Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate.
OBJECTIVE
To evaluate the clinical efficacy of transcatheter arterial embolization with n-butyl cyanoacrylate (NBCA) for ruptured pseudoaneurysms, which are difficult to control by coil embolization alone.


METHODS
Ruptured pseudoaneurysms developed at the celiac trunk (n = 1), gastroduodenal artery (n = 2), pancreatic arcade (n = 1), hepatic artery (n = 3), renal artery (n = 1), and intercostal artery (n = 1) in nine patients. NBCA was mixed with iodized-oil (1:2) and injected via the 3-F microcatheter under fluoroscopic guidance, after the catheter was advanced close to the pseudoaneurysm. Coil embolization was performed to control blood flow before administration of NBCA in seven patients. NBCA was injected immediately after coil embolization in four patients. Embolization with NBCA was performed for recurrent bleeding that occurred within 1-21 days (mean, 10.7 days) after initial coil embolization in three patients. Two patients with peripheral pseudoaneurysms underwent embolization with NBCA alone.


RESULTS
The NBCA mixture was visible under fluoroscopy, and was useful in monitoring the embolization process and deciding the endpoint. Embolization was technically successful without major complications in all patients. Pseudoaneurysms and afferent and efferent arteries were eliminated immediately after embolization. Bleeding was stopped after embolization in all cases. Rebleeding did not occur in any patient during their follow-up periods of 0.7-69.5 months (mean, 17.9 months).


CONCLUSIONS
Embolization with NBCA is a feasible and useful treatment for ruptured pseudoaneurysms, which are difficult to control by coil embolization alone.
Yamakado
K
K
Department of Radiology, Mie University School of Medicine, Tsu, Japan.
Nakatsuka
A
A
Tanaka
N
N
Takano
K
K
Matsumura
K
K
Takeda
K
K
D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D000792:Angiography; D002404:Catheterization / Q000379:methods*; D002445:Celiac Artery / Q000000981:diagnostic imaging; D004386:Duodenum / Q000098:blood supply; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage*; D005260:Female; D005471:Fluoroscopy; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply; D015641:Radiography, Interventional; D012077:Renal Artery / Q000000981:diagnostic imaging; D013270:Stomach / Q000098:blood supply
D004659:Enbucrilate