EMBOLIZATION OF A HIGH-OUTPUT POSTNEPHRECTOMY AORTOCAVAL FISTULA WITHGIANTURCO COILS AND CYANOACRYLATE

The authors describe the endovascular treatment of a high-output, larg e-caliber, postnephrectomy aortocaval fistula using a mixture of cyano acrylate and lipiodol combined with Gianturco coil embolization. Thirt y-nine coils were used to decrease the flow through the fistula so tha t a fast-polymerizing glue mixture could be injected into the fistula. During rapid polymerization, the N-butyl-2-cyanoacrylate (NBCA) mixtu re was trapped within the coils, providing an easily controllable glue cast in the fistula, thereby preventing inadvertent embolization into the lungs. This approach can be of considerable benefit for thee endo vascular treatment of central high-output fistulas.