Endovascular N-Butyl Cyanoacrylate Embolization for Recurrent Post-Traumatic Radial Arteriovenous Fistula After Failed Surgical Ligation - A Technical Note and Literature Review

Sep 30, 2026

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Endovascular N-butyl cyanoacrylate (NBCA) embolization is presented as a technically simple, single-session option for a recurrent post-traumatic radial arteriovenous fistula (AVF) after failed surgical ligation. The report describes a trauma-related recurrence following previous wrist interventions, including angiographic characterization of a direct AVF and collateral assessment using a selective Allen test. NBCA is delivered via microcatheter glue embolization with blood pressure cuff-assisted flow control, and the case is contextualized with a brief literature comparison against alternative endovascular strategies.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

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Introduction

Technique

Clinical presentation and prior surgery

Angiographic findings and diagnosis

Treatment approach

Vascular Specialist International pISSN 2288-7970 • eISSN 2288-7989 (2026) 42:2 Endovascular N-Butyl Cyanoacrylate Embolization for Recurrent Post-Traumatic Radial Arteriovenous Fistula After Failed Surgical Ligation: A Technical Note and Literature Review Technical Note Ashwin Garg Department of Radiology, Hamdard Institute of Medical Sciences and Research, New Delhi, India Radial arteriovenous fistulas (AVFs), although rare and usually trauma-related, are being observed more frequently due to the growing popularity of transradial catheterization. Treatment options include physical compression, surgical repair, or endovascular intervention. While surgical ligation remains the standard treatment for most extremity AVFs, treatment failure and recurrence have been reported. Endovascular embolization with N-butyl cyanoacrylate (NBCA) is well established in neurovascular and visceral interventions; however, its application in extremity AVFs has rarely been documented. We present a case of recurrent post-traumatic radial AVF successfully treated using NBCA as the sole embolic agent in a single session following failed surgical ligation. This case highlights a technically simple and cost-effective approach using microcatheter-based glue embolization and blood pressure cuff-assisted flow control. A brief literature review is also provided, comparing this technique with other endovascular treatment options, including stent graft placement and balloon-assisted glue embolization. Key Words: Wounds and injuries, Radial artery, Arteriovenous fistula, Therapeutic embolization, Cyanoacrylates Received September 26, 2025 Revised November 15, 2025 Accepted December 8, 2025 Published on January 7, 2026 Corresponding author: Ashwin Garg Department of Radiology, Hamdard Institute of Medical Sciences and Research, Hamdard Nagar, New Delhi 110062, India Tel: 91-9999569536 E-mail: [ashwin_garg@yahoo.co.in](ashwin_garg@yahoo.co.in) [https://orcid.org/0000-0003-3856-471X](https://orcid.org/0000-0003-3856-471X) © 2026 The Korean Society for Vascular Surgery This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([http://creativecommons.org/licenses/by-nc/4.0](http://creativecommons.org/licenses/by-nc/4.0)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Cite this article; Vasc Specialist Int 2026. [https://doi.org/10.5758/vsi.250113](https://doi.org/10.5758/vsi.250113) INTRODUCTION Radial arteriovenous fistulas (AVFs) are rare vascular lesions that most commonly arise as a consequence of trauma. Although their incidence remains low, radial AVFs are being reported more frequently with the expanding use of transradial coronary catheterization and peripheral catheterization. Patients often present in a delayed fashion, frequently after the development of established symptoms such as swelling, pain, or a palpable thrill. Conventional treatment options include prolonged physical compression and surgical ligation; however, endovascular management has increasingly been adopted, particularly in cases of treatment failure or recurrence. In this report, we describe a unique case of postoperative recurrence of a radial AVF in which N-butyl cyanoacrylate (NBCA) was used as the sole embolic agent with blood pressure cuff-assisted flow control, providing a technically simple and cost-effective alternative to conventional approaches. This manuscript does not contain any identifiable patient information. All clinical details and images have been fully anonymized. Due to the retrospective nature of the report and complete de-identification of data, patient consent and ethics committee approval were not required. [https://doi.org/10.5758/vsi.250113](https://doi.org/10.5758/vsi.250113) Page 1 of 6 TECHNIQUE A 23-year-old male presented to our hospital with a history o

FAQs

What condition does the technical note focus on?

It focuses on a recurrent post-traumatic radial arteriovenous fistula after surgical ligation failed.

Why was endovascular NBCA embolization chosen in the reported case?

NBCA was used as the sole embolic agent with blood pressure cuff-assisted flow control, offering a technically simple and cost-effective alternative after recurrence.

What role did angiography play in management?

Angiography demonstrated a direct AVF configuration and evaluated distal perfusion, including a selective angiographic Allen test to confirm adequate collateral circulation.

Sep 30, 2026

Uploaded by Ophelia