In-vitro model of translumbar embolization of endoleaks with NBCA: Risk of gluing different access devices

Endoleaks are well-reported complications of endovascular aneurysmal repair, with the type 2 varieties being the most common. Repair of this complication is performed via transarterial or percutaneous translumbar approaches, and use of N-butyl cyanoacrylate (NBCA) as the embolic agent has shown promise. There is potential, however, for adherence of catheters and devices to this liquid embolic agent. Objective. We wanted to test the utility of a flowing model to simulate translumbar access to treat endoleaks. We sought to assess the risk of adherence of different devices used for translumbar injections of NBCA at different concentrations. Methods. An in-vitro flowing model simulating an aneurysmal sac with endoleak was created. Swine plasma was circulated into a simulated sac with one entry and two exit points. Various access devices were used to access and embolize the aneurysm sac with NBCA, and the resistance to remove the devices was studied. Results. Of the devices tested, no resistance was felt when withdrawing metallic needles and plastic sheaths. Mild to no resistance was noted for catheters, and only the sheath with a curved catheter became adhered to the aneurysm sac (balloon). Conclusion. An in-vitro test of flowing translumbar access was successfully created using simple and inexpensive devices. In this model, the risk of gluing the devices in place was low. Metallic needles and straight sheaths did not have any resistance, and reflux of a concentrated mixture of embolic agent resulted in adherence of the curved catheter and sheath.