Percutaneous fluoroscopically guided n-butyl cyanoacrylate (NBCA) injection for iatrogenic femoral arterial pseudoaneurysm under temporary balloon occlusion of arterial blood flow.
OBJECTIVE
To evaluate the safety and efficacy of n-butyl cyanoacrylate (NBCA) injection under fluoroscopy for iatrogenic femoral artery pseudoaneurysms under temporary balloon occlusion.


METHODS
This treatment was approved by the Ethics Committee of our institute, and informed consent was obtained from the patients. Three male patients aged 82, 77, and 51 years developed femoral arterial pseudoaneurysms after catheterization. The pseudoaneurysms (diameter: 30, 12, and 15 mm; neck diameter: 1.8, 5.2, and 1.4 mm) were treated with percutaneous NBCA injection under fluoroscopy after failed ultrasound (US)-guided compression. First, a 4-Fr balloon catheter was inserted into the responsible femoral artery via the contralateral approach. An 18-gauge needle was placed in the pseudoaneurysm under US guidance, and a test injection of contrast medium was performed under fluoroscopic guidance to evaluate the extent of the pseudoaneurysm. NBCA-lipiodol (Lp) (ratio, 1:3) was then injected under balloon inflation. The balloon catheter was deflated and withdrawn after treatment.


RESULTS
The total volume of the injected NBCA-Lp was 0.4-1.5 ml. In each case, angiography immediately after NBCA-Lp injection showed eradication of the pseudoaneurysm, and color Doppler US revealed no blood flow signal. No complications were observed. Color Doppler US showed no recurrence in the three patients at their last follow-ups at 6, 12, and 12 months.


CONCLUSIONS
Percutaneous NBCA injection under fluoroscopy with the support of balloon inflation was safe, feasible, and useful for eradicating iatrogenic femoral artery pseudoaneurysms in three cases following failed US compression.
Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Motoki
M
Nakai
Morio
M
Sato
Hiroki
H
Sanda
Akira
A
Ikoma
Nobuyuki
N
Kawai
Hiroki
H
Minamiguchi
Kouhei
K
Nakata
Takami
T
Tanaka
Tetsuo
T
Sonomura
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D021721:Balloon Occlusion; D001783:Blood Flow Velocity; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D003287:Contrast Media; D004659:Enbucrilate / Q000008:administration & dosage / Q000627:therapeutic use*; D005263:Femoral Artery; D005471:Fluoroscopy; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D015641:Radiography, Interventional; D018615:Ultrasonography, Doppler, Color
D003287:Contrast Media; D004659:Enbucrilate