Embolization of Bronchial Arteries with N-Butyl Cyanoacrylate for Management of Massive Hemoptysis: A Technical Review

N-butyl cyanoacrylate (NBCA) is an adhesive material, which has been used as an embolic agent in various vascular beds. Its role in the management of patients with acute massive hemoptysis has not been reported. In this article we report our experience with 12 such patients who underwent bronchial artery embolization using NBCA and compare the results with 36 procedures using polyvinyl alcohol (PVA) particles. As compared with PVA, NBCA embolizations appear more durable, leading to fewer rebleeds. There were 12 episodes of recurrent hemoptysis after 36 procedures using PVA (33%) with 8 being due to bleeding from a previously embolized vessel. Conversely, there were only 2 of the 12 patients who were treated by NBCA who experienced rebleed (16.6%). In this article, we describe the technical nuances of NBCA embolization of bronchial arteries and review potential pitfalls.