Endovascular adhesive repair using N-butyl cyanoacrylate for spontaneous dissecting aneurysms of the celiac and hepatic arteries: technique and long-term outcomes.

PURPOSE: To describe false lumen embolization with an endovascular adhesive repair concept, in which N-butyl cyanoacrylate is injected with the intention of promoting reapposition of the dissected layers while preserving the parent-artery.

MATERIALS AND

METHODS

Three men aged 50, 55, and 68 years with spontaneous dissecting aneurysms of the celiac axis (two patients) or the right hepatic artery (one patient, with dissection extending from the common hepatic artery) were treated; one patient had segmental arterial mediolysis; in another, the gastroduodenal collateral pathway had been surgically interrupted by prior pancreaticoduodenectomy. Indications were aneurysm enlargement with persistent pain, progressive aneurysm enlargement, and concern for rupture during planned endoscopic treatment. A microcatheter was navigated into the false lumen under digital subtraction angiography, and a 33% N-butyl cyanoacrylate-iodized oil mixture was injected to embolize the false lumen and appose the intimal flap. In two patients, a silicone balloon catheter was used to limit N-butyl cyanoacrylate overflow into the true lumen; it was introduced through a separate femoral access in Case 1 and through the same guiding sheath as the microcatheter in Case 2. Technical and clinical success, parent-artery patency, complications, and recurrence were assessed.

RESULTS

Evident inflow into the false lumen disappeared in all cases, with all parent-arteries preserved. There was no rupture, unintended non-target embolization, or catheter adhesion. Follow-up showed no recurrence, and patency was verified during clinically indicated vascular studies at 10.5, 6, and 4 years; in two patients the repaired segment again served as a catheterization route.

CONCLUSION

False lumen embolization with an endovascular adhesive repair concept was technically successful with parent-artery preservation in three highly selected patients, and patency was confirmed at 10.5, 6, and 4 years after treatment. Further investigation is required to determine the safety, reproducibility, and appropriate indications of this technique.

LEVEL OF EVIDENCE: Level 4, Case Series.