Effectiveness Of Transarterial Embolization Research Articles

The effect of transarterial embolization and nephrectomy on acute kidney injury in patients with blunt renal trauma: An American College of Surgeons - Trauma Quality Improvement Program analysis

IntroductionTransarterial embolization (TAE) or nephrectomy for patients with blunt renal trauma might result in acute kidney injury (AKI). Thus, we analyzed the American College of Surgeons - Trauma Quality Improvement Program (TQIP) to validate this. We hypothesized that nephrectomy, and not TAE, would be a risk factor for AKI in patients with blunt renal trauma. Material and methodsAdult patients with blunt injuries from the TQIP between 2017 and 2019 were eligible for inclusion. The patients were divided into three treatment groups: conservative treatment, TAE, and nephrectomy. Multivariable logistic regression was used to clarify the AKI predictors. ResultsThe study included 12,843 patients, wherein 12,373 (96.3 %), 229 (1.8 %), and 241 (1.9 %) patients were in the conservative, TAE, and nephrectomy groups, respectively. A total of 269 (2.2 %), 20 (8.7 %), and 29 (12.0 %) patients had AKI in the three groups, respectively. Both TAE (odds ratio [OR], 2.367; 95 % confidence interval [CI], 1.372–3.900; p = 0.001) and Nephrectomy (OR, 2.745; 95 % CI, 1.629–4.528; p < 0.001) were a statistically significant predictor for AKI in the multivariable logistic regression. ConclusionsTAE and nephrectomy were statistically associated with AKI in patients with blunt renal trauma. This result differs from our previous research findings that nephrectomy, but not TAE, was a risk factor for AKI in patients with blunt renal trauma. Further prospective and well-designed research may be needed.

Current Assessment of the Use of Angioembolization in Radical and Palliative Surgical Treatment of Kidney Cancer (Literature review)

The incidence of new cases of renal cell carcinoma (NCC) in recent years has been steadily increasing both in the world and in Ukraine, and is about 403,000 and 4,900 per year, respectively. This phenomenon is largely due to the growing popularity of imaging methods (ultrasound, CT, MRI) and increased life expectancy (NCC is associated with old age). The important role of the kidneys in homeostasis maintaining, biological features of NCC (long latent course, susceptibility to recurrence, the likelihood of synchronous/metachronous contralateral kidney damage, high probability of metastases at the time of primary diagnosis), high risk of complications of surgical interventions stimulate organ-preserving ablation techniques. Trans-arterial embolization (TAE) is one of them. Its use is justified by the hypervascular nature of NCC. Presumably, blocking the blood supply to the tumor can reduce intraoperative blood loss, tumor volume, severity of pain, and hematuria. To date, a number of publications of retrospective/pilot studies and meta-analyzes have emerged that highlight the role of TAE in the treatment of NCC. A non-systematic analysis of previous publications was conducted, which highlight the effects of trans-arterial embolization in neoadjuvant and palliative regimens in patients with NCC. Search for relevant publications was conducted by keywords in electronic databases and bibliographies of selected articles for analysis. The results of retrospective and prospective studies of TAE before kidney resection or radical nephrectomy (RNE) do not provide clear evidence in its favor. A number of studies have shown that neoadjuvant TAE allows to: reduce blood loss, reduce the duration of surgery, minimize injury to surrounding tissues, conduct a more complete eradication of the tumor, expand the indications for surgery, increase the rates of 5 and 10 years of cancer-specific survival after radical intervention. Other studies, on the other hand, have found no ability for TAE to improve cancer-specific and overall survival after RNE. Also, according to pilot data, TAE does not improve the results of surgical treatment of patients with NCC and inferior vena cava thrombosis. It was found that TAE before venacavatrombectomy is associated with greater: duration of surgery, perioperative mortality, frequency of postoperative complications. Percutaneous ablation in NCC T1 is comparable in results to radical surgical treatment, but is associated with a fairly high risk of bleeding (3.5–14%). It is shown that TAE (ethanol in combination with lipiodol or microspheres) before radiofrequency ablation (RA) to reduce the risk of bleeding and local recurrence in patients with an average tumor diameter of 3.6 cm (max – 9 cm). The rationality of the combined use of TAE and cryoablation has not been conclusively proven. In patients with inoperable tumors or with contraindications to surgery, TAE can effectively control symptoms, achieve cytoreduction, and increase life expectancy. The effectiveness of TAE in the control of symptoms in palliative mode reaches 68-75%. In pilot studies, it was found that the latest modifications of TAE with the addition of chemotherapeutics or radioactive substances in NCC can cause more pronounced cytoreduction according to CT with contrast. Randomized placebo-controlled, sufficiently sampled studies are mandatory to establish the indications and effects of TAE in patients with NCC.

