N-butyl Cyanoacrylate Embolization Research Articles

Iodixanol as a New Contrast Agent for Cyanoacrylate Embolization: A Preliminary In Vivo Swine Study.

N-butyl cyanoacrylate (NBCA) is a lipophilic, permanent embolic glue that must be opacified for fluoroscopic guidance. Empirically, lipophilic Lipiodol Ultra Fluid® (LUF) has been added to produce a single-phase physically stable mixture. Varying the dilution ratio allows control of glue polymerization kinetics. LUF is far more costly than water-soluble iodinated contrast agents (ICAs). Our purpose was to evaluate whether a water-soluble nonionic iso-osmolar ICA could be used instead. We embolized both renal arteries of six swine using 1:3 NBCA-LUF or NBCA-iodixanol in 1:1, 1:3, and 1:7 ratios. We used both micro-computed tomography to assess the distality of glue penetration and indexed cast ratio and histology to assess distality, arterial obliteration, vessel-wall damage, and renal-parenchyma necrosis. Glue-LUF produced significantly greater indexed cast ratio and renal-artery ROI values and a significantly shorter cast-to-capsule distance. The injected volume was significantly greater with 1:7 iodixanol than with the other mixtures. No significant differences were found for histological evidence of artery obliteration, vessel-wall damage, or renal-parenchyma necrosis. This is the first study dealing with ICA alone as a contrast agent for cyanoacrylate embolization, compared to LUF. More research is needed to determine whether water-soluble nonionic iodinated agents can be used for human NBCA embolization given the good safety profile, availability, and low cost of ICA.

The story of N-butyl cyanoacrylate saphenous vein ablation

In 2009, our group was approached by an experienced radiologist who proposed to close refluxing saphenous veins with glue; an idea based on his experience with N-butyl cyanoacrylate (TRUFILL) embolization of cerebral arterial venous malformations. We henceforth began with a swine model, 1 Almeida J.I. Min R.J. Rabe R. McLean D.J. Madsen M. Cyanoacrylate adhesive for the closure of truncal veins: 60-day swine model results. Vasc Endovascular Surg. 2011; 45: 631-635 Crossref PubMed Scopus (74) Google Scholar and then moved to first-in-human studies 2 Almeida J.I. Javier J.J. Mackay E. Bautista C. Proebstle T. One-year follow-up of first human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. J Vasc Surg Venous Lymphatic Disord. 2013; 1: 174-180 Abstract Full Text Full Text PDF PubMed Scopus (122) Google Scholar for nonthermal ablation of the saphenous vein with their proprietary N-butyl cyanoacrylate glue. Of interest, during the regulatory development pathway, this product was approved as a device, not a drug. It's efficacy has proved excellent, and during the past decade cyanoacrylate closure (CAC) has been adopted widely worldwide. However, reports of hypersensitivity-related adverse events, and granulomas, have begun to surface. It is timely that Dr Athavale and his team have recently published an excellent systematic review on CAC. Based on the available literature, the adverse events related to cyanoacrylate glue can be divided into the following: phlebitis, hypersensitivity (type I and type IV), foreign body granuloma, endovenous glue induced thrombosis and infection. These adverse events may require prolonged steroid use or vein excision. Cyanoacrylate glue reactions: A systematic review, cases, and proposed mechanismsJournal of Vascular Surgery: Venous and Lymphatic DisordersVol. 11Issue 4PreviewCyanoacrylate glue closure was first used in humans 10 years ago to treat venous reflux of the axial veins. Studies have since shown its clinical efficacy in vein closure. However, great need exists to elucidate further the types of specific adverse reactions that cyanoacrylate glue can cause for better patient selection and to minimize these events. In the present study, we systematically reviewed the literature to identify the types of reported reactions. In addition, we explored the pathophysiology contributing to these reactions and proposed the mechanistic pathway with inclusion of actual cases. Full-Text PDF

Liver Venous Deprivation Using Amplatzer Vascular Plug-Assisted N-Butyl Cyanoacrylate Embolization of the Portal and Hepatic Veins: How Do I Do it?

