Madhusudhan Kumble Seetharama MD, FRCR, Presenter: Nothing to Disclose

Shivanand Ramachandra Gamanagatti MBBS, MD, Abstract Co-Author: Nothing to Disclose

T. V. Prasad MD, Abstract Co-Author: Nothing to Disclose

Pramod Garg MBBS, MD, Abstract Co-Author: Nothing to Disclose

Peush Sahni MBBS, MS, Abstract Co-Author: Nothing to Disclose

Arun Kumar Gupta MBBS, MD, Abstract Co-Author: Nothing to Disclose

1. To evaluate the feasibility, safety and efficacy of n-butyl cyanoacrylate (NBCA) in embolization of visceral artery pseudoaneurysms (PsA). 2. To illustrate and discuss the indications for the use of NBCA in visceral artery PsA.

30 patients (25 males, 5 females; age range: 15 – 50 years) of gastrointestinal bleed with 30 visceral artery PsA embolized using NBCA between Jan 2011 and Dec 2013 were retrospectively evaluated. The reasons for not using coils, which is the embolizing agent of choice, were assessed in each case. All PsA were embolized using co-axial technique. Glue – lipiodol mixture (25% - 30% glue concentration) was injected in small aliquots (0.1 – 0.3 mL) with serial flushing till the PsA was completely embolized. The technical and clinical success rates were evaluated along with the encountered minor and major complications.

All patients were embolized using NBCA (100% primary technical success) at first presentation. The reasons for using glue as primary embolizing agent were PsA arising from main artery which cannot be sacrificed (18 patients), inadequate landing zone for the coils (4 patients), inability to reach close or distal to the PsA (5 patients) and failed previous coil embolization (3 patients). Mean amount of glue used per procedure was 0.24 mL. Recurrence of PsA occurred in 3 patients indicating a clinical success of 90%. All the three were embolized using coil, glue and thrombin, respectively with 100% secondary technical success. Minor and major complications were seen in 3 patients (10%) each which were managed without major consequences.

NBCA is a safe and effective embolizing agent in expert hands and in selective cases where coils cannot be used or have failed.

Embolization of visceral PsA with coils / microcoils may not be possible in some unusual situations and in such cases NBCA can prove to be an effective embolizing agent in experienced hands.

Kumble Seetharama, M, Gamanagatti, S, Prasad, T, Garg, P, Sahni, P, Gupta, A, Endovascular Embolization of Visceral Artery Pseudoaneurysms using N-Butyl Cyanoacrylate or Glue: Preliminary Experience in a Tertiary Care Centre.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013877.html