± 1.5] vs 4.0 [SD ± 1.1]; P < .01), Qmax (10.4 mL/s [SD ± 6.3] vs 6.1 mL/s [SD ± 2.5]; P < .01), and prostate grand volume at 6 months (113.3 mL [SD ± 69.3] vs 156.6 mL [SD ± 104.6]; P < .01). These results demonstrate the use of nBCA for PAE as a technically feasible and safe option with excellent short-term outcomes.

3-year clinical outcomes of A Singapore VenaSeal™ real world post-market evaluation Study (ASVS) for varicose vein ablation

IntroductionMedium-term clinical outcome data are lacking for cyanoacrylate glue (CAG) ablation for symptomatic varicose veins, especially from the Asian population.ObjectivesAim was to determine the 3-year symptomatic relief gained from using the VenaSeal™ device to close refluxing truncal veins from the Singaporean ASVS prospective registry.MethodsThe revised Venous Clinical Severity Score (rVCSS) and three quality of life (QoL) questionnaires were completed to assess clinical improvement in venous disease symptoms along with a dedicated patient satisfaction survey. 70 patients (107 limbs; 40 females; mean age of 60.9 ± 13.6 years) were included at 3 years.ResultsAt 3 years, rVCSS showed sustained improvement from baseline (5.00 to 0.00; p < 0.001) and 51/70 (72.9%) had improvement by at least 2 or more CEAP categories.Freedom from reintervention was 90% and 85.7% patients were extremely satisfied with the treatment outcome. No further reports of further hypersensitivity reactions after one year.ConclusionThe 3-year follow-up results of the ASVS registry demonstrated continued and sustained clinical efficacy with few reinterventions following CAG embolization in Asian patients with chronic venous insufficiency.Trial registrationClinicalTrials.gov Registration: NCT03893201.

Blocked-flow vs. free-flow cyanoacrylate glue embolization: Histological differences in an in vivo rabbit renal artery model

PurposeThe purpose of this in vivo animal study was to compare the acute histological effects on the arterial vessel wall of free-flow vs. blocked-flow embolization with metacryloxysulfolane-n‑butyl cyanoacrylate (MS-NBCA) in several concentrations. Materials and methodsA total of 42 rabbit renal arteries were embolized using MS-NBCA mixed with ethiodized oil. The MS-NBCA concentration was 12.5%, 25%, or 50%. All mixtures were injected under both free-flow and blocked-flow conditions. The rabbits were euthanised 30 min after arterial embolization. Arterial-lumen distension, intimal inflammation and necrosis, peri‑arterial edema, and distality of MS-NBCA penetration were assessed histologically. Multivariable regression analyses were performed using a manual backward procedure, with linear, ordinal and logistic regression to search for factors associated with these outcomes ResultsMarked or severe dilatation was observed in 36 out of 42 arteries (86%) and marked or transmural intimal arteritis in all 42 arteries (42/42; 100%). Lumen dilatation caused focal vessel-wall flattening, which resulted in intimal necrosis. Multifocal necrosis extending from the intima to the media occurred in 23 out of 42 kidneys (55%) and peri‑arterial edema with multifocal vascular leakage in 19 out of 42 kidneys (45%). At multivariable analysis, blocked-flow MS-NBCA injection was associated with greater severity of vessel-wall lesions, including intimal arteritis (P = 0.003) and intimal necrosis (P = 0.014), compared to free-flow injection. Blocked-flow injection was also associated with peri‑arterial edema (P = 0.008) and greater distality of MS-NBCA penetration (P = 0.001). ConclusionBlocked-flow MS-NBCA injection during renal artery embolization is significantly associated with more acute arterial-wall damage and greater distality of glue penetration compared to free-flow injection in a rabbit model. These preliminary findings may have clinical implications, as blocked-flow injection is routinely used to treat specific vascular diseases or malformations in human.

A pictorial essay of ultrasound findings after endovascular procedures for superficial chronic venous disease

To date endovascular surgical techniques represent an effective and widely used choice in the treatment of superficial venous insufficiency. In recent years, tumescent ablative techniques (endovenous laser ablation, radiofrequency ablation) have been joined by non-tumescent ablative techniques (mechanical-chemical ablation and cyanoacrylate glue embolization). The Duplex ultrasound (DUS) is the survey mostly used to evaluate the outcome of these procedures. The aim of this work was to provide an updated overview of the ultrasound aspects that can be found in the follow-up of patients undergoing endovascular procedures. Specifically, the characteristic imaging pictures will be described in the immediate and short/medium term follow-up. The DUS is a fundamental element of the investigation of venous system of the lower limbs after the surgical and endovascular treatment of varicose veins. Therefore, it is necessary to update one’s knowledge regarding ultrasound patterns related to new endovascular procedures.

