Embolization with detachable balloons — Applications outside the head

Abstract

Detachable balloons, although widely used as an embolization material in neurovascular work, are rarely used outside the head. Yet they offer distinct advantages over other methods of embolization in certain situations. They can effect an instant and precise occlusion of large arteries and fistulae and unlike any other embolization technique the occlusion is reversible until the balloon is finally detached. In addition, they can be floated out to distal locations inaccessible with more conventional catheter techniques. They are inflated with contrast medium or silicone monomers. Large arteries and arteriovenous fistulae (AVFs) are best suited to balloon embolization where embolization distal to the fistula resulting in parenchymal infarction is not indicated. Thirteen patients underwent 14 detachable balloon embolizations. Eleven had large AVFs (4 coronary AVFs, 4 Blalock-Taussig shunts, 2 vertebro-vertebral fistulae and 1 renal AVF) and three had large arteries (2 aorto-pulmonary collaterals in one patient and 1 innominate artery pseudo-aneurysm). Twelve of these embolization procedures were successful and there were no complications. The two failures were due to inability to pass the balloon catheter around an acute angle in the introducer catheter and to early deflation. These cases illustrate a wide range of situations where balloon embolization may be used successfully. Continued refinement and improvement in the technique will allow expansion of the indications for non-neurological balloon embolization.