Efficacy Of Transarterial Embolization Research Articles

Spontaneous Soft Tissue Hematomas in Patients with Coagulation Impairment: Safety and Efficacy of Transarterial Embolization.

The aim of this study is to report the authors' experience of percutaneous transarterial embolization (TAE) in patients with spontaneous soft tissue hematomas (SSTH) and active bleeding with anticoagulation impairment. The study retrospectively identified 78 patients who received a diagnosis of SSTH by CT scan and underwent TAE between 2010 and 2019 in a single trauma center. The patients were stratified using Popov classification into categories: 2A, 2B, 2C, and 3. The patient's 30-day survival after TAE was considered the primary outcome; immediate technical success, the need for additional TAE, and TAE-related complications were considered secondary outcomes. Immediate technical success, complication rate, and risk factors for death were analyzed. Follow-up stopped on day 30 from TAE. 27 patients (35%) fell into category 2A, 8 (10%) into category 2B, 4 (5%) into category 2C, and 39 (50%) into category 3. Immediate technical success was achieved in 77 patients (98.7%). Complications included damage at the arterial puncture site (2 patients, 2.5%) and acute kidney injury (24 patients, 31%). Only 2 patients (2.5%) had been discharged with a new diagnosis of chronic kidney disease. The 30-day overall mortality rate was 19% (15 patients). The mortality rate was higher in hemodynamically unstable patients, in Popov categories 2B, 2C, and 3, and in patients with an initial eGFR < 30 mL/min × 1.73 m2. The study demonstrated a higher mortality risk for categories 2B, 2C, and 3 compared to category 2A. Nonetheless, TAE has proven effective and safe in type 2A patients. Even though it is unclear whether type 2A patients could benefit from conservative treatment rather than TAE, in the authors' opinion, a TAE endovascular approach should be promptly considered for all patients in ACT with active bleeding demonstrated on CT scans.

Safety and efficacy of emergency transarterial embolization for mesenteric bleeding

BackgroundPatients with spontaneous or traumatic active mesenteric bleeding cannot be treated endoscopically. Transarterial embolization can serve as a potential alternative to emergency surgery. Literature on transarterial embolization for mesenteric bleeding remains very scarce. The objective of this study was to evaluate the safety and efficacy of transarterial embolization for mesenteric bleeding. We reviewed all consecutive patients admitted for mesenteric bleeding to the interventional radiology department, in a tertiary center, between January 2010 and March 2021. Mesenteric bleeding was defined as mesenteric hematoma and contrast extravasation and/or pseudoaneurysm visible on pre-operative CT scan. We evaluated technical success, clinical success, and complications.ResultsAmong the 17 patients admitted to the interventional department for mesenteric bleeding, 15 presented with active mesenteric bleeding requiring transarterial embolization with five patients with hemodynamic instability. Mean age was 67 ± 14 years, including 12 (70.6%) males. Technical success was achieved in 14/15 (93.3%) patients. One patient with technical failure was treated by percutaneous embolization with NBCA-Lipiodol mixture. Three patients (20%) had early rebleeding: two were treated by successful repeat embolization and one by surgery. One patient (6.7%) had early death within 30 days and two patients (13.3%) had late death after 30 days. Mean length of hospitalization was 12.8 ± 7 days. There were no transarterial embolization-related ischemic complications.ConclusionTransarterial embolization is a safe and effective technique for treating mesenteric bleeding even in patients with hemodynamic instability. Transarterial embolization doesn’t close the door to surgery and could be proposed as first intention in case of mesenteric bleeding.

Angiographic features and transarterial embolization of retained placenta with abnormal vaginal bleeding