Liver resection can be curative in a select group of patients with primary and secondary hepatobiliary malignancies.[1] For these patients, the size and function of the future liver remnant (FLR) must be carefully considered to limit the potential for posthepatectomy liver failure (PHLF), a predominant cause of mortality.[1] [2] [3] [4] Preoperative portal vein embolization (PVE) has been shown to increase the volume of the FLR, allowing more patients to become surgical candidates and improving postoperative outcomes.[1] [2] [5] [6] [7] PVE occludes the portal venous branches supplying the lobe of the liver to be resected and redirects blood flow toward the FLR, leading to compensatory hypertrophy.[2] [8]

Proper ophthalmic artery aneurysms.

The ophthalmic segment of the internal carotid artery (ICA) represents a common site for cerebral aneurysms. However, aneurysms of the ophthalmic artery (OphA) itself represent rare lesions and have been associated with trauma and flow-related lesions such as arteriovenous fistulas or malformations. Here, we explore clinical and radiological features of four patients managed for five proper ophthalmic artery aneurysms (POAAs). Patients undergoing diagnostic cerebral angiogram (DCA) between January 2018 and November 2021 with newly or previously identified POAA were retrospectively reviewed. Clinical and radiological data were analyzed to identify common and unique features. Four patients with identification of five POAA were identified. Three patients suffered traumatic brain injury with subsequent identification of POAA on DCA. Patient 1 presented with a traumatic carotid-cavernous-sinus fistula requiring transvenous coil embolization and second stage flow diversion of the ICA. Patient 2 suffered a gunshot wound with ICA compromise, ethmoidal dural arteriovenous fistula (dAVF) development with rapid growth of two POAAs eventually requiring Onyx embolization. Patient 3 was assaulted and DCA showed a POAA without any other cerebrovascular pathology. Patient 4 had undergone N-butyl cyanoacrylate embolization of an ethmoidal dAVF 13 years ago with the feeding OphA carrying a large POAA. Re-DCADCA was performed for a newly developed and unrelated transverse-sigmoid-sinus dAVF. Management of POAAs poses a challenge to neurovascular surgeons since POAAs inherit a risk for visual deterioration or hemorrhage. DCA facilitates identification of coexisting cerebrovascular pathology. If clinically silent and not accompanied by cerebrovascular disease, observation appears reasonable.

Lymphatic Embolization versus Sclerotherapy for Symptomatic Post-operative Pelvic Lymphocele (LESPOL): A Randomized Pilot Study

This study was performed to compare clinical outcomes of lymphatic n-butyl cyanoacrylate (NBCA) embolization and ethanol sclerotherapy in patients with symptomatic postoperative pelvic lymphoceles. This prospective, open-label, randomized, and controlled trial took place at two medical centers in Korea. Patients ≥ 18 years old with symptomatic postoperative pelvic lymphoceles were randomly assigned (1:1) to one of two study arms: embolization or sclerotherapy. A target of 44 patients was set for each group to assess clinical outcomes. The trial began in August 2018 but ended as a pilot study in February 2020. Problematic patient enrollment precluded full population recruitment, only 11 patients (embolization, 5; sclerotherapy, 6) eventually participating. Clinical success and drainage tube removal rates were 100% in both arms. To achieve clinical success, significantly more procedures were needed in the sclerotherapy group than in the embolization group (4.5 ± 1.23 vs 2.0 ± 1.00; p < 0.001). The time to achieve daily drainage reduction thresholds (< 20 mL or < 20% of initial daily drainage) was also less in the sclerotherapy (vs embolization) group but fell short of statistical significance (4.8 ± 2.63 days vs 7.0 ± 3.67 days; p = 0.267). No significant adverse events or recurring symptomatic lymphoceles were evident at 3-month follow-up visits. Both NBCA embolization and ethanol sclerotherapy might be safe and effective in treating symptomatic postoperative pelvic lymphoceles, showing no significant difference in clinical outcomes. In a future randomized prospective study, it is essential to establish better inclusion criteria to selectively include intractable lymphoceles to find out the difference in the outcome between the two treatments. Trial registration: The study is registered as KCT0003078 at the Clinical Research Information Service ( http://cris.nih.go.kr ). Registered April 2, 2018.

