Endovascular treatment of postcatheterization femoral arteriovenous fistulas with n-butyl-cyanoacrilate embolization

AIM To evaluate the feasibility, safety, and outcomes of n-butyl-cyanoacrylate (nBCA) embolization in patients with iatrogenic femoral arteriovenous fistulas (AVFs). MATERIALS AND METHODS This retrospective study included 22 patients (13 men, 9 women; mean age 63.6 ± 8.0 years) who underwent nBCA embolization for femoral AVFs. Diagnosis was confirmed by Doppler ultrasound. Procedures involved selective catheterization and injection of an nBCA and ethiodized oil mixture under angiographic guidance. Follow-up was performed with Doppler ultrasound at 1 and 12 months. Technical success was defined as angiographic elimination of early venous filling without the need for additional treatment. Group comparisons used the Mann-Whitney U test, and the impact of tract length on outcomes was evaluated by ROC analysis. Effect size (Cohen's h) and post-hoc power analysis were performed. RESULTS Technical success was achieved in 19 of 22 patients (86.3 %). The median fistula tract length was 13.5 mm (range: 6-36 mm). Success rates were significantly higher for tracts >6.5 mm (94.7 % vs. 33 %; p=0.035, Cohen's h ≈ 1.51). ROC analysis showed an AUC of 0.886 (95 % CI: 0.710-1.000), with 94.7 % sensitivity and 66.7 % specificity at a 6.5 mm cut-off. Post-hoc power was 76 %. Two patients required stent-graft placement for incomplete closure. One case of asymptomatic partial venous glue migration occurred, with no clinical sequelae. No major complications or recurrences were observed. CONCLUSION nBCA embolization is a safe and effective treatment for iatrogenic femoral AVFs, especially with sufficient tract length. It is a promising alternative to surgery or stent-graft placement.