Balloon-Assisted n -Butyl Cyanoacrylate Filling of Saccular Portal and Splenic Vein Pseudoaneurysms

Abstract

Purpose:

This report describes endovascular treatment of saccular portal and splenic vein pseudoaneurysms using n-butyl-2-cyanoacrylate (nBCA) with balloon assistance.

Case report:

The first case was a 39-year-old female who developed a gastric ulcer after undergoing living-donor liver transplantation (LDLT) due to liver failure following surgery for congenital biliary atresia. Two saccular pseudoaneurysms were developed in the main trunk of the splenic vein, caused by the gastric ulcer, and protruded into the stomach. The second case was a 43-year-old male who presented with a saccular pseudoaneurysm in the main portal vein after LDLT. Because these pseudoaneurysms caused severe hemorrhage in both cases, endovascular treatments were performed via the transhepatic approach in the first case and via the ileocolic approach in the second case. Each pseudoaneurysm was successfully packed with 50% nBCA under balloon-assisted flow control, while preserving the parent veins.

Conclusion:

Balloon-assisted nBCA filling of saccular portal venous system pseudoaneurysms is an effective endovascular treatment that can preserve blood flow in parent veins. This technique could become a treatment option, especially when surgery or stent graft placement is difficult for clinical or technical reasons or due to limited stent availability.

Clinical Impact

This report presents an alternative endovascular method for embolizing portal venous system pseudoaneurysms while preserving parent veins. This approach, consisting of nBCA filling with balloon-assisted flow control, offers an alternative to stent graft or covered stent placement. Balloon-assisted nBCA filling can become a viable treatment option for saccular portal venous system pseudoaneurysms, particularly when surgery or stent graft placement is difficult for clinical or technical reasons, or due to limited stent availability.