Unusual Intracerebral Hemorrhage Secondary to Delayed Posttraumatic Middle Meningeal Artery Pseudoaneurysm, Successfully Treated by Endovascular N-Butyl Cyanoacrylate Embolization

AbstractPseudoaneurysm of the middle meningeal artery, presenting as a delayed sequela of trauma, being a rare entity, may sometimes present as an acute intraparenchymal hemorrhage, with a risk of rerupture and mortality. The optimal management in acute settings remains undetermined. We, hereby, report a case of elderly gentleman with a history of a road traffic accident. Noncontrast computed tomography (NCCT) brain was reported to have left parietal hemorrhagic contusion without any mass effect. The patient was managed conservatively without any major neurological deficits. After 7 months, the patient presented with severe headache, altered sensorium, and right hemiparesis. NCCT brain showed acute left thalamocapsular hemorrhage with minimal subarachnoid hemorrhage with associated mass effect and impending herniation. Considering the fall in patient's baseline Glasgow comma scale response, pupillary asymmetry, and CT findings, immediate decompression and hematoma evacuation were advised. In view of atypical morphology, the patient was planned for urgent digital subtraction angiography prior to the surgery to rule out the ruptured aneurysm or pial arterio-venous fistula. Selective angiography of the left external carotid artery demonstrated a dissecting pseudoaneurysm feeding from the middle meningeal artery (MMA), which was embolized using n-butyl cyanoacrylate (NBCA). Postprocedure DynaCT revealed the left temporal bone fracture, indicating this pseudoaneurysm to be most likely posttraumatic delayed sequelae. Postembolization, the patient underwent surgical decompression and excision of hematoma. Patient's neurological status gradually improved and was discharged with the minimal deficit. Our case highlights the importance of awareness of the posttraumatic MMA pseudoaneurysm as an uncommon but treatable entity, which can be easily diagnosed using cerebral angiography and amenable to safe and effective endovascular embolization using NBCA.

Evaluation of mid-term results in our patients treated with N-Butyl cyanoacrylate embolization in saphenous vein insufficiency

Aim: The aim of this study is to present our mid-term results obtained from patients with advanced saphenous vein insufficiency treated with N-butyl cyanoacrylate embolization (CAE). Material and Methods: In the present study, we included 1013 patients who were treated with CAE because of moderate and severe saphenous vein insufficiency in Eskişehir Osmangazi University Medical Faculty Hospital Cardiovascular Surgery Clinic between January 2015 and November 2019. The patients were rechecked at 1st, 6th, 12th, 24th and 36th months. Venous Clinical Severity Score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ) results recorded at preoperative and postoperativee period. Doppler ultrasonography (USG) was performed to all patients in all controls. The absence of re-canalized flow in Doppler USG was accepted as the success of the procedure. Results: The mean age of 1013 patients was 51.27±14.30 years (448 men (44.2%) and 565 women (55.8%)). The average procedure time was 12.4±2.1 minutes, the average amount of CA used in the procedure was 1.6 ml (min: 1 ml - max: 2ml). In outpatient controls, complication rates was low, thrombophlebitis occurred in 17 patients (1.7%) and ecchymosis occurred in 9 patients (0.9%). The occlusion rate was 97.6% according to the 1-year follow-up results and 93.3% according to the 3-year follow-up results. The decrease in VCSS and AVVQ scores was statistically significant when the preoperative and postoperative period results compared (p&lt;.05). Conclusion: In the present study, we think that CAE is a safely and effective treatment method for saphenous vein insufficiency. It has low complication, high occlusion rates and provides better comfort to the patients.