ObjectivesTo clarify characteristic angiographic features and clinical efficacy of selective transarterial embolization (TAE) of retained placenta with abnormal vaginal bleeding.MethodsThe study cohort comprised 22 patients (mean age, 33.5 years; range, 22–24 years) who underwent selective TAE for retained placenta with abnormal bleeding between January 2018 and December 2020 at our institution. Angiographic images were reviewed by two certified radiologists with consensus. Medical records were reviewed to evaluate the efficacy of TAE. Angiographic features of retained placenta, technical success (disappearance of abnormal findings on angiography), complications, clinical outcomes (hemostatic effects and recurrent bleeding) were evaluated.ResultsPelvic angiography showed a dilated vascular channel mimicking arteriovenous fistulas or an aneurysm contiguous with dilated uterine arteries in the mid-arterial–capillary phase in 20 patients; it showed contrast brush in the remaining two patients. TAE technical success was achieved in all patients. No major complications were observed in any patients. Fifteen patients were followed up with expectant management after TAE; all but one patient showed no re-bleeding during the follow-up period (mean follow-up interval, 3.4 months; range, 1–17 months). One patient showed minor rebleeding, which resolved spontaneously. Seven patients underwent scheduled hysteroscopic resection within 1 week after TAE, and no excessive bleeding was observed during or after the surgical procedure in all seven patients.ConclusionsThe characteristic angiographic feature of retained placenta is “dilated vascular channel that mimic low flow AVM.” TAE is a safe and effective treatment to manage retained placenta with abnormal bleeding.

Transcatheter Arterial Embolization in Acute Non-Variceal Gastrointestinal Bleedings: A Ten-Year Single-Center Experience in 91 Patients and Review of the Literature.

Objective: To report the safety and efficacy of trans-arterial embolization (TAE) for upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB) due to different etiologies in 91 patients for ten years. Methods: A retrospective analysis of GIB treated between January 2010 and December 2020 was performed. TAE was performed using different embolic agents (coils, particles, glue, gelatin sponge, and EVOH-based agents). Technical success, secondary technical success, clinical success, and complications were evaluated. Results: Technical success was achieved in 74/91 (81.32%) patients. Seventeen patients (18.68%) required re-intervention. Secondary technical success was achieved in all cases (100.0%). Clinical success was achieved in 81/91 patients (89.01%). No major complications were recorded; overall, minor complications occurred in 20/91 patients. Conclusions: TAE is a technically feasible and safe therapeutic option for patients with GIB from a known or blind anatomic source where endoscopic therapy has failed or is deemed unfeasible.

The Efficacy of Transarterial Embolization for Postpartum Hemorrhage Complicated with Disseminated Intravascular Coagulation: A Single-Center Experience.

Indications for the use of transarterial embolization (TAE) for postpartum hemorrhage (PPH) have been established. However, the efficacy of TAE for PPH complicated by disseminated intravascular coagulation (DIC) remains controversial. In this study, we investigated the efficacy of TAE for PPH complicated by DIC. A database review was conducted to identify patients who were treated with TAE for PPH at our hospital. TAE was performed in 41 patients during the study period. Effective hemostasis was achieved in all cases, but additional procedures, such as re-embolization or hysterectomy, were required in five patients (12.2%). The typical causes of PPH included uterine atony (18 cases), placenta previa (15 cases), amniotic fluid embolism (DIC-type) (11 cases), and placenta accreta spectrum (10 cases). The mean blood loss was 3836 mL. The mean obstetrical DIC and the International Society on Thrombosis and Hemostasis DIC scores were 7.9 and 2.6, respectively. The efficacy of hemostasis was comparable between patients with and without DIC. However, the complete success rate of TAE was lower in patients with DIC as the condition worsened than that in non-DIC patients. Overall, TAE is effective as a minimally invasive treatment for PPH complicated by DIC.

Clinical Outcomes of Transarterial Embolization in the Treatment of Pulmonary Sequestration.

To assess the safety and efficacy of transarterial embolization (TAE) for pulmonary sequestration (PS). A single-center, retrospective study was conducted from March 2013 and December 2020. Patient characteristics, laboratory/imaging, complications, and the TAE procedure were reviewed. We report 11 symptomatic patients with PS successfully treated by TAE. The aberrant supplying arteries were embolized, and there were no immediate complications. One to three days after TAE, patients complained of mild chest pain (n = 4), moderate chest pain (n = 3), and low-grade fever (n = 1). Chest pain symptoms were completely resolved after 2-4days. One patient with PS and bronchiectasis required thoracoscopic resection due to continued symptoms. The remaining 10 patients showed disappearance of chest pain and hemoptysis and decreased lesion size at 2weeks and 3months, with a clinical success rate of 90.9%. TAE may be a feasible alternative treatment for pulmonary sequestration.

Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma.

