Use of Phil Embolic Agent for Bleeding in Non-Neurological Interventions.

Pierleone Lucatelli,Piergiorgio Nardis,Simone Zilahi De Gyurgyokai,Mario Bezzi,Carlo Catalano,Alessandro Cannavale,Stefano Cipollari,Mario Corona,Claudio Trobiani,Leonardo Teodoli,Bianca Rocco

doi:10.3390/jcm10040701

Pierleone Lucatelli, Piergiorgio Nardis + Show 9 more

Open Access

https://doi.org/10.3390/jcm10040701

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Abstract

Objective: To evaluate the safety and efficacy of the Phil liquid embolic agent in non-neurological embolization procedures. M&M: Thirty-five patients with a mean age of 62.5 years underwent percutaneous embolization using Phil for the treatment of visceral arterial bleedings in 20/35 patients (including three gluteal, one bladder, two superior mesenteric, three epigastric, one deep femoral, five internal iliac, four intercostal, and one lingual arteries), splanchnic pseudoaneurysms in 11/35 patients (including three hepatic, five splenic, and three renal arteries), pancreatic bleeding metastasis in 1/35 patient, and gastric bleeding varices in 3/35 patients. Phil is composed of a non-adhesive copolymer dissolved in DMSO (Anhydrous Dimethyl Sulfoxide) with different viscosity. Procedures were performed slowly under continuous fluoroscopic guidance to avoid embolization of non-target vessels. Results: Clinical success was obtained with a single intervention in 34 cases (97.15%), while a repeated procedure was required in one case (2.85%). No technical complications nor non-target embolization occurred. A case of post-embolic syndrome was noted (2.85%) in one patient. DMSO administration-related pain was successfully controlled by medical therapy. Conclusion: Phil can be considered a safe and effective embolic agent for the treatment of non-neurologic bleeding.

Highlights

Relevant abdominal bleeding is always an acute or subacute emergency requiring prompt treatment
Phil injection was correctly performed in all cases and no technical complications were recorded
Technical success was obtained with a single intervention in 97.15% of the cases, while a repeated procedure was required in 2.85% of the cases

Summary

Introduction

Relevant abdominal bleeding is always an acute or subacute emergency requiring prompt treatment. Trans-catheter embolization has evolved into a mainstay in the management of acute bleeding, being introduced in several guidelines as a therapeutic tool to be employed in stable patients [1,2,3,4,5]. Transcatheter embolization is a minimally invasive procedure that combines excellent technical and clinical outcome with a low risk of complications [2,5]. Various agents, including polyvinyl alcohol particles (PVA), acrylic polymers, coils, microspheres, alcohol, and n-butylcyanoacrylate (NBCA) have been used for selective arterial embolization procedures in many vascular pathologies without reaching satisfactory clinical results [8]. The ideal embolic agent is still not available, especially in the emergency

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