Prospective Evaluation of the Safety and Feasibility of N-Butyl Cyanoacrylate Embolization

Prospective Evaluation of the Safety and Feasibility of N-Butyl Cyanoacrylate Embolization

Risk Factors of Brain Arteriovenous Malformation Embolization as Adjunctive Therapy: Single-Center 10-Year Experience

In the multimodality treatment of complex brain arteriovenous malformations (AVMs), the role of endovascular embolization is not fully elucidated. To assess the risk of embolization, we retrospectively evaluated the outcomes of endovascular treatment for AVM, focusing on the embolization-related complications. The present study included patients with brain AVM who underwent embolization at our hospital between April 2011 and May 2021. Risk factors for peri- and postoperative complications were analyzed. During the study period, 36 AVMs were treated during 58 embolization sessions. The goal of the embolization was preoperative in 24 (67%), pre-radiosurgical in 9 (25%), and palliative in 3 (8%) cases. The overall complication rate was 43% (25 of 58) per session and 36% (13 of 36) per patient. Ischemic and hemorrhagic complications were observed in 14 (24%) and 14 (24%) cases, respectively. n-Butyl cyanoacrylate (n-BCA) embolization was detected as the significant risk for postoperative hemorrhage in the univariate (79% vs. 36%, P= 0.012; Fisher exact test) and the multivariable analysis (odds ratio 4.90, 95% confidence interval 1.08-22.2, P= 0.039). The number of embolized feeder in a single session also tended to be higher in a hemorrhagic complication group (median 3.5 vs. 2.0, P= 0.11; Mann-Whitney U-test). The risk of embolization in multimodality treatment for complex brain AVM was substantial. n-BCA embolization may carry a higher risk of postoperative hemorrhage. An accumulation of cases is awaited to investigate the effectiveness of minimal target embolization in the future.

Applying spectrochemical analyses on venous disease patients treated by N-Butyl Cyanoacrylate Ablation Surgery.

The venous disease of the legs is a common disease among adults that may lead to a deterioration in the structure and concentration of biomolecules. N-Butyl Cyanoacrylate Ablation Surgery (NBCA) or cyanoacrylate embolization (CAE) technique to adhesive the saphenous vein is an alternative method for the treatment of venous disease. We aimed to show what kind of changes occurs after CAE surgery using FTIR spectroscopy combined chemometrics. We compared before and after surgery blood sera of patients to find whether a correlation between spectral data and laboratory indexes. We studied the blood sera of those who suffered from varicose veins and treated them by CAE technique. In order to examine the molecular profiles in blood sera who underwent the CAE technique of the great saphenous vein for the treatment we used Fourier Transform InfraRed spectroscopy (FTIR) spectroscopy of blood samples of patients before and after surgery as a fast diagnostic technique. To obtain information about the spectra variation among the types of samples Principal component analysis (PCA) was performed for fingerprint, amide II with amide I regions. To find normality among variations Partial Least Square P-P plot of residual was performed. Absorbance values were statistically significant only in amide II, amide I, and OH vibrations. In the blood collected before surgery, higher peaks area of α-helix and β-harmonica were noticed. However, in both groups of samples, a higher amount of β-harmonica was visible. Pearson correlation analysis showed that the value of white blood cells (WBC) correlate with absorbance at 2858 cm-1 wavenumber. Moreover, a correlation between neutrophil (NEU) and OH vibrations, and between hematocrit (HCT) and 1082 cm-1, were found. Furthermore, a high correlation Platelets (PLT) and FTIR peak at 1165 cm-1, was noticed. This methodology suggests with PCA analysis CAE caused structural and quantitative chemical changes in blood samples of patients.

The "Bright Falx" Sign-Midline Embolic Penetration Is Associated With Faster Resolution of Chronic Subdural Hematoma After Middle Meningeal Artery Embolization: A Case Series.

