Partial Splenic Embolization Using n-Butyl Cyanoacrylate Glue: A Technical Overview

Abstract Partial splenic embolization (PSE) is a minimally invasive alternative to splenectomy for conditions such as hypersplenism, portal hypertension, and splenic artery steal syndrome. Although no consensus exists regarding the optimal embolic agent, n-butyl cyanoacrylate (n-BCA) has gained increasing interest due to its ability to provide rapid, durable occlusion independent of the coagulation cascade, along with its potential antimicrobial effects. This review outlines techniques, outcomes, and challenges of PSE using n-BCA. The procedure is typically performed via femoral or radial/brachial access, often facilitated by long sheaths or “mother-child” systems to navigate tortuous anatomy. A dilute n-BCA-Lipiodol mixture (1:5–1:6) supplemented with tantalum for radiopacity is delivered through a D5W-primed microcatheter under fluoroscopic guidance. Multiple delivery strategies may be used to optimize distal distribution and minimize reflux, with careful catheter withdrawal to avoid entrapment. Post-embolization syndrome and periprocedural pain are common but usually managed effectively with multimodal analgesia, while serious complications such as abscess, portal vein thrombosis, or non-target embolization remain uncommon. Clinical studies demonstrate that n-BCA achieves high technical success, rapid splenic devascularization, and significant early increases in platelet and leukocyte counts, thereby enabling systemic therapies in patients with oncologic hypersplenism. Compared with other embolics, n-BCA reduces recanalization risk, shortens procedure time, and allows viscosity-based customization, although direct head-to-head trials in PSE remain limited. Additionally, n-BCA exhibits antimicrobial activity and favorable infection profiles. n-BCA is a safe and effective embolic agent for PSE, offering both durable mechanical occlusion and potential infection-mitigating properties. Further comparative studies are warranted to confirm long-term outcomes and define its role relative to particulate and mechanical agents.