Inadvertent accident during balloon-occluded glue injection for facial AVM: rescue procedure using intentional glue injection

Abstract

Background Glue embolization during balloon inflation is a novel technique with many advantages. However, the procedure’s major complication is the adhesion of the balloon catheter by glue. Several studies have reported strategies to prevent this. However, no reports have described a rescue method after accidental adhesion occurs. Case presentation A 26-year-old male was referred to the department of interventional radiology for sclerotherapy of an aggravating large facial arteriovenous malformation (AVM). We planned a transvenous approach to decrease the velocity of AVM and increase the efficacy of the sclerotherapy treatment. We performed glue embolization of a major draining vein during microballoon inflation. Upon injection of the glue, inadvertent glue reflux occurred, and the microballoon was stuck to the vessel wall. While removing the microballoon catheter, its shaft broke in the guiding catheter. We filled the inner lumen of the guiding catheter with glue and waited for polymerization to fixate the broken microballoon catheter inside the guiding catheter. Fortunately, the stuck microballoon was separated, and two broken pieces of microballoon catheter were removed through femoral vein short sheath. Conclusion Intentional glue casting in the outer catheter is very useful when removing anything that is inside the catheter or stuck due to the glue reflux. It can be applied to various similar emergency situations.