Cyanoacrylate occlusion of a renal arteriovenous fistula

Renal arteriovenous fistulas have been treated nonsurgically by introducing a variety of therapeutic emboli through angiographic catheters. Autologous clot 11-51. Gelfoam [4, 6], lead shot 171. and steel coils [61 have been used. Particulate emboli frequently block proximal arteries rather than occlude the fistula itself. If the emboli are too small, they may pass through the shunt to the lungs. The creation of an intravascular cast within the fistula offers a theoretical cure. This report shows how isobutyl 2-cyanoacrylate (Ethicon, Inc., Somerville, N.J.), a rapidly polymenizing tissue adhesive, delivered through a balloon microcatheter, has been used to form such a cast.