Feasibility and Safety of Sac Embolization Using N-Butyl Cyanoacrylate in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms or Isolated Iliac Artery Aneurysms

概要

Purpose: To evaluate the feasibility and safety of sac embolization with N-butyl cyanoacrylate (NBCA) in emergency endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (AAA) and iliac artery aneurysm (IAA) in comparison to EVAR without sac embolization.

Background: EVAR is a valuable treatment option for patients with ruptured AAA or IAA. However, a drawback of EVAR during follow-up is endoleaks. In ruptured aneurysms, type 2 endoleaks may lead to persistent bleeding from the ruptured site. Sac embolization using embolic materials such as coils and thrombin during elective EVAR has been reported to be useful in preventing type 2 endoleaks. We hypothesized that sac embolization using NBCA could be useful not only to prevent endoleaks, but also to seal the ruptured site.

Material and Methods: Between February 2012 and December 2019, among 44 consecutive patients with ruptured AAA or IAA, 29 underwent EVAR. Of these, 22 patients (median age 77.5 years; 18 men) had concomitant sac embolization using NBCA; the remaining 7 patients (median age 88 years; 6 men) underwent EVAR without sac embolization and form the control group. The technical success, clinical success (hemodynamic stabilization), procedure-related complications, and mortality were compared between the groups.

Results: All EVAR procedures and embolizations were successful. The clinical success rates in the NBCA and control groups were 95% (21/22) and 71% (5/7), respectively (p=0.14). There was no complication related to the procedure. Type II endoleak occurred in 4 of 21 patients (19%) in the NBCA group vs none of the control patients. One patient (5%) died in the NBCA group vs 3 (43%) in the controls (p=0.034).

Conclusion: Thus, sac embolization using NBCA in emergency EVAR appears to be feasible and safe for ruptured AAA and IAA.

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