Prophylactic splenic artery embolization using n-butyl-2-cyanoacrylate and coils prior to endoscopic necrosectomy in a patient with necrotizing pancreatitis: A case report

• Published in: Radiology case reports Vol. 19; no. 8; pp. 3483 - 3487
• Main Authors: Kamada, Hiroki, Oguro, Sota, Fukushi, Tatsuro, Tannai, Hiromitsu, Ota, Hideki, Takase, Kei
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.08.2024; Elsevier
• Subjects: Case Report; Endoscopic necrosectomy; NBCA (n-butyl-2-cyanoarylate); Necrotizing pancreatitis; Polytetrafluoroethylene (PTFE)-coated microcatheter; Prophylactic embolization; Endoscopic necrosectomy; Prophylactic embolization; Polytetrafluoroethylene (PTFE)-coated microcatheter; Necrotizing pancreatitis; NBCA (n-butyl-2-cyanoarylate)
• ISSN: 1930-0433; 1930-0433
• DOI: 10.1016/j.radcr.2024.05.027

We present a case of prophylactic endovascular embolization in a 51-year-old man with necrotizing pancreatitis (NP) before undergoing endoscopic necrosectomy (EN). Contrast-enhanced CT imaging revealed the presence of a walled-off necrosis (WON) surrounding the pancreas, with the splenic artery coursing through the cavity. The splenic artery was embolized using n-butyl-2-cyanoacrylate (NBCA) and coils to mitigate the risk of massive bleeding in EN. A newly developed polytetrafluoroethylene (PTFE)-coated microcatheter was used to inject NBCA, enabling embolization of a long segment of the splenic artery without adhering to the vessel wall. Coils were placed distal and proximal to the embolized segment to optimize control. Over 5 sessions of EN, no massive bleeding was encountered. This report demonstrates the benefits of utilizing PTFE-coated microcatheters for enhanced safety and maneuverability during embolization with NBCA. Furthermore, it highlights the importance of prophylactic embolization during EN for managing NP.