Chronic subdural hematomas (CSDHs) are common in the elderly population and patients taking antiplatelet/anticoagulation medications. Middle meningeal artery (MMA) embolization has become an adjunctive treatment to observation and surgery. Despite many embolization techniques, best practices for optimal CSDH resolution remain unknown. To report a retrospective case series of MMA embolization for CSDHs regarding rate of hematoma improvement and the significance of distal embolic penetration into the falx. Retrospective chart review was performed on all patients who underwent MMA embolization for CSDHs between January 2017 and June 2021. Patient demographics, clinical presentation, anticoagulant use, and radiographic features were collected. Pre-embolization and postembolization computed tomography scans were analyzed for volumetric changes and assessed for midline penetration of embolic material in the falx. MMA embolization was performed in 37 patients and 53 hemispheres. Older patients took longer to obtain complete resolution of CSDHs (r = 0.47, P = .03). Patients with larger pre-embolization (r = 0.57, P = .007) and postembolization (r = 0.56, P = .008) CSDH volumes took longer to completely resolve. Patients who had n-butyl cyanoacrylate embolization with midline penetration, as evidenced by the "bright falx" sign, had faster improvement rates than those who did not (5.64 cm 3 /d vs 1.2 cm 3 /d, P = .02). Distal penetration of embolic material, particularly n-butyl cyanoacrylate, into the falx may lead to more rapid improvement of CSDH.

Fogarty-assisted transcatheter embolization of a large renal high-flow arteriovenous fistula

BackgroundRenal high-flow arteriovenous fistulas and its complications may involve high output heart failure, hematuria, hypertension or lethal hemorrhage.Case presentationThis case report covers the case of a 65-year-old male patient with a large renal high-flow arteriovenous fistula of the right kidney (RAVF), treated with balloon-assisted coil and liquid (n-Butyl Cyanoacrylate) embolization. By use of ballon-occlusion with an over-the-wire Fogarty catheter and advancement of a microcatheter through the lumen distal to the balloon during the transcatheter embolization of a high-flow RAVF, control of arterial blood flow is feasible by temporary occlusion of the afferent artery. This technique of flow modulation facilitates controlled deployment of embolization materials and decreases the risk of inadvertent distal embolization by use of only one 6-French (F) arterial sheath.ConclusionsBalloon-assisted embolization using a Fogarty occlusion catheter represents a feasible, safe and effective treatment option for the treatment of large, high-flow arteriovenous fistulas of the kidney.

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Using N-Butyl Cyanoacrylate With D5W Push Technique.

Middle meningeal artery (MMA) embolization has been recognized as a promising treatment for patients with subdural hematoma (SDH). To present the technical feasibility and efficacy of n-butyl cyanoacrylate (n-BCA) embolization in the largest consecutive cohort to date. We retrospectively reviewed our consecutive cases of recurrent SDH treated with MMA embolization using diluted n-BCA with the "sugar rush" technique. In brief, a 2.1-Fr microcatheter was used to selectively catheterize the frontal and posterior branches of the MMA. 5% dextrose in water (D5W) was injected through an intermediate catheter while injecting n-BCA through the microcatheter. Complete obliteration of MMA and lack of SDH recurrence in a 3-6 months follow-up computed tomography scan were defined as efficacy outcomes. Cranial nerve palsy, vision loss, transient neurological deficit, and stroke were defined as safety outcomes. A total of 61 patients were identified with a mean (±standard deviation) age of 62.5 ± 9 years. In 6 patients (10%), coil embolization of the origin of the frontal or posterior branch was performed because super-selective catheterization of the branch was unsuccessful because of tortuous anatomy. Complete obliteration of frontal and posterior branches was achieved in 100% of the cases. Recurrent SDH was seen in 3 patients (5%). No incidence of cranial nerve palsy, vision loss, or stroke occurred. One patient suffered a transient neurological deficit. MMA embolization using diluted n-BCA with concomitant D5W injection is associated with a high degree of distal penetration and complete branch occlusion and minimal risk of cranial nerve palsy or other thromboembolic complications.

N-butyl Cyanoacrylate Embolization Alone Treatment for Organized Hematoma with Repeated Epistaxis: A Case Report

N-butyl Cyanoacrylate Embolization Alone Treatment for Organized Hematoma with Repeated Epistaxis: A Case Report

Does second generation n-butyl cyanoacrylate embolization really smooth in greater saphenous vein closure?

