The Use of Glue as an Embolic Agent in Trauma

Abstract

Nonoperative management is becoming more common for hemodynamically stable patients with hemorrhagic traumatic injuries. N-butyl 2-cyanoacrylate (NBCA) glue is a safe and effective embolic agent in cases of solid organ traumatic injury, hemorrhage associated with pelvic fractures, as well as deep and superficial trauma. Although glue can be effectively used off-label in these cases (either alone or in combination with other embolization methods, such as microcoils), operators should first understand the mechanism of action, advantages and disadvantages, common applications, and proper preparation and injection techniques to reduce risk of complications such as nontarget embolization, proximal occlusion preventing distal embolization, and microcatheter occlusion.

Keywords

interventional radiology - glue embolization - trauma - N-butyl 2-cyanoacrylate glue

Publikationsverlauf

Artikel online veröffentlicht:
22. September 2025

• References

• 1 Comby PO, Guillen K, Chevallier O. et al. Endovascular use of cyanoacrylate-Lipiodol mixture for peripheral embolization: properties, techniques, pitfalls, and applications. J Clin Med 2021; 10 (19) 4320
• 2 Lee H, Yoon CJ, Seong NJ, Jeon CH, Yoon HI, Go J. Cryptogenic hemoptysis: effectiveness of bronchial artery embolization using N-butyl cyanoacrylate. J Vasc Interv Radiol 2017; 28 (08) 1161-1166
• 3 Ali A, Ahle M, Björnsson B, Sandström P. Portal vein embolization with N-butyl cyanoacrylate glue is superior to other materials: a systematic review and meta-analysis. Eur Radiol 2021; 31 (08) 5464-5478
• 4 Wong GR, Yu H, Isaacson AJ. Comparison of cost and efficacy of Trufill® vs Histoacryl® n-butyl cyanoacrylate for translumbar type 2 endoleak embolization. Vasc Endovascular Surg 2021; 55 (02) 152-157
• 5 Bellala P, Valakkada J, Ayyappan A, Kumar S. Evidences in uterine artery embolization: a radiologist's primer. Indian Society of Vascular and Interventional RAdiology 2023; 7: 87-96
• 6 Chevaller O, Comby P-O, Guillen K. et al. Efficacy, safety and outcomes of transcatheter arterial embolization with N-butyl cyanoacrylate glue for non-variceal gastrointestinal bleeding: a systematic review and meta-analysis. Diagn Interv Imaging 2021; 102 (7-8): 479-487
• 7 Loffroy R, Guiu B, Cercueil JP, Krausé D. Endovascular therapeutic embolisation: an overview of occluding agents and their effects on embolised tissues. Curr Vasc Pharmacol 2009; 7 (02) 250-263
• 8 Stassen N, Bhullar I, Cheng J. et al. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73 (05) S294-S300
• 9 Suzuki T, Shiraishi A, Ito K, Otomo Y. Comparative effectiveness of angioembolization versus open surgery in patients with blunt splenic injury. Sci Rep 2024; 14 (01) 8800
• 10 Schimmer JA, van der Steeg AF, Zuidema WP. Splenic function after angioembolization for splenic trauma in children and adults: a systematic review. Injury 2016; 47 (03) 525-530
• 11 Venn GA, Clements W, Moriarty H, Goh GS. Proximal splenic embolisation versus distal splenic embolisation for management of focal distal arterial injuries of the spleen. J Med Imaging Radiat Oncol 2021; 65 (07) 869-874
• 12 Schnüriger B, Inaba K, Konstantinidis A, Lustenberger T, Chan LS, Demetriades D. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis. J Trauma 2011; 70 (01) 252-260
• 13 Stassen NA, Bhullar I, Cheng JD. et al. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73 (05) S288-S293
• 14 Charnsangavej C, Chuang VP, Wallace S, Soo CS, Bowers T. Angiographic classification of hepatic arterial collaterals. Radiology 1982; 144 (03) 485-494
• 15 Green CS, Bulger EM, Kwan SW. Outcomes and complications of angioembolization for hepatic trauma: a systematic review of the literature. J Trauma Acute Care Surg 2016; 80 (03) 529-537
• 16 Roh S. Endovascular embolization of persistent liver injuries not responding to conservative management: a narrative review. J Trauma Inj 2023; 36 (03) 165-171
• 17 Lee P, Roh S. Renal embolization for trauma: a narrative review. J Trauma Inj 2024; 37 (03) 171-181
• 18 Salcedo ES, Brown IE, Corwin MT, Galante JM. Pelvic angioembolization in trauma—indications and outcomes. Int J Surg 2016; 33 (Pt B): 231-236
• 19 Rimola J, Perendreu J, Falcó J, Fortuño JR, Massuet A, Branera J. Percutaneous arterial embolization in the management of rectus sheath hematoma. AJR Am J Roentgenol 2007; 188 (06) W497-502
• 20 Ibukuro K, Fukuda H, Tobe K, Akita K, Takeguchi T. The vascular anatomy of the ligaments of the liver: gross anatomy, imaging and clinical applications. Br J Radiol 2016; 89 (1064): 20150925
• 21 Takeuchi Y, Morishita H, Sato Y. et al; Committee of Practice Guidelines of the Japanese Society of Interventional Radiology. Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition. Jpn J Radiol 2014; 32 (08) 500-517
• 22 Walker B, Lung M, Lataifeh H. et al. The incidence of ischemic cholecystitis after prophylactic cystic artery embolization: a single-center retrospective study. Arab J Intervent Radiol 2023; 7: 88-93
• 23 Young S, Rostambeigi N, Golzarian J. The common but complicated tool: review of embolic materials for the interventional radiologist. Semin Intervent Radiol 2021; 38 (05) 535-541