Role of Transarterial Embolization in the Management of Hepatic Artery Pseudoaneurysm Postlaparoscopic Cholecystectomy

Abstract Purpose To assess the safety and effectiveness of transarterial embolization (TAE) in the management of hepatic artery pseudoaneurysms following laparoscopic cholecystectomy (LC). Materials and Methods This is a retrospective study consisting of 13 patients who had undergone TAE for management of pseudoaneurysms of the hepatic artery or its branches following LC. Patients presented with symptoms such as hypotension, hematemesis, melena or gradual anemia post LC. Abdominal CT revealed hepatic artery pseudoaneurysm in all patients. TAE was performed with either coils or N-butyl cyanoacrylate or both. We evaluated technical and clinical effectiveness and complications of TAE. Results TAE was successful both technically and in stopping bleeding in all patients (100% technical and clinical success). No patient had rebleeding after TAE. Four patients required laparotomy for draining hemoperitoneum and clots. Endoscopic retrograde cholangiopancreatography (ERCP) for hemobilia or bile duct injury was done in eight patients. Following TAE, hepatic infarct was observed in three patients. Postembolization syndrome was seen in four patients and one patient died due to sepsis. Conclusions TAE is effective for treatment of hepatic artery pseudoaneurysms after LC. Hepatic infarcts and postembolization syndrome are the most common complications and can be managed conservatively.

Clinical results of transarterial embolization for post-partum hemorrhage in 62 patients.

The pathology of post-partum hemorrhage (PPH) differs depending on its cause, background and timing of bleeding, and the effectiveness of transarterial embolization (TAE) is thought to vary based on these characteristics. The aim of this study is to evaluate the treatment outcomes of TAE for PPH. Technical success, initial clinical success (hemostasis without repeat TAE or surgical treatment after initial TAE) and final clinical success (hemostasis with or without repeat TAE, but without surgical treatment) were assessed in 62 Japanese patients. Factors affecting final clinical success were analyzed using univariate analysis. Values of P < 0.05 were considered statistically significant. Further, the clinical course and factors associated with rebleeding, return of menstruation and fertility, and complications of TAE were assessed. Final clinical success rate was significantly lower in cases with obstetrical disseminated intravascular coagulation (DIC) or the International Society on Thrombosis and Hemostasis (ISTH) DIC (P = 0.01, 0.03). Rebleeding (n = 9, 14.5%) was more common in patients with retained products of conception (RPOC) (P = 0.006). On long-term follow-up in 23 patients, return of menstruation was confirmed in 17 (73.9%) of these patients. Subsequent pregnancy was confirmed in seven patients (30.4%). TAE-related complications were seen in 6 patients (9.0%). There were no maternal deaths. Obstetrical and ISTH DIC reduced the success rate of TAE for PPH (P = 0.01, 0.03). Rebleeding, which is observed significantly more frequently in PPH caused by RPOC (P = 0.006), can be effectively treated by repeat TAE.

Transarterial embolization of renal cell carcinoma as an adjunctive therapy prior to cryoablation: a propensity score matching analysis.

We aimed to assess the safety and effectiveness of transarterial embolization (TAE) prior to percutaneous cryoablation (PCA) in the management of renal cell carcinoma (RCC) compared with PCA alone using a propensity score matching analysis to minimize confounding factors. A retrospective review of all PCAs performed for renal masses identified 9 patients who underwent TAE prior to PCA. These patients were matched in a 2:1 ratio with patients who underwent PCA only using age, gender, and tumor size to create the propensity score model for matching. Other demographic, clinical, and outcomes data were collected. The TAE+PCA group included 5 males and 4 females with a mean age of 67.9 years and mean tumor diameter of 51.7 mm. The PCA only group included 11 males and 7 females with a mean age of 66.8 years and mean tumor diameter of 46.2 mm. No significant differences in these propensity score matched characteristics were identified. Further, the groups had no significant differences in tumor geometry (P = 0.831), R.E.N.A.L. nephrometry scores (P = 0.144), or comorbidity indices (P = 0.392). TAE was technically successful and without complication in all cases. PCA was technically successful in 8 of 9 patients in the TAE+PCA group and in 14 of 18 patients in the PCA only group (P = 0.483). No significant differences in the rate of complications (P = 0.483), change in eGFR (P = 0.691), or change in hematocrit (P = 0.152) were identified between the two groups. TAE of RCC prior to PCA is safe and technically feasible; however, no objective benefits over PCA alone were identified by propensity score matching analysis. Due to small sample size and limitations of the study, no definite conclusions should be drawn. Larger, prospective studies of this therapeutic approach are warranted.

