title: Sac angiography and glue embolization in emergency endovascular aneurysm repair for ruptured abdominal aortic aneurysm.
abstract: OBJECTIVE
  The purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.
  
  
  METHODS
  A retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.
  
  
  RESULTS
  Sac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.
  
  
  CONCLUSIONS
  EVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients.
authors.affiliation: Department of Interventional Radiology, Kawasaki Saiwai Hospital, 31-27, Omiya-cho, Saiwai-Ku, Kawasaki, Kanagawa, 212-0014, Japan, r06118@hotmail.co.jp.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Koike
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Nishimura
authors.forename: Soichiro
authors.initials: S
authors.lastname: Hase
authors.forename: Motoshige
authors.initials: M
authors.lastname: Yamasaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000628:therapy*; D001019:Aortic Rupture / Q000000981:diagnostic imaging* / Q000628:therapy*; D003287:Contrast Media; D004621:Embolization, Therapeutic; D004632:Emergency Medical Services / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D004659:Enbucrilate