BackgroundSevere bleeding after blunt maxillofacial trauma is a rare but life-threatening event. Non-responders to conventional treatment options with surgically inaccessible bleeding points can be treated by transarterial embolization (TAE) of the external carotid artery (ECA) or its branches. Case series on such embolizations are small; considering the relatively high incidence of maxillofacial trauma, the ECA TAE procedure has been hypothesized either underused or underreported. In addition, the literature on the ECA TAE using novel non-adhesive liquid embolization agents is remarkably scarce.Patients and methodsPubMed review was performed to identify the ECA TAE literature in the context of blunt maxillofacial trauma. If available, the location of the ECA injury, the location of embolization, the chosen embolization agent, and efficacy and safety of the TAE were noted for each case. Survival prognostic factors were also reviewed. Additionally, we present an illustrative TAE case using a precipitating hydrophobic injectable liquid (PHIL) to safely and effectively control a massive bleeding originating bilaterally in the ECA territories.Results and conclusionsBased on a review of 205 cases, the efficacy of TAE was 79.4–100%, while the rate of major complications was about 2–4%. Successful TAE haemostasis, Glasgow Coma Scale score ≥ 8 at presentation, injury severity score ≤ 32, shock index ≤ 1.1 before TAE and ≤ 0.8 after TAE were significantly correlated with higher survival rate. PHIL allowed for fast yet punctilious application, thus saving invaluable time in life-threatening situations while simultaneously diminishing the possibility of inadvertent injection into the ECA-internal carotid artery (ICA) anastomoses.

Transarterial embolization in management of post-traumatic hematuria

Introduction: Iatrogenic injuries are the most common (&gt;50%) cause of renal vascular lesions and most of these vascular lesions resolve spontaneously, however, surgical or percutaneous treatment is recommended when there is massive bleeding, renal hemorrhage persisting for more than 72 hours, or progressively deteriorating renal functions. Renal artery embolization is considered safe, effective as well as less invasive as the alternative treatment method is emergent nephrectomy or clamping of the renal artery which results in the loss of the kidney. We conducted a study to describe the efficacy of transarterial embolization in the management of post-traumatic hematuria.&#x0D; Methods: Retrospective review of 30 patients from April 2013 to July 2017 who underwent transarterial embolization for renal vascular lesions following blunt and iatrogenic renal injuries was done. Type of renal vascular lesions, the angiographic status of visualized vascular lesions immediately following embolization, and post-procedural status of hematuria were evaluated.&#x0D; Results: Thirty patients with a mean age of 35.3 years were included in the study. Twenty-two patients with pseudoaneurysm and eight with arteriovenous fistula in the kidney underwent transarterial embolization. Selective embolization was done in 28 out of 30 patients with complete resolution of hematuria. Two patients underwent non-selective embolization of the main renal artery which was necessary for control of hematuria. &#x0D; Conclusions: Transarterial embolization is a highly effective technique in the management of traumatic renal vascular lesions presenting with left threatening or continuous hematuria.

Synergism of wt-p53 and synthetic material in local nano-TAE gene therapy of hepatoma: comparison of four systems and the possible mechanism

BackgroundTAE-gene therapy for hepatoma, incorporating the tumor-targeted therapeutic efficacy of trans-arterial embolization, hydroxyapatite nanoparticles (nHAP) and anti-cancer wild-type p53 gene (wt-p53), was presented in our former studies (Int J Nanomedicine 8:3757-68, 2013, Liver Int 32:998-1007, 2012). However, the incompletely antitumoral effect entails defined guidelines on searching properer materials for this novel therapy.MethodsUnmodified nHAP, Ca(2+) modified nHAP, poly-lysine modified nHAP and liposome were separately used to form U-nanoplex, Ca-nanoplex, Pll-nanoplex, L-nanoplex respectively with wt-p53 expressing plasmid. The four nanoplexs were then applied in vitro for human normal hepacyte L02 and hepatoma HePG2 cell line, and in vivo for rabbits with hepatic VX2 tumor by injection of nanoplexs/lipiodol emulsion into the hepatic artery in a tumor target manner. The distribution, superficial potential, physical structure, morphology and chemical compositions of nanoplexs were evaluated by TEM, SEM, EDS etc., with the objective of understanding their roles in hepatoma TAE-gene therapy.ResultsIn vitro, L-nanoplex managed the highest gene transferring efficiency. Though with the second highest transfection activity, Pll-nanoplex showed the strongest tumor inhibition activity while maintaining safe to the normal hepacyte L02. In fact, only Pll-nanoplex can combine both the antitumoral effect to HePG2 and safe procedure to L02 among the four systems above. In vivo, being the only one with successful gene transference to hepatic VX2 tumor, Pll-nanoplex/lipiodol emulsion can target the tumor more specifically, which may explain its best therapeutic effect and hepatic biologic response. Further physical characterizations of the four nanoplexs suggested particle size and proper electronic organic surface may be crucial for nano-TAE gene therapy.ConclusionPll-nanoplex is the most proper system for the combined therapy due to its selectively retention in liver cancer cells, secondary to its morphological and physico-chemical properties of nanometric particle size, steady emulsion, proper organic and electronic surface.

