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Management of complication during bronchial artery aneurysm embolization

Submission Type:Case Study

1 Department of Diagnostic and Interventional Radiology, Singapore General Hospital, Singapore 169608, Singapore.

2 Department of Diagnostic and Interventional Radiology, Singapore General Hospital, Singapore 169608, Singapore.

3 Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore 169609, Singapore.

4 Department of Diagnostic and Interventional Radiology, Singapore General Hospital, Singapore 169608, Singapore.

Abstract

Purpose: To report our management technique of glue reflux occurring during embolization of a bronchial artery aneurysm.

 

Case Report: A 68-year-old Chinese male patient presented with an asymptomatic 1.5cm bronchial artery aneurysm, for which he underwent embolization with n-butyl-2-cyanoacrylate (NBCA) glue. During the procedure, a small volume of glue mixture was noted protruding out of the aneurysm into the aorta, which subsequently detached and travelled into the left external iliac artery and left popliteal artery. The glue cast in the left external iliac artery was snared and deposited into the left internal iliac artery, while the smaller fragment in the left popliteal artery was removed. Completion angiograms showed complete occlusion of the bronchial artery aneurysm, and patent bilateral iliac and left lower limb arteries. The patient remained asymptomatic and ultrasound scan one month later showed patent bilateral common, internal and external iliac arteries. Computed tomography performed 16 months post-embolization showed complete occlusion of the aneurysm.

 

Conclusion: This technical report describes a known complication of transcatheter embolization, non-target distal embolization, which must be recognised and managed well to avoid sequelae. This technical complication was recognised and managed as shown with no adverse outcome and good long-term treatment of the lesion.

Main Subjects

Training
Radiological Education
Quality Assurance
+4

Keywords

aneurysm
bronchial artery
transcatheter embolization
n-butyl-2-cyanoacrylate
NBCA
glue
reflux
distal embolization

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