Conor Oilver Bogue MBBCh, Presenter: Nothing to Disclose

Derek Charles Armstrong MD, Abstract Co-Author: Nothing to Disclose

Karel G. Terbrugge MD, Abstract Co-Author: Nothing to Disclose

Michael John Temple MD, Abstract Co-Author: Nothing to Disclose

Joao Guilherme Amaral MD, Abstract Co-Author: Nothing to Disclose

Philip John MBChB, FRCR, Abstract Co-Author: Nothing to Disclose

To report complications arising following n-butyl cyanoacrylate glue for embolization of vascular lesions in children.

Radiology databases and patient charts were analysed for all vascular interventional procedures in which glue was used between January 2000 and March 2008. Local ethics board approval was obtained. Glue was used in 62 procedures (53 children). Patient demographics, clinical features, procedure records and complications were analysed. Complications were classified as major / minor according to SIR criteria and outcomes of complications were documented.

High flow lesions (n=43) included cerebral arteriovenous malformations (AVM) (n=16),Vein of Galen malformations (VOGM) (n=12), intracranial dural arteriovenous fistulae (AVF) (n=3), cerebral mycotic aneurysm (n=1), facial AVM (n=1), extremity AVM (n=3) , hepatic AVM (n=3), hepatic arterioportal fistula (n=2) and hepatic hemangioma (n=2). Low flow lesions included extremity (n=7) and thoracic (n=1) venous malformations. Major complications occurred in 9/63 procedures, were directly related to glue in 7 (11.1%). Minor complications seen in 9/63 procedures, were directly related to glue in 7 (11.1%). All major complications (7 procedures, 6 patients) occurred in high flow lesions (4 hepatic, 2 VOGMs, 1 extremity AVM) in patients aged between 6days – 10years (mean 23 months), and weighed between 2.85 - 44.2kg (mean 10.9kg) . 4/6 patients with major complications were aged <2 wks of age and or had refractory cardiac failure. Following major complications, 2/6 patients had no long term sequelae, 1 patient required laparotomy with good outcome and 3/6 patients (all < 1month of age) died. Minor complications (7 procedures, 6 patients) occurred in high flow lesions in 6/7 (3 hepatic, 2 cerebral AVMs, 1 VOGM ) and a low flow venous malformation in 1/7. These patients aged between 4 months - 14 years (mean 8years) and weighed between 4.6 - 58.7 kg (mean 27.6kg ). Heart failure was present in 2 patients but was medically controlled in both.

In our series major complications from glue embolization were more prevalent in infants and young children with high flow vascular lesions and heart failure. Major complications were associated with a 50% mortality. Mortality was seen only in the neonatal age group.

This paper increases awareness of the risks of vascular embolisation procedures in infancy.

Bogue, C, Armstrong, D, Terbrugge, K, Temple, M, Amaral, J, John, P, Complications of N-Butyl-2-Cyanoacrylate Glue for Vascular Embolization in Children.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6022471.html