Transcatheter arterial embolization using n-butyl cyanoacrylate metacryloxysulfolane for traumatic or iatrogenic non-visceral hemorrhage.

PURPOSE: To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) using n-butyl cyanoacrylate metacryloxysulfolane (NBCA-MS) as a first-line embolic agent for the management of traumatic and iatrogenic non-visceral arterial hemorrhages in an emergency setting.

MATERIALS AND

METHODS

This retrospective study included all consecutive patients who underwent selective TAE with NBCA-MS for non-visceral hemorrhage of traumatic or iatrogenic origin between June 2021 and June 2025. All patients were assessed with contrast-enhanced multidetector computed tomography (CT) demonstrating active arterial bleeding or pseudoaneurysm prior to embolization. TAE was performed via a femoral approach using selective microcatheterization, followed by embolization with NBCA-MS mixed with ethiodized oil at variable dilutions. Technical success was defined as complete angiographic occlusion of the bleeding vessels. Clinical success was defined as sustained hemostasis without need for repeat endovascular or surgical intervention /within 30 days. Procedure-related complications were recorded according to CIRSE guidelines.

RESULTS

Fifty-four patients (37 males; median age 60.5 years) underwent 54 TAE procedures. Traumatic hemorrhage accounted for 83.3% of cases, and iatrogenic hemorrhage for 16.7%. A single artery was embolized in 72.2% of procedures. Technical success was achieved in all cases (100%). Clinical success was observed in 46 patients (85.2%). Six patients required repeat embolization due to hemorrhage from vessels within the same vascular territory that had not been bleeding during the initial procedure and were therefore not embolized at that time. No procedure-related deaths, major complications, or off-target embolizations were observed.

CONCLUSION

NBCA-MS-based TAE is a safe, effective, and versatile treatment for traumatic and iatrogenic non-visceral arterial hemorrhage. Its high technical success, favorable clinical outcomes, and excellent safety profile support its use as a reliable first-line embolic agent in urgent clinical scenarios.