Trans-arterial embolization of malignant tumor-related gastrointestinal bleeding: technical and clinical efficacy

BackgroundGastrointestinal (GI) tract bleeding is a major cause of mortality among patients with GI malignancies. We aimed to assess the technical and clinical efficacy of trans-arterial embolization (TAE) as a symptomatic treatment of tumor-related GI bleeding. This study was conducted for patients with GI bleeding secondary to histopathologically proven different GI malignancies. Fourteen patients underwent trans-arterial embolization. Patients were followed up clinically for any complications or episodes of recurrent bleeding.ResultsFourteen patients were included (9 males and 5 females) with mean age 55.5 years (range 42–69 years). All procedures were technically successful with post-procedural hemorrhage control and no immediate complication. The 30-day post-procedural clinical success rate was 78.4%. Three repeated clinically successful TAE sessions were done for recurrent bleeding. The median post-procedural follow-up duration was 241 days. The 30-day mortality rate was 7.1%, while the overall mortality rate was 35.7%.ConclusionTrans-arterial embolization of tumor-related GI bleeding controlled hemorrhage with acceptable clinical success rate and without complication in this small group of patients.

Transarterial embolization of sinusal dural arteriovenous fistula with transvenous balloon protection

Objective To evaluate the safety and efficacy of transarterial embolization of dural arteriovenous malformation (DAVF) using transvenous Copernic RC balloon protection. Methods Fifteen patients with DAVF (6 from Departments of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University and 9 from Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University) embolized using transvenous balloon protection between March 2014 and November 2017 were included retrospectively. Fourteen patients had single fistula in which 11 were located at transverse-sigmoid sinus (TSS) and 3 were located at superior sagittal sinus (SSS). One patient had multiple fistulas located at SSS and tentorium. Two patients presented with Cognard type I fistula, 7 with Cognard type Ⅱa, 1 with Cognard type Ⅱb and 5 with Cognard type Ⅱa+ b. Ten patients were treated for the first time and 5 were re-treated. The clinical and angiographic data were collected and the cure rate, complications and clinical outcome were analyzed. Results In the 10 patients treated for the first time, complete occlusion was achieved in 8 patients, near-complete occlusion in 1 and partial occlusion in 1. In the 5 patients re-treated, complete occlusion was achieved in 1, near-complete occlusion in 2 and partial occlusion in 2. All the involved sinuses were patent after embolization. Three patients suffered from severe complications including 1 with epidural hemorrhage, 1 with cerebellar hemorrhage and 1 with cerebellar infarction. All patients were followed up for 5 to 48 months(median: 19 months). Seven patients′ symptoms disappeared at follow-up, 7 patients were improved including 2 with postinterventional hemorrhage. One patient with cerebellar infarction deteriorated. The angiography follow-up was achieved in 8 cases for 4 to 24 months(median: 7 months). There was no recurrence in 6 patients with complete occlusion. One patient with near-complete occlusion and 1 with partial occlusion were stable. Conclusions The transvenous balloon assisted technique seems helpful to preserve the patency of dural sinus and improve the occlusion rate during the embolization of DAVF. However, it might have risks of hemorrhage and infarction and should be used carefully. Key words: Arteriovenous fistula; Embolization, therapeutic; Dural; Transvenous balloon

The utility of transarterial embolization and computed tomography for life-threatening spontaneous retroperitoneal hemorrhage

