{"title":"Clinical Application of n-Butyl-2- Cyanoacrylate (NBCA) in the Transarterial Embolization for Type I/II Endoleak During and After EVAR Surgery","authors":"Li-Ping Jiang, Qi-Bin Wang, Xu Wang, Hong-Mei Zhang, Luo-Yi Ren","doi":"10.1016/j.avsg.2024.09.060","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"110 ","pages":"Pages 439-446"},"PeriodicalIF":1.6000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0890509624006563","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/18 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
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.
期刊介绍：
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence
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