Cyanoacrylate (CA) has been used as an embolizing agent in the treatment of greater saphenous vein (GSV) insufficiency in recent years and the results regarding the use of this method have started to be published. To the best of our knowledge, the publications in literature do not mention about a significant negative effect of endovenous CA (EVCA) embolization. We aimed to evaluate the effects and undesirable events of this relatively new treatment method and compare them with literature, using the follow-up data of our patients. Patients who had GSV insufficiency for at least 3 months and were treated with EVCA embolization because of this disease were included in the study. Patients were excluded if they had deep vein thrombosis (DVT), excessive tortuous GSV, and peripheral neuropathy. Hospital archive records were reviewed and undesirable events like DVT, thrombophlebitis, and pain related to this treatment procedure were recorded. EVCA embolization procedure was performed in a total of 54 patients with an average age of 49.36 ± 13.06 years for the purpose of treating GSV insufficiency. One patient was observed to develop n-butyl CA (NBCA) extension of approximately 5 mm from saphenofemoral junction (SFJ) to the main femoral vein and painful thrombophlebitic reaction was observed in 6 extremities at the first control examination. In our opinion, while EVCA embolization is a treatment option with similar success rates to endovenous thermal ablation (EVTA), it should be kept in mind that there may be a possibility of developing thrombophlebitis and NBCA extension or thrombus extension to the deep veins.

N-Butyl Cyanoacrylate Embolization in Management of Iatrogenic Renal Hemorrhages—Single-Center Study Evaluating Safety and Efficacy

Abstract Objectives The aim of the study was to evaluate the efficacy of endovascular N-butyl cyanoacrylate (NBCA)/glue embolization alone in the management of iatrogenic renal injuries and its effect on renal function. Methods Thirty-one patients who presented with significant iatrogenic renal injuries over a time period ranging from June 2013 to June 2018 were evaluated. The clinical features, lab parameters, and imaging findings were recorded. The embolizing agent used was exclusively NBCA. The success rate was calculated along with the effect of glue embolization on kidney in the form of postembolization ischemia and change in the serum creatinine levels in immediate pre- and postembolization period. The time between the iatrogenic injury and angioembolization as well as the time from angioembolization to discharge was also calculated. Recurrence was evaluated at 1 and 6 months follow-up. Results NBCA embolization showed 100% technical and clinical success in our study and no recurrence was noted at follow-up. Glue was also able to achieve complete embolization in patients with coagulopathy (n = 14, 45.1%). Percentage area deficit of normal renal blush in the postembolization check angiogram varied from 4 to 15.7% with a mean deficit of 7.65%. No significant difference in the serum creatinine was noted in immediate postembolization period. Conclusions We conclude that glue is an effective embolizing agent for management of iatrogenic renal injuries even in coagulopathy patients with minimal area of parenchymal loss, no significant effect on renal functions, and no recurrence on 6 months follow-up.

Transcatheter arterial embolization for massive hemobilia with N-butyl cyanoacrylate (NBCA) Glubran 2.

Massive hemobilia is a life-threatening condition and therapeutic challenge. Few studies have demonstrated the use of N-butyl cyanoacrylate (NBCA) for massive hemobilia. To investigate the efficacy and safety of transcatheter arterial embolization (TAE) using NBCA Glubran 2 for massive hemobilia. Between January 2012 and December 2019, the data of 26 patients (mean age 63.4 ± 12.6 years) with massive hemobilia were retrospectively evaluated for TAE using NBCA. The patients' baseline characteristics, severities of hemobilia, and imaging findings were collected. Emergent TAE was performed using 1:2-1:4 mixtures of NBCA and ethiodized oil. Technical success, clinical success, procedure-related complications, and follow-up outcomes were assessed. Pre-procedure arteriography demonstrated injuries to the right hepatic artery (n = 24) and cystic artery (n = 2). Initial coil embolization distal to the lesions was required in 5 (19.2%) patients to control high blood flow and prevent end-organ damage. After a mean treatment time of 11.2 ± 5.3 min, technical success was achieved in 100% of the patients without non-target embolization and catheter adhesion. Clinical success was achieved in 25 (96.2%) patients. Major complications were noted in 1 (3.8%) patient with gallbladder necrosis. During a median follow-up time of 16.5 months (range 3-24 months), two patients died due to carcinomas, whereas none of the patients experienced recurrent hemobilia, embolic material migration, or post-embolization complications. NBCA embolization for massive hemobilia is associated with rapid and effective hemostasis, as well as few major complications. This treatment modality may be a promising alternative to coil embolization.

