N-Butyl Cyanoacrylate Use for the Management of Type II Endoleak in Endovascular Aortic Repair: A Scoping Review

Objective: Different endovascular techniques are available for type II endoleak management. This scoping review aimed to summarize the available evidence on the use of N-Butyl cyanoacrylate (NBCA) for type II endoleak management. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A protocol was registered on Open Science Framework. A systematic search using the PCC (Population, Concept, Context) framework was performed in PubMed, Scopus and Cochrane Library. Findings were systematically presented using structured tables summarizing NBCA techniques, efficacy and safety outcomes. Results: Following full-text assessment, 65 studies were included, comprising cohort and comparative studies, case reports, technical reports and preclinical studies. Single-arm cohort studies reported technical success rates of 90–100%, complication rates of 0–40% and variable durability outcomes, with clinical success ranging from 88 to 100%, endoleak resolution from 40 to 100% and aneurysm sac increase from 13 to 50%. Comparative studies reported improved outcomes with ethanol addition to the NBCA-ethiodized oil mixture compared with NBCA-ethiodized oil alone, shorter procedure times with direct puncture versus intra-arterial approach and more durable mid-term outcomes with selective embolization of contributing branches. Individually reported complications highlighted embolization risks and technical reports focused on catheter utilization. Pre-emptive embolization showed favorable outcomes on sac diameter reduction and endoleak type II occurrence. Conclusions: NBCA demonstrated technical feasibility for type II endoleak management, with variable durability. Considerable heterogeneity existed in access techniques, mixture ratios and outcome reporting. Preventive use demonstrated promising outcomes. Given the retrospective designs, limited sample sizes and heterogenous outcomes, adequately powered prospective studies are warranted.