Safety and effectiveness of transarterial embolization for splenic artery hemorrhage in patients undergoing radical gastrectomy.

Background Perigastric lymph nodes are dissected during gastrectomy, potentially resulting in life-threatening postoperative bleeding. Purpose To evaluate the safety and effectiveness of transarterial embolization (TAE) for bleeding from the splenic artery in patients who underwent gastrectomy. Material and Methods Between January 2004 and December 2016, 14,523 patients underwent gastrectomy at our institution, and ten patients (nine men; mean age = 64.7 years; age range = 51-80 years) underwent TAE for postoperative bleeding from the splenic artery. The location of bleeding was classified as either: (i) the main splenic artery (MSA) or (ii) the parenchymal splenic artery (PSA). The clinical outcomes of TAE were explored. Results Bleeding occurred at a median of 13.5 days (range = 4-34 days) after gastrectomy. The onset of bleeding was late in all patients and clinically manifested as abdominal bleeding in seven patients and luminal bleeding in three patients. Technical and clinical success rates were 100% and 70%, respectively. The three major complications occurred only in patients with MSA bleeding, resulting in two 30-day mortality cases and one splenic abscess with fistula formation to the jejunum. The causes of death were infarctions in the spleen and/or remnant stomach and sepsis. Conclusion TAE seems to be effective in stabilizing patients with bleeding from the splenic artery. Moreover, TAE with curative intent may be performed for bleeding from the PSA; however, further resection of the remnant stomach and/or spleen seems to be required to avoid sepsis and mortality in case of bleeding from the MSA.

High-grade traumatic torso visceral injury with hemodynamic instability: effectiveness of transarterial embolization using n-butyl cyanoacrylate.

Trauma patients with uncontrolled hemorrhage encountering coagulopathy are often associated with poor outcome. Recently, the concept of damage control interventional radiology, which focuses on “speedy stoppage of bleeding” by interventional radiology among trauma patients with hemodynamic instability and acute traumatic coagulopathy, was proposed as an alternative to damage control surgery. N‐butyl cyanoacrylate (NBCA) has been used as a liquid embolic agent in various non‐traumatic situations, where it has been shown to have a high technical success rate and low recurrent bleeding rate, especially in patients with coagulopathy. In this case, we treated a young patient with hemodynamic instability caused by a high‐grade hepatic injury, who underwent arterial embolization (AE) using NBCA assisted with resuscitative endovascular balloon occlusion of the aorta and achieved successful hemostasis. A review of published works using PUBMED was carried out, and 10 published reports involving 23 trauma patients who underwent AE using NBCA were identified. Among them, only four reports involving five trauma patients with torso visceral injuries were identified. Three of five patients who were hemodynamically unstable underwent AE using NBCA, resulting in the stabilization of hemodynamics. We concluded that AE with resuscitative endovascular balloon occlusion of the aorta as a damage control interventional radiology procedure might be acceptable for the hemodynamically unstable hepatic injury, and NBCA could be one of the effective hemostatic agents for this purpose, in cases of trauma‐induced coagulopathy.

Effect of transarterial embolization for post-partum hemorrhage on subsequent pregnancy

Although pregnancy after transarterial embolization (TAE) has occasionally been reported, gelatin sponge was used as the embolic agent in most of these cases. Reports on the effect of TAE with permanent embolic agents such as N-butyl cyanoacrylate or coil on subsequent pregnancies are rare. We describe placenta accreta associated with difficult hemostasis in two patients who became pregnant after TAE with permanent embolic agents. In pregnancy after TAE with permanent embolic agents, placenta accreta occurs frequently and well-developed collateral vessels are highly likely, resulting in difficult hemostasis. Although the acceptability of pregnancy after TAE with permanent embolic agents is controversial, patients should be informed that pregnancy is extremely high risk.