Comparative Outcome Analysis of N-Butyl Cyanoacrylate Embolization of the False Lumen Versus Thoracic Endovascular Aortic Repair in Aortic Dissection

PurposeTo evaluate the feasibility, safety, and effectiveness of N-butyl cyanoacrylate (NBCA) embolization for the treatment of aortic dissection. Materials and MethodsIn this single-center retrospective study conducted from February 2003 to June 2019, NBCA embolization of an aortic false lumen was attempted in 12 patients (median age, 59 y; range, 41–68 y) and thoracic endovascular aortic repair (TEVAR) was performed in 53 patients (median age, 59 y; range, 37–70 y) for aortic dissection with one or more indications of persisting pain, malperfusion, rupture or impending rupture, maximal aortic diameter ≥ 55 mm, and/or rapid aortic enlargement. The main exclusion criterion for embolization was the presence of fast blood flow in the aortic false lumen on aortography. The efficacy of NBCA embolization and TEVAR was compared by evaluating technical and clinical outcomes, repeat intervention–free survival (RFS), and overall survival (OS). ResultsTechnical success was achieved in 11 of the 12 patients treated with NBCA embolization (91.7%), and clinical success was achieved in 9 of these 11 (81.8%). No significant difference was found between embolization and TEVAR in clinical success rates (embolization, 81.8%; TEVAR, 84.9%; P = .409) or procedure-related complications (embolization, 1 patient [8.3%]; TEVAR, 4 patients [7.5%]; P = .701). In addition, embolization showed comparable 5-y RFS (embolization, 82.5% ± 9.3; TEVAR, 85.5% ± 4.8; P = .641) and 5-y OS (embolization, 100%; TEVAR, 95.4% ± 3.2; P = .744) rates to TEVAR. ConclusionsNBCA embolization of the false lumen in aortic dissection seems to be a safe and effective treatment modality for the closure of false lumen in selected patients.

Management of life-threatening aortoesophageal fistula: experiences learned from eight patients.

Aortoesophageal fistula (AEF) is a rare but fatal condition causing massive upper gastrointestinal bleeding. To report our experiences in the management of life-threatening AEF. A total of eight patients (seven men, one woman; mean age = 59.4 years; age range = 43‒76 years) presenting with AEF between 2005 and 2018 were recruited from three different Korean hospitals. The medical records of these patients were reviewed for patient demographics, clinical features, diagnostic and therapeutic modalities, and outcomes. Two patients died as a result of massive hemorrhage before endovascular or surgical treatment could be undertaken. Of the six patients who were treated, five underwent endovascular interventions: embolization of the fistula using n-butyl cyanoacrylate (NBCA) and subsequent thoracic endovascular aortic repair (TEVAR) in two patients; TEVAR alone in two patients; and NBCA embolization alone in one patient. Among them, three patients who received TEVAR with or without NBCA embolization in a timely fashion recovered and were discharged. One patient who received delayed TEVAR died of disseminated intravascular coagulation, and one who received NBCA embolization alone died of hemorrhagic shock, both dying within three days of treatment. The remaining patient who underwent surgical aortic repair is alive after 13 years. Rapid identification and surgical treatment are necessary to increase the likelihood of survival, if emergency surgery is feasible. TEVAR in a timely fashion facilitates hemodynamic stabilization by rapidly controlling hemorrhage and saves the patient's life.

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.