Clinical Application of n-Butyl-2- Cyanoacrylate (NBCA) in the Transarterial Embolization for Type I/II Endoleak During and After EVAR Surgery

Li-Ping Jiang; Qi-Bin Wang; Xu Wang; Hong-Mei Zhang; Luo-Yi Ren

doi:10.1016/j.avsg.2024.09.060

Clinical Application of n-Butyl-2- Cyanoacrylate (NBCA) in the Transarterial Embolization for Type I/II Endoleak During and After EVAR Surgery

Ann Vasc Surg. 2024 Oct 18;110(Pt A):439-446. doi: 10.1016/j.avsg.2024.09.060. Online ahead of print.

Authors

Li-Ping Jiang¹, Qi-Bin Wang², Xu Wang², Hong-Mei Zhang², Luo-Yi Ren²

Affiliations

¹ Interventional Diagnosis and Treatment Department, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China. Electronic address: jlp201900972@163.com.
² Interventional Diagnosis and Treatment Department, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China.

PMID: 39427979
DOI: 10.1016/j.avsg.2024.09.060

Abstract

Background: Exploring the effectiveness and safety of n-butyl-2-cyanoacrylate (NBCA) in the transarterial embolization for common endoleak during and after endovascular repair of aortic aneurysm (EVAR).

Methods: A total of 226 patients with abdominal aortic aneurysm (AAA) were treated with EVAR in 4 years from August 2019 to February 2023, including 46 patients with ruptured aneurysms (rAAA). 37 cases, 28 nonruptured AAA patients and 9 rAAA patients, developed endoleak during EVAR surgery and follow-up period and were then treated with NBCA for transarterial embolization. A follow-up was done for at least 6 months to observe its clinical efficacy and adverse reactions.

Results: Among 37 cases of endoleak, there were 8 cases of primary type Ia endoleak and one case of primary right type Ib endoleak in the rAAA group, one case of primary type Ib endoleak, 2 cases of secondary type Ia endoleak, and 25 cases of postoperative type II endoleak in the nonruptured AAA group. Three patients with primary type Ia endoleak were treated with coil-assisted NBCA in the rAAA group, while the remaining 34 patients with type I and type II endoleaks were treated with NBCA alone. All transarterial embolization achieved technical success, and the endoleak disappeared. Postoperative hospitalization observation showed that 3 cases of patients in the rAAA group who experienced primary type Ia endoleak during emergency EVAR surgery died within 4 days after surgery due to hemorrhagic shock and multiple organ failure. Two patients experienced non-AAA-related deaths during the follow-up period.

Conclusions: Transarterial embolization with NBCA for the treatment of primary and secondary endoleak is a safe and effective method. It can achieve more dense embolization of the aneurysm sac and more complex endoleaks embolization. And, it showed a low recurrence rate of endoleak and the incidence of perioperative complications after surgery, which is worthy of clinical promotion and application. Even in emergency EVAR combined with primary type I endoleak treatment in rAAA patients, patients can still benefit.