Evaluatıng the Impact of Great Saphenous Veın Reflux Pattern on Clınıcal Severıty and Treatment Modalıty

Objectives: This research aimed to determine the impact of reflux patterns in patients with great saphenous vein (GSV) insufficiency on clinical severity and management. Methods: We evaluated 771 lower extremities of 452 patients having GSV insufficiency with Doppler Ultrasound. We characterized the reflux patterns like previously done in the literature: type 1, GSV reflux without the involvement of perimalleolar region or saphenofemoral junction (SFJ); type 2, GSV reflux involving perimalleolar region; type 3, GSV reflux involving SFJ; type 4, GSV reflux involving both perimalleolar region and SFJ. Then we conducted a study to evaluate the relationship between GSV reflux type and age, gender, venous clinical severity score (VCSS), clinical, etiological, anatomical and pathophysiological elements (CEAP), body mass index (BMI) and gave an effort to compare the groups by therapeutic strategies. Results: The mean age was 44±11 years. The male-to-female ratio was 0.49. The most commonly observed reflux pattern was type 3 (48%) in patients with GSV insufficiency and varicose veins. Patients with type 1 reflux were younger, had lower BMI, and had a better clinical situation (p=0.002). VCSS was associated with perimalleolar region involvement, as increased in type 2 reflux than type 1, and higher VCSS was related to SFJ involvement as defined in type 3 reflux. Type 4 reflux patients had the highest VCSS that means the most severe clinical presentation. Sclerotherapy was the most common treatment modality in type 1 reflux (p&lt;0.001). Also, in type 2 and type 4 reflux, sclerotherapy was more preferred than type 3 (p&lt;0.001). Type 4 reflux pattern required mostly radiofrequency ablation, compared with type 3 (28.2% vs 20.5%; p&lt;0.05) after initial diagnosis. Cyanoacrylate glue embolization was the appropriate therapeutic option in only 3.2% of type 4 reflux patients, which was significantly lower than type 3. Conclusion: According to the reflux pattern classification system based on SFJ and malleolar region involvement as practiced in this study, we described a correlation between VCSS, CEAP, BMI, and the extent of venous insufficiency. This correlation with consideration of cosmetic reasons and vein diameter measurements can suggest further treatment modality. Advances in knowledge: We investigated a practical, clinically applicable, and widely accepted standard method for classifying GSV insufficiency. Mapping venous insufficiency with such a system is essential to determine the clinical severity and the most appropriate treatment modality.

S1874 EUS-Guided Cyanoacrylate Glue Embolization of Rectal Varices Prior to EMR of Large Rectal Polyp

S1874 EUS-Guided Cyanoacrylate Glue Embolization of Rectal Varices Prior to EMR of Large Rectal Polyp

Ultrasound-Guided Percutaneous Antegrade Varicocele Embolization with Cyanoacrylate Glue as an Alternative to the Standard Retrograde Approach.

We report a case of a 29-year-old male referred to our hospital for endovascular treatment of a left-sided painful varicocele. Standard retrograde embolization via the left renal vein was not possible because of the presence of a left circum-aortic renal vein making the catheterization of the testicular vein not feasible. The patient was successfully treated via ultrasound-guided percutaneous antegrade access of the testicular vein at the inguinal level with subsequent cyanoacrylate glue embolization as a minimally invasive alternative to surgical therapy. This is a new approach to varicocele embolization when the left renal vein does not feed the varicocele.

Bleeding after Microwave Ablation in Hepatocellular Carcinoma: Successful Treatment with Percutaneous Ultrasound-Guided Cyanoacrylate Glue Embolization.

Bleeding after Microwave Ablation in Hepatocellular Carcinoma: Successful Treatment with Percutaneous Ultrasound-Guided Cyanoacrylate Glue Embolization.

Periorbital Inner Canthal Arteriovenous Malformations: Percutaneous Glue Embolization in Three Cases

AbstractInner canthal or palpebral arteriovenous malformations (AVMs) are uncommon and difficult lesions to treat if they are of high-flow type. Though they may present with mainly cosmetic reasons, they derive feeders from the ophthalmic artery and are associated with dangerous anastomoses. Percutaneous liquid embolic agent has been used to treat various head and neck vascular malformations and tumors and, if done in meticulous attention to detail, can offer cure or control before surgical excision. We report three adults who presented with medial canthal swelling and on imaging diagnosed to have high-flow AVMs. They underwent percutaneous n-butyl cyanoacrylate (glue) embolization and subsequently operated to excise the embolized malformation without any blood loss or complications.

