Tissue Response to N-butyl-2-cyanoacrylate After Percutaneous Injection Into Cutaneous Vascular Lesions

In Brief Despite the fact that cyanoacrylates, a group of rapidly polymerizing adhesives, are used widely in general surgery, neuroradiology, otolaryngology, and plastic surgery, scientific data on histopathological changes resulting from the deposition of N-butyl-2-cyanoacrylate (NBCA), a new-generation cyanoacrylate derivative, in human tissues is based largely on experimental observations in animals and sporadic postmortem studies in humans. The authors report the consecutive pathological findings of a patient who underwent surgery for facial hemangioma after percutaneous injection of NBCA for devascularization of a lesion, and underwent additional surgery 1 and 6 months after the initial operation for the removal of the residual NBCA cast from the injection site. Acute inflammatory findings after injection of NBCA and the development of a chronic granulomatous foreign body reaction support the histological findings of experimental animal studies and postmortem examinations on humans. Additionally, their findings support the proposed hypothetical sequence of events for the recanalization of cyanoacrylate-embolized vascular structures. Serial histologic examination of AV malformations and hemangiomas percutaneously injected with n-butyl 2- cyanoacrylate demonstrated thrombosis and acute inflammation progressing to a chronic granulomatous foreign body reaction with subsequent recanalization of embolized vascular structures.