Endovascular Embolization of Traumatic Vessel Injury Using N-butyl Cyanoacrylate: A Case Series

• Published in: Indian journal of otolaryngology, and head, and neck surgery and head, and neck surgery, 2024-04, Vol.76 (2), p.1554-1562
• Main Authors: Morsi, Rami Z., Baskaran, Archit, Thind, Sonam, Carrión-Penagos, Julián, Desai, Harsh, Kothari, Sachin A., Mirza, Mahmood, Lazaridis, Christos, Goldenberg, Fernando, Hurley, Michael C., Mendelson, Scott J., Prabhakaran, Shyam, Zakrison, Tanya, Mansour, Ali, Kass-Hout, Tareq
• Format: Article
• Language: English
• Subjects: Embolization; Head and Neck Surgery; Injuries; Medicine; Medicine & Public Health; Original Article; Otorhinolaryngology; Patients; Veins & arteries
• ISSN: 2231-3796; 0973-7707
• DOI: 10.1007/s12070-023-04357-1

There is limited evidence of N-butyl cyanoacrylate (n-BCA) use in endovascular embolization of traumatic face and neck vessel injuries. We investigated the safety and effectiveness of n-BCA for this purpose. We retrospectively analyzed consecutive patients presenting to a Level 1 trauma center between April 2021 and July 2022. We included patients aged ≥ 18 years old with any vessel injury in the face and neck circulation requiring n-BCA embolization. The primary endpoint was n-BCA effectiveness defined as immediate control of active bleeding post-embolization. In total, 13 patients met the inclusion criteria. The median decade of life was 3 (IQR 3 – 5) with a male predominance (n = 11, 84.6%). Median Glasgow Coma Scale score on presentation was 15 (IQR 3–15). Eleven patients suffered gunshot wound injuries; two patients suffered blunt injuries. Injured vessels included facial artery (n = 6, 46.2%), buccal branch artery (n = 3, 23.1%), internal maxillary (n = 5, 38.5%), cervical internal carotid artery (n = 1, 7.7%), and vertebral artery (n = 1, 7.7%). All patients were treated with 1:2 n-BCA to ethiodol mixture with immediate extravasation control. No bleeding recurrence or need for retreatment occurred. One patient died in-hospital (7.7%). Patients were discharged to home (n = 8, 61.5%), day rehabilitation (n = 1, 7.7%), or acute rehabilitation (n = 3, 23.1%). One patient developed a right posterior cerebral artery infarct with hemorrhagic transformation. To our knowledge, this is the first study demonstrating the safety and effectiveness of n-BCA liquid embolism in traumatic vessel injuries, especially penetrating gunshot wounds.