Single-stage embolization with n-butyl cyanoacrylate and surgical resection of venous malformations.

Sclerotherapy or surgical resection is options for symptomatic venous malformations (VM). Sclerotherapy may require repetitive intervention and resection is often avoided due to operative morbidity. The purpose of this study was to report use of single-stage n-butyl cyanoacrylate glue embolization and surgical resection of focal VM. A review of patients with focal VM who underwent glue embolization followed by resection at a single tertiary care vascular malformations center was performed. All embolizations were performed with ultrasound and fluoroscopy under the same anesthetic as resection. Patient characteristics and outcomes were evaluated. Fifteen procedures were performed in 12 patients with a total of 20 VM addressed, as several patients had multiple VM. Mean age was 16 ± 9 years. Malformation locations included scalp, hip, gluteal, labial, toe, finger, face, lip, chest, and foot and size ranged from 1.0 to 10.5cm. Median (range) of prior sclerotherapy treatments was 3 (0-5) and three patients previously underwent surgical resection. Median blood loss was zero (0-10) mL. Surgical complications occurred after five procedures (33%) including superficial wound dehiscence and cellulitis. No complications required readmission or reoperation. At a median follow up of 195 (103-266) days, no patients have required additional treatment. Glue embolization and resection of focal VM of variable size and location appears to have durable results and low surgical morbidity. This single-stage procedure, often performed as an outpatient, may be utilized as upfront treatment for symptomatic malformations or for VM refractory to other treatments.

Type III coronary perforation during chronic total occlusion percutaneous coronary interventions treated with Cyanoacrylate glue embolization: case report and review of the technique

Type III coronary perforation during chronic total occlusion percutaneous coronary interventions treated with Cyanoacrylate glue embolization: case report and review of the technique

EUS-Guided Coil and Glue Embolization of Jejunal Varices: Presidential Poster Award

Jejunal varices are uncommon and challenging to manage given their anatomical location. There is currently no standardized treatment. However, EUS-guided cyanoacrylate glue injection and coil embolization have been reported. We describe successful use of EUS-guided cyanoacrylate glue and coil embolization for non-bleeding jejunal varices. A 58-year-old male patient with history of Roux-en-Y gastrojejunostomy presented with hematemesis and hematochezia. On initial assessment via push enteroscopy, non-bleeding jejunal varices with high risk stigmata were identified 15-20cm distal to the gastrojejunostomy. A varix measuring up to 8 millimeters in diameter was identified sonographically with color Doppler. After accessing the varix with 19 gauge FNA needle, D5W was injected into the vessel to confirm the position. Coil embolization was chosen over glue injection alone due to the large size of the vessel and concern for glue migration. A 0.035-inch cone-shaped fibered coil was chosen for embolization. Coil size was chosen to be approximately 20 percent larger in diameter than the target vessel to create enough radial force to prevent migration. The coil contains thrombogenic fibers to promote clot aggregation and occlude the vessel. The coil was deployed into the varix using a stylet and was identified as hyper-echogenic expansion occupying the lumen of the varix on EUS. The needle was left in place after coil deployment to maintain access in case a second coil or glue injection was needed. Two minutes after coil placement, no further flow was seen within the vessel. Therefore, glue injection was not performed and the needle was retracted. For a smaller varix measuring 5 millimeters in diameter, glue injection was deemed sufficient for embolization. The varix was accessed with a 22 gauge FNA needle and 2 cubic centimeters of 100% n-butyl-cyanoacrylate glued was injected. After confirming no active flow in the vessel after glue injection, the needle was retracted. Enteroscopy was performed after embolization and no active bleeding was seen from the varices. EUS-guided intervention can be successfully used for embolization of small bowel varices. EUS-guided coil embolization may be used in larger varices to prevent glue migration. EUS-guided cyanoacrylate glue alone is often effective for embolization of smaller varices. Watch the video: https://goo.gl/cxrwTr1695_A Figure 1. Left: Coil with thrombogenic fibers was chosen. The fibers promote clot aggregation and occlude the vessel Right: A large varix measuring up to 8 millimeters in diameter on color Doppler is identified1695_B Figure 2. Left: Deployed coil is identified as hyper-echogenic expansion occupying the lumen of the large varix on EUS (marked with a red circle) Right: 2 minutes after the coil placement, no further flow is seen within the vessel on color Doppler1695_C Figure 3. Left: Smaller varix measuring up to 5 millimeters is identified with color Doppler Right: Diminished flow through the varix on color Doppler is noted after injection of 2 cubic centimeters of 100% n-butyl-cyanoacrylate glue

N-butyl cyanoacrylate embolotherapy: techniques, complications, and management.

