Safe Prostatic Artery Embolization with Cyanoacrylate: Representative Cases Demonstrating Non-Target Artery...

This study describes five case of prostatic artery embolization (PAE) using n-butyl cyanoacrylate methylsulfone (NBCA; Glubran 2, GEM; Viareggio, Italy) to evaluate its technical advantages, against standard particulate embolization, in managing complex pelvic vascular anatomy while preserving non-target arteries, with particular focus on penile artery protection. NBCA was mixed with iodized oil (Lipiodol Ultra Fluid; Guerbet, Aulnay-sous-Bois, France) at 1:5 dilution and injected in small aliquots (0.1-0.3 mL) under fluoroscopy using a blocked-flow technique, with injection stopped at reflux into the horizontal PA segment. After a few seconds, before the complete polymerization of the glue, the microcatheter is quickly withdrawn, flushed, and reused for the contralateral side. NBCA allowed precise embolic control through distinct mechanisms (direct distal, indirect distal, proximal, reflux and controlateral control), avoiding the need for protective coiling. Glue-based PAE seems a reproducible, safe, and efficient alternative to particulate embolization, offering enhanced embolization control and non-target artery preservation in anatomically complex patients.