Transarterial embolization in the management of intractable epistaxis: the angiographic findings and results based on etiologies

Conclusions: Transarterial embolization (TAE) appears to be a safe and effective treatment for patients with intractable epistaxis, despite different etiologies or angiography findings. Idiopathic epistaxis is prone to present with negative angiographic findings. Objective: To retrospectively evaluate the safety and effectiveness of TAE for intractable epistaxis, and focus on the factors of etiology and angiographic findings. Materials and methods: From March 2008 to December 2014, the data of 43 patients with intractable bleeding undergoing TAE were reviewed. The outcomes of interventional therapy were assessed according to different etiology (malignant or benign disease) and angiographic finding (positive or negative angiogram). Results: Positive angiographic findings were found in 11 of 12 cases with malignant diseases and 22 of 31 cases with benign diseases, respectively (p = 0.237). Among the 10 cases with negative angiographic findings, the negative angiography rate of idiopathic epistaxis was higher than that of epistaxis with definite etiology (p = 0.003). Bleeding was controlled successfully in all of the 43 patients after embolization. During the mean follow-up period of 24.0 ± 16.7 months, five patients relapsed. No significant difference was found in recurrence rates between malignant and benign diseases or between positive and negative angiography (p = 0.241, p = 0.704, respectively).

A small interfering RNA targeting vascular endothelial growth factor efficiently inhibits growth of VX2 cells and VX2 tumor model of hepatocellular carcinoma in rabbit by transarterial embolization-mediated siRNA delivery.

IntroductionHepatocellular carcinoma is currently the second leading cause of cancer-related deaths worldwide with an increasing incidence.ObjectiveThe objective of this study is to investigate the effect of vascular endothelial growth factor small interfering RNA (VEGF-siRNA) on rabbit VX2 carcinoma cell viability in vitro and the effect of transarterial embolization (TAE)-mediated VEGF-siRNA delivery on the growth of rabbit VX2 liver-transplanted model in vivo.MethodsQuantitative reverse transcription polymerase chain reaction, enzyme-linked immunosorbent assay, and Western blot technologies were used to detect the expression level of VEGF. TAE and computed tomography scan were used to deliver the VEGF-siRNA and detect the tumor volume in vivo, respectively. Microvessel density was detected by immunohistochemistry with CD34 antibody. A biochemical autoanalyzer was used to evaluate the hepatic and renal toxicity.ResultsThe designed VEGF-siRNAs could effectively decrease the expression levels of VEGF mRNA and protein in vitro and in vivo. In vitro, the viability of rabbit VX2 carcinoma cells was reduced by 38.5%±7.3% (VEGF-siRNA no 1) and 30.0%±5.8% (VEGF-siRNA no 3) at 48 hours after transfection. Moreover, in rabbit VX2 liver-transplanted model, the growth ratios of tumors at 28 days after TAE-mediated siRNA delivery were 155.18%±19.42% in the control group, 79.67%±19.63% in the low-dose group, and 36.09%±15.73% in the high-dose group, with significant differences among these three groups. Microvessel density dropped to 34.22±4.01 and 22.63±4.07 in the low-dose group and high-dose group, respectively, compared with the control group (57.88±5.67), with significant differences among these three groups. Furthermore, inoculation of VX2 tumor into the liver itself at later stage induced significant increase in alanine aminotransferase and aspartate aminotransferase, indicating an obvious damage of liver functions, while treatment of VX2 tumor via TAE-mediated VEGF-siRNA had no toxicity to the livers and kidneys of rabbits, and VEGF-siRNA had the ability to protect liver damage induced by tumor growth.ConclusionThis is the first study to demonstrate that targeting VEGF via TAE-mediated siRNA delivery may become a powerful new option for effective treatment of hepatocellular carcinoma in the clinic.

フォガティーカテーテルによる両下肢動脈塞栓除去術後に合併したひ骨動静脈ろうの１例

A 71-year-old man was admitted to our emergency center complaining of severe pain and cyanosis in both legs. No arterial pulses were palpable in either foot, and emergency aortography revealed thromboembolism of the right knee and left common iliac artery. Thromboembolectomy via a Fogarty catheterTM was performed on both sides and cyanosis disappeared, but swelling developed in the lower leg and pulsation in the right foot was weak even after embolectomy. Angiography 30 days later revealed a peroneal arteriovenous (AV) fistula on the right side. Transarterial embolization (TAE) with a MDC coilTM was performed, and the swelling resolved and the pulsation in the right foot improved soon after the TAE. Peroneal AV fistula is an unusual complication of Fogarty catheterTM embolectomy, often detected only after postoperative follow-up angiography. We emphasize the importance of angiography following embolectomy and the effectiveness of TAE in treating AV fistula.