To assess the safety and efficacy of transarterial embolization (TAE) and to evaluate the utility of contrast-enhanced computed tomography (CE-CT) for life-threatening spontaneous retroperitoneal hemorrhage (SRH). Nineteen patients underwent TAE following CE-CT for life-threatening SRH. CE-CT and angiographic findings, technical successes, and clinical successes were evaluated. The diagnostic performance of CE-CT for the detection of active bleeding arteries was also assessed by two independent readers. Active extravasation of contrast material was accurately observed in 78.9‒84.2% of the patients on CE-CT. Angiograms revealed active extravasation in 37 arteries of 15 patients (78.9%), and 4 patients showed no sign of active bleeding. Sensitivity, positive predictive value, and accuracy rate of CE-CT for the detection of active bleeding vessels was 59.5%, 62.9‒71.0% and 55.6‒60.0% respectively. The successful embolization of 48 intended arteries was achieved in all the patients, including empirical TAE in four patients. Hemodynamic stabilization was achieved in 17 patients (89.5%) with a significant decrease in transfusion (p<0.001). TAE is a technically safe and clinically effective treatment method for life-threatening SRH. CE-CT has moderate capability for accurate identification of active bleeding arteries. TAE including arteries that potentially distribute anatomic territory of the hematoma is essential.

Transarterial embolization of carvernous sinus dural arteriovenous fistulas of slender feeding artery with rapid injection of Onyx

Objective To observe the efficacy of transarterial embolization of carvernous sinus dural arteriovenous fistulas (CSDAVFs) with slender feeding artery by rapid injection of Onyx. Methods From December 2010 to December 2016, a total of 20 patients with CSDAVFs with slender feeding artery were admitted to the Neurosurgery Department of the First Affiliated Hospital of Soochow University (12 cases), Changhai Hospital of the Second Military Medical University (4 cases) and the Second Affiliated Hospital of Medical College, Zhejiang University (4 cases). Those clinical data were analyzed retrospectively in this study. All underwent transarterial embolization with rapid injection of Onyx. Results Twenty-two interventional therapeutic procedures and embolization of feeding arteries were performed in all 20 patients, which involved ascending pharyngeal arteries in 11, middle meningeal arteries in 7, accessory meningeal arteries in 2 and internal maxillary arteries in 2. The mean time of Onyx injection was 5 sec-4 min and the volume of Onyx injected was 0.4-1.5 ml. Postoperative immediate complete embolization was achieved in 8, near-complete embolization in 11 and partial embolization in 1 (with 3 repeats of procedures). Postoperatively, there were 2 cases of ipsilateral facial numbness and 1 case of ipsilateral eyelid ptosis and eye movement disorder occurring after 3 times of arterial embolization. The follow-up period was 2-32 months, with an average of 9.5±2.7 months. In 19 patients with complete embolization and secondary embolization, the clinical symptoms disappeared completely. Among them, 18 cases of conjunctival hyperemia and ocular protrusion disappeared within 2 weeks after operation, and 1 case of heavier conjunctival edema disappeared within 3 weeks after operation. The symptoms of diplopia and vision loss improved within 1 to 3 months after surgery, and there was no recurrence. Twelve patients were followed up by DSA, and 7 patients with complete embolization showed complete occlusion of the fistula and no recurrence. Conclusion Transarterial embolization with rapid injection of Onyx may effectively treat CSDAVFs with slender feeding artery with relatively little complications and satisfactory follow-up results. Key words: Arteriovenous fistula; Dura mater; Carvernous sinus; Treatment outcome

Transarterial Onyx Embolization of Bilateral Transverse–Sigmoid Dural Arteriovenous Malformation with Transvenous Balloon Assist—Initial U.S. Experience with Copernic RC Venous Remodeling Balloon

Currently, the mainstay treatment of dural arteriovenous fistula (DAVF) involves endovascular approaches, especially for high-grade lesions. Transarterial embolization with preservation of venous sinuses has become the preferred approach due to the development of newer liquid embolic agents. For further precision during embolization, the use of temporary balloon occlusion to protect the patency of dural sinuses from the embolic agent's migration has been described. A 64-year-old man presented with bilateral pulsatile tinnitus and visual decline. A diagnostic cerebral angiogram demonstrated a complex bilateral Borden type II and Cognard type IIB DAVF. Treatment was carried out endovascularly under general anesthesia in a staged fashion. In the first stage, the balloon was inflated during embolization to protect the right transverse sigmoid venous sinus system and torcula. In the second stage, the balloon was again inflated to protect the left transverse sigmoid venous sinus system and torcula during embolization. Complete obliteration of the left DAVF was achieved, and patency of the left transverse and sigmoid sinuses was preserved. Patency of the right transverse and sigmoid sinus was also conserved post procedure. The patient was treated successfully with transarterial Onyx embolization with transvenous balloon protection of the sinus. This case is the first reported use of the Copernic RC balloon in the United States under the compassionate use guidelines of the U.S. Food and Drug Administration. The use of this balloon is becoming a useful treatment alternative in selected cases of DAVFs as it improves the safety and efficacy of transarterial embolization as evidenced in this case.