The purpose of this article is to describe acute complications associated with adhesive cyanoacrylate deposition in the peripheral circulation and their management. Despite best efforts, n-butyl cyanoacrylate glue embolization is inherently unpredictable and complications do occur. An understanding of preparation techniques that minimize adverse event rates and the technical skillset required to manage complications are necessary for the safe and efficient use of liquid embolic agents.

First Report of Balloon-Occluded Antegrade Cyanoacrylate Glue Embolization (BAGE) for Bleeding Rectal Varices from India

First Report of Balloon-Occluded Antegrade Cyanoacrylate Glue Embolization (BAGE) for Bleeding Rectal Varices from India

Preoperative Cyanoacrylate Embolization of Venous Malformations

AbstractPercutaneous sclerotherapy and standalone surgical excision have historically been the mainstay of treatment for pediatric venous malformations (VMs). However, both approaches have significant limitations. Sclerotherapy often requires multiple treatment sessions, with each round adding additional procedural and anesthetic risks as well as radiation exposure. Standalone surgical excision of VMs can be complicated by high-volume blood loss, and indistinct lesion margins can lead to incomplete resection, resulting in recurrence. An alternative to these approaches is percutaneous cyanoacrylate glue embolization followed by immediate surgical excision, a single-stage procedure that allows for better surgical margin definition and reduced intraoperative blood loss, potentially leading to more definitive treatment. The authors describe the interventional radiology aspects of this combined procedure, emphasizing materials preparation and embolization technique.

EUS-Guided Coil Embolization and Glue Injection in the Management of Bleeding Gastric Varices

Endoscopic cyanoacrylate injection is the standard primary intervention for management of large gastric varices due to benefits seen in hemostasis and rebleeding rates when it is compared to sclerotherapy or with band ligation. This case demonstrates a the role of EUS guided coil embolization and glue injection utilizing Tornado coils and Cyanoacrylate glue in the management of such large bleeding gastric varices. The patient is a 55-year-old Hispanic male with a past medical history of a twenty-year alcohol intake and peptic ulcer disease who presented with hematemesis and melena. Physical exam of the patient was non contributory. He was started on a proton pump inhibitor, octreotide, and ceftriaxone. An initial EGD demonstrated moderate sized esophageal varices without stigmata of recent bleeding and large gastric varices with red wale marks. The patient underwent repeat EGD and EUS with Doppler imaging which demonstrated visualization of large gastric varices in the fundus. Doppler ultrasound techniques demonstrated large flow within the gastric varices. A Tornado coil and Cyanoacrylate glue were loaded into a Cook 19 gauge EchoTip needle. The large varices were injected with the Tornado coil and 3 cc of Cyanoacrylate glue leading to embolization and cessation of blood flow as demonstrated through Doppler investigation. The patient had no subsequent gastrointestinal bleeding and was discharged home on a proton pump inhibitor, propranolol, ceftriaxone, and Carafate with a plan to follow up in clinic in one week. Utilization of tornado coil's synthetic fibers in conjuntion with cyanoacrylate injection allows for a space occupation effect of the coil and cyanoacrylate retention leading to obliteration of the varix lumen with the added benefit of the need for less volume of cyanoacrylate. The techniques demonstrate the novel ability to manage large gastric varices specifically, with tornado coil and cyanoacrylate glue embolization through EUS guidance.Figure: EUS scope visualization of the gastric varices including Doppler views demonstrating large varices with turbulent flow.Figure: A FNA 19 gauge needle can be visualized puncturing the large cluster of gastric varices and the coil was introduced through the stylet followed by an injection of 3 ccs of cyanoacrylate glue.Figure: Doppler visualization post injection demonstrating decreased flow in the gastric varices post embolization.

