{"id":7158,"date":"2020-12-29T12:59:22","date_gmt":"2020-12-29T11:59:22","guid":{"rendered":"https:\/\/www.gemitaly.it\/?page_id=7158"},"modified":"2020-12-30T18:49:27","modified_gmt":"2020-12-30T17:49:27","slug":"the-role-of-glubran-2-cyanoacrylate-glue-in-embolization-of-endoleak","status":"publish","type":"page","link":"https:\/\/www.gemitaly.it\/en\/glubran-2-in-interventional-radiology-1-session\/the-role-of-glubran-2-cyanoacrylate-glue-in-embolization-of-endoleak\/","title":{"rendered":"The role of GLUBRAN 2 cyanoacrylate glue in embolization of Endoleak"},"content":{"rendered":"

The role of GLUBRAN 2 cyanoacrylate glue in embolization of Endoleak<\/h3>\n

Dario Poretti MD<\/p>\n

As we all know, endoleak treatments are probably the most difficult part of an EVAR procedure. They currently represent the majority of the complications (10-50%) after EVAR, and the main reason for reintervention (Golzarian J et al., Tech Vasc Interv Radiol 2005). We mainly deal with Type II endoleaks (caused by retrograde branch flow) however also sometimes we treat Type I endoleaks, which treatment options include proximal cuff or extension endograft, as well as balloon angioplasty with large balloons (25 to 30 mm) or large stent placement. Some use coils in the aneurysmal sac and, very occasionally, we have used glue.<\/p>\n<\/div>

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TYPE I ENDOLEAK<\/h3>\n

In this case, we had a very angulated neck, firstly treated unsuccessfully with balloons. We proceeded to insert the catheter outside the graft and inside the aneurysmal sac and checked through aggressive angiography that no flow would leak out of the sac. We injected the glue and completely froze the leak. It is a procedure that requires extreme care, but in a complex case such as this, it proved reliable. Considering hyperdensity, follow up images should preferably be taken through MR scanning, rather than CT. It is to be noted, though, that glue has less hyperdensity, compared to other embolizing materials.<\/p>\n<\/div>

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TYPE II ENDOLEAK<\/h3>\n

The endoleak cavity acts as an \u201carteriovenous malformation nidus\u201d thrombosing the nidus is the key for a successful embolization.<\/strong><\/p>\n

(Baum RA, Endovascular Today, 2003)<\/p>\n

The nidus theory has been investigated: this study involved 29pts to compare outcomes of type II endoleak embolization involving: endoleak nidus only – vs – nidus and branch vessels.<\/p>\n

Embolization of nidus and branch vessels is not superior to embolization of only the nidus in terms of occlusion of type II endoleak and change in sac size despite requiring longer procedure time and resulting in greater patient radiation exposure.<\/strong><\/p>\n

(Hyeon Yu. J Vasc Interv Radiol. 2017 Feb;28(2):176-184)<\/p>\n

In terms of embolization routes<\/strong>, we have:<\/p>\n