Transcatheter embolization of systemic artery-to-pulmonary artery shunts with n-butyl-2-cyanoacrylate for pediatric hemoptysis: a single-center retrospective study

BACKGROUND: Systemic artery-to-pulmonary artery (SA-PA) shunt represents a critical pathological mechanism underlying hemoptysis in pediatric patients, yet focused interventional research targeting this specific condition remains limited. Traditional embolic materials are frequently associated with elevated recurrence rates in SA-PA shunt cases. This study assesses the effectiveness and safety profile of n-butyl-2-cyanoacrylate (NBCA) embolization for hemoptysis secondary to pediatric SA-PA shunts, while examining the clinical significance of individualized NBCA dilution protocols. METHODS: This study retrospectively reviewed pediatric hemoptysis cases treated with NBCA embolization for SA-PA shunts at a single center from May 2021 to March 2025. Baseline characteristics, culprit feeding artery features, and NBCA-Lipiodol mixing ratios were collected. The primary study endpoints were technical success rate, 24-hour clinical success rate, incidence of severe complications, and hemoptysis recurrence rate. The Kaplan-Meier analysis was applied to generate the hemoptysis-free survival curve. RESULTS: The study cohort comprised 26 pediatric patients (mean age, 9.12 ± 3.44 years; 12 males and 14 females). Fifty-one abnormal systemic feeding arteries were embolized: 16 (31.4%) orthotopic bronchial arteries, 9 (17.6%) ectopic bronchial arteries, and 26 (51.0%) non-bronchial systemic arteries. The mixing ratio of NBCA-Lipiodol varied between 1:2 and 1:4. The rates of technical success and 24-hour clinical success both reached 100.0%. The early (≤ 1 year) hemoptysis recurrence rate was 7.7%, with no late hemoptysis recurrence over a median 25-month follow-up. Kaplan-Meier analysis showed that median hemoptysis-free survival was not reached. CONCLUSIONS: NBCA embolization achieved favorable safety and efficacy profiles in managing SA-PA shunt-related hemoptysis among pediatric patients, demonstrating sustained clinical benefit with limited disease recurrence. It is a valuable interventional treatment option worthy of clinical promotion.