Early Experience in the Management of Postoperative Lymphatic Leakage Using Lipiodol Lymphangiography and Adjunctive Glue Embolization

PurposeTo evaluate the safety and efficacy of Lipiodol lymphangiography and 3 adjunctive N-butyl cyanoacrylate (NBCA) glue embolization techniques for the management of postoperative lymphatic leakage. Materials and MethodsThis retrospective study included 27 patients with postoperative lymphatic leakage (17 with ascites, 3 with chylothorax, 6 with lymphoceles, and 1 with a skin fistula) who underwent Lipiodol lymphangiography for diagnostic and therapeutic purposes in 3 tertiary referral centers between August 2010 and January 2016. Adjunctive glue embolization was performed as needed by using 3 different techniques: “lymphopseudoaneurysm” embolization, closest upstream lymph node embolization, or direct upstream lymphatic vessel embolization. ResultsSixteen patients were observed to determine the therapeutic effect of lymphangiography, and 8 patients (50%) recovered without further embolization. In 16 patients, including 11 who underwent immediate embolization after lymphangiography and 5 who underwent delayed embolization, a total of 28 embolizations (12 lymphopseudoaneurysms, 14 lymph nodes, and 2 lymphatic vessels) were performed. The technical and clinical success rates of the adjunctive embolizations were 89% (25 of 28) and 94% (15 of 16), respectively. The overall clinical success rate was 85% (23 of 27). The median time from initial lymphangiography to recovery was 5 days. No procedure-related major complications were reported. ConclusionsLipiodol lymphangiography and adjunctive glue embolization techniques appear safe and provide promising efficacy for the management of postoperative lymphatic leakage.

Temporary Inferior Vena Cava Filters: Indications, Retrieval Rates and Follow-Up Management at a Single Academic Institution

Objectives: This study assessed the safety and efficacy of cyanoacrylate glue embolization (CGE) for the treatment of refluxing varicose veins. Methods: A prospective registry was created starting January 2014 for all patients with refluxing varicose veins undergoing CGE at a single center. Neither tumescent anesthesia nor postinterventional compression stockings were incorporated into the treatment. All patients underwent clinical examination and duplex ultrasound evaluation at 2 and 6 months postprocedure. Results: CGE was performed in 67 patients or 103 extremities with 108 vein segments. Target vein segments included 82.4% (89 of 108) great saphenous veins, 12.0% (13 of 108) short saphenous veins, and 5.6% (6 of 108) accessory saphenous veins. The treated segment lengths had a range from 12 cm to 63 cm. Technical success, defined as complete closure of the refluxing vein immediately after the procedure diagnosed by duplex ultrasound, occurred in 100% (108 of 108) of vein segments. The procedure was well tolerated, with only 10.4% (7 of 67) of patients experiencing venospasm. Ultrasound results were available for 80.6% (54 of 67) and 46.3% (31 of 67) of patients at 2 and 6 months, respectively. Only one of 108 target vein segments demonstrated recanalization. The target vein segment occlusion rate at 6 months was 96.8% (30 of 31). No cellulitis or postprocedural paresthesia was reported. No serious adverse events, including deep vein thrombosis, occurred. Conclusions: CGE of refluxing varicose veins is safe and effective without the use of compression stockings or tumescent anesthesia at 6 months.

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

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%.

Factors determining the success of endovascular treatments among patients with spinal dural arteriovenous fistulas

Despite improvements of embolization agents and techniques, endovascular treatment of spinal dural arteriovenous fistula (SDAVF) is still limited by inconsistent success. The aim of embolization is to occlude initial portion of the draining vein by liquid embolic materials. This study investigates factors that contribute to the success of embolization treatments among SDAVF patients. We performed a retrospective analysis on consecutive SDAVF patients who received N-butyl cyanoacrylate (NBCA) glue embolization between January 1992 and June 2012. Univariable and multivariable logistic regression analyses were performed to calculate the probability of successful draining vein occlusion for variable procedure-related factors. We attempted endovascular approach as the first intention treatment in 66 out of 90 consecutive patients. Among them, a total of 43 NBCA glue injections were performed in 40 patients. Successful embolization was achieved in 24 patients (60 %). In multivariable analyses, antegrade flow during microcatheter test injection (OR 13.2, 95 % CI 1.7 to 105.4) and use of glue concentration ≥ 30 % (OR 0.1, 95 % CI 0.01 to 0.8) were detected as significant positive and negative predictors of successful venous penetration, respectively. With persistent antegrade flow, the success rates using a glue mixture of more than 30 % dropped significantly from 85.0 to 42.9 % (p = 0.049). If contrast stagnated during microcatheter injections, success rates were low regardless of glue concentrations. Presence of antegrade flow toward the draining vein and injection of NBCA glue less than 30 % are associated with higher chance of draining vein penetration and, therefore, successful endovascular SDAVF obliteration.