Cardiovascular and interventional radiology · 2026
Safety and Efficacy of Vascular Embolization with N-Butyl Cyanoacrylate-Lipiodol Mixture: A Systematic Literature Review and Meta-Analysis of 8996 Patients.
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Loffroy Romaric, Fouad Mohamed Mostafa, Ben Nasr Mouadh, Giurazza Francesco, Collettini Federico, Maleux Geert, Urbano Jose, Fischman Aaron, Kondo Hiroshi, Bent Clare, Peynircioglu Bora, Soulez Gilles, Abd El Tawab Karim, Luz José Hugo Mendes, Ierardi Anna-Maria, Bilhim Tiago, Clarençon Frédéric, Comby Pierre-Olivier, Darmon-Kern Elisabeth, Chevallier Olivier
Аннотация
PURPOSE: To systematically review the literature and perform a meta-analysis assessing the efficacy and safety of N-butyl cyanoacrylate (NBCA) glue diluted with Lipiodol for vascular embolization.
METHODS: A systematic search of MEDLINE/PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) identified studies published between January 2004 and May 2024. Data were independently extracted and evaluated by two reviewers. Studies reporting efficacy and/or safety outcomes in ≥10 patients treated with NBCA-Lipiodol® Ultra Fluid alone were included. The primary outcome was the overall rate of technically successful embolization, defined as immediate haemostasis or complete occlusion; secondary outcomes included technical success by indication, recurrent bleeding, clinical success by indication, defined according to each indication, and procedure-related complications, including reported major complications.
RESULTS: A total of 150 studies involving 8996 patients were included: 132 peripheral (8301 patients) and 18 central (695 patients) embolization studies. Outcomes varied across indications. Technical success ranged from 94.1% (tumour) to 100% for peripheral indications and from 76.1% (dAVF) to 97.1% (CNS tumour) for central indications. Clinical success ranged from 73.9% (variceal bleeding) to 100% (varicoceles) for peripheral indications and from 57.9% (AVM) to 89.5% (dAVF) for central indications. Substantial between-study heterogeneity was observed, with indication and study design identified as moderators. The overall technical success rate under a random-effects model was 96.5% [95% CI 95.6-97.4], while the estimated clinical success rates were 86.2% [82.3-89.7] for peripheral and 78.7% [57.6-93.9] for central indications. The overall and major complication rates were 15.6% [12.4-19.1] and 3.2% [2.5-3.9], respectively.
CONCLUSION: NBCA is a safe and effective embolic agent across a broad range of vascular indications. It provides high technical and clinical success rates with low reported major complication rates in both peripheral and central territories.
METHODS: A systematic search of MEDLINE/PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) identified studies published between January 2004 and May 2024. Data were independently extracted and evaluated by two reviewers. Studies reporting efficacy and/or safety outcomes in ≥10 patients treated with NBCA-Lipiodol® Ultra Fluid alone were included. The primary outcome was the overall rate of technically successful embolization, defined as immediate haemostasis or complete occlusion; secondary outcomes included technical success by indication, recurrent bleeding, clinical success by indication, defined according to each indication, and procedure-related complications, including reported major complications.
RESULTS: A total of 150 studies involving 8996 patients were included: 132 peripheral (8301 patients) and 18 central (695 patients) embolization studies. Outcomes varied across indications. Technical success ranged from 94.1% (tumour) to 100% for peripheral indications and from 76.1% (dAVF) to 97.1% (CNS tumour) for central indications. Clinical success ranged from 73.9% (variceal bleeding) to 100% (varicoceles) for peripheral indications and from 57.9% (AVM) to 89.5% (dAVF) for central indications. Substantial between-study heterogeneity was observed, with indication and study design identified as moderators. The overall technical success rate under a random-effects model was 96.5% [95% CI 95.6-97.4], while the estimated clinical success rates were 86.2% [82.3-89.7] for peripheral and 78.7% [57.6-93.9] for central indications. The overall and major complication rates were 15.6% [12.4-19.1] and 3.2% [2.5-3.9], respectively.
CONCLUSION: NBCA is a safe and effective embolic agent across a broad range of vascular indications. It provides high technical and clinical success rates with low reported major complication rates in both peripheral and central territories.