Endovascular Management of Recurrent Spontaneous Hemarthrosis After Arthroplasty.

Recurrent spontaneous hemarthrosis is an infrequent but debilitating late complication of joint replacement, affecting up to 1.6% of patients with arthroplasty of the affected joint. Repeated episodes of bleeding result in an inflammatory cascade that further propagates bleeding events. Open and arthroscopic synovectomy are often performed when conservative treatments fail. Transarterial embolization is increasingly utilized as a less invasive option; however, its role is not widely established. We performed a systematic literature review to report the safety and efficacy of transarterial embolization in treating recurrent hemarthrosis in the setting of prior arthroplasty. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, Embase, and SCOPUS databases of patients undergoing embolization for recurrent hemarthrosis after arthroplasty. Patients immediately post-operative, those embolized at first bleeding episode, and those with hemophilia were excluded. Demographic data, clinical information, angiographic findings, treatment, and outcomes were tabulated. The search identified 119 titles of which 24 were deemed relevant, comprising 91 patients undergoing 99 embolization procedures. Mean time from prosthesis implantation was 32.2months. Technical success was 99%. Mean follow-up time was 24.9months. There were 10 recurrences (10%). Two cases were complicated by joint infection requiring arthroplasty revision. Transarterial embolization for recurrent spontaneous hemarthrosis may be safe and effective in patients having undergone arthroplasty of the affected joint.

Transarterial Embolization of Angiomyolipoma: A Systematic Review

Transarterial embolization is increasingly used in the management of renal angiomyolipoma. The level of evidence establishing the safety and efficacy of transarterial embolization has not increased in parallel. Using the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) criteria a systematic review of transarterial embolization of angiomyolipoma was performed to establish procedural safety and efficacy. A MEDLINE® PubMed® search revealed 1,739 publications, of which 31 studies met eligibility criteria. A total of 524 cases of transarterial embolization of angiomyolipoma were included in analysis. Self-limiting post-embolization syndrome developed following 35.9% of embolizations and further morbidity developed in 6.9%. No procedural mortality was reported. At a mean followup of 39 months the mean size reduction was 3.4 cm (-38.3% of angiomyolipoma diameter). Unplanned repeat embolization or surgery was required in 20.9% of cases during this period. The most frequent indications for repeat procedures included angiomyolipoma revascularization in 30.0% of cases, unchanged or increasing size in 22.6%, refractory or recurring symptoms in 16.7% and representation with acute retroperitoneal hemorrhage in 14.3%. Treatment included a combination of 2 or more embolic agents in 46.8% of cases, ethanol monotherapy in 41.7%, coil monotherapy in 6.2% and foam or microparticle monotherapy in 5.2%. Transarterial embolization of angiomyolipoma demonstrates low rates of mortality and serious complications. Re-treatment rates and size reduction at a mean followup of 39 months are presented. Longitudinal data assessing long-term size reduction and re-treatment rates are lacking. Recommendations guiding the indications for transarterial embolization and clear followup require further longitudinal data.

Efficacy of transarterial embolisation in the management of post-partum haemorrhage and its impact on subsequent pregnancies.

Transarterial embolisation (TAE) has been attracting attention as a treatment option for post-partum haemorrhage (PPH). We investigated cases in which TAE was performed for PPH to determine the efficacy of TAE for the treatment of PPH and its impact on subsequent pregnancies and childbirth in a multi-institutional case-series study. A total of 211 women who underwent emergency (n=161) or prophylactic (n=50) TAE for the management of PPH from 2002 to 2011 in the Chugoku and Shikoku regions of Japan were evaluated. Data on maternal background, treatment efficacy, adverse events in 113 cases followed up after TAE and subsequent pregnancies in 76 women were obtained. The overall success rate of emergency and prophylactic TAE was 91.9 and 96.0%, respectively. The rate of complications such as infection, uterine necrosis and amenorrhoea was 13.3% among women followed up after TAE. Forty women became pregnant after TAE, and the pregnancy rate among those who desired fertility was 52.6%. Twenty-eight gave birth, including four preterm deliveries. Five (16.7%) were associated with a hysterectomy due to placenta accreta. To reduce haemorrhage and avoid hysterectomy, TAE may be considered as a treatment option for PPH, however short and long terms complications are not uncommon.

Transarterial embolization with low concentration of n-butyl cyanoacrylate in VX2 hepatic tumor rabbit: an experimental study

Objective To investigate the feasibility, safety and efficacy of transarterial embolization with low concentration of n-butyl cyanoacrylate(NBCA) in rabbit VX2 liver tumor models. MethodsTwenty-four rabbits were implanted with VX2 hepatic tumors into the left hepatic lobes, and were scanned with CT to measure the volume of the tumor after 14 days. They were randomly divided into three groups with 8 rabbits assigned to each group. Transarterial embolization was conducted with physiological saline in control group A, with pure Lipiodol in group B, with 2.5% NBCA in group C. Hepatic toxicity was evaluated by blood biochemical analysis of the plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST). One week later, the volumes of the tumors were measured by CT again. Tumor growth rate was the ratio of tumor's volume at 7th day after embolization to the tumors' volume before embolization. The survival periods of the rabbits of the three groups after treatment were also recorded. The data of ALT and AST mean values from each group were analyzed with repeated measurement analysis of variance (ANOVA). Tumor growth rates and survival periods were analyzed by using one-way ANOVA. Results All animal models were successfully established and underwent interventional catheterization. Both ALT and AST mean values of the rabbits in group A, B and C at each time point before and after embolization were significantly different (ALT F=10.508, 16.443, 19.828, respectively; AST F=23.696, 23.334, 15.594, respectively)(P＜0.05). ALT in group A, B, C were (49.4±13.5), (115.2±48.8), (124.7±49.4)U/L, while AST in group A, B, C were (52.3±12.0), (128.3±50.1), (137.0±66.9)U/L 4 days after embolization. The ALT and AST mean values were significantly elevated 4 days after embolization in group B and group C compared with those before embolization and those of group A 4 days after treatment(P＜0.05). However, the ALT and AST mean values showed no statistically significant difference in all the groups before embolization and 7 days after embolization. On the other hand, the growth rates of the tumors differed significantly among the three groups(F=110.865, P=0.000). The group C showed significantly lower tumor growth rate (0.839±0.144)% than the group A(2.978±0.547)%(P=0.000), but no significantly different tumor growth rate compared with group B(0.871±0.0725)%( P=0.845). Consequently, the survival period of the animals in group C(38.9±4.0) days was significantly longer than that in group A(32.1±3.1)days (P=0.006), while it was not significantly different from that in group B(36.9±4.8)days(P=0.366). ConclusionsTransarterial embolization with low concentration of NBCA was feasible and safe. It could be a new option of treatment for HCC and might have potential further clinical value. Key words: Animal experimentation; Carcinoma, hepatocellular; Embolization, therapeutic

Intractable haematuria: long‐term results after selective embolization of the internal iliac arteries

Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo determine the feasibility and efficacy of transarterial embolization (TAE) in haemorrhagic urological emergencies, and to assess the perioperative morbidity, effect of timing of intervention on the requirement for blood transfusion, and the long‐term follow‐up.PATIENTS AND METHODSBetween October 1997 and March 2009, 44 patients (30 men and 14 women; mean age 79 years, range 51–95) with intractable haematuria secondary to advanced pelvic tumour arising from or invading the bladder, underwent internal iliac TAE. Twenty‐four patients had transitional carcinoma of the urinary bladder, 12 adenocarcinoma of the prostate, five carcinoma of the uterus, one cancer of the vagina, two carcinoma of the rectum, three carcinoma of the kidney, two simultaneous carcinoma of prostate and bladder, one simultaneous carcinoma of prostate and kidney and one had haemorrhagic cystitis after radiotherapy.RESULTSTAE of the internal iliac arteries produced initial complete control of bleeding in 36 of the 44 patients (82%). At a mean (range) follow‐up of 10.5 (1–97) months TAE there was permanent control of bleeding in 19 (43%) patients. A second TAE session was use in five (11%) patients and it was successful in two of them. There were 24 patients (55%) who required a mean of 4 (1–17) transfusion units before embolization; only 13 (30%) required more blood products after TAE. The mean haematocrit level before and after TAE was 27% and 31% (P &lt; 0001), and the respective haemoglobin level were 8.7 and 10.3 g/dL (P &lt; 0001). During the follow‐up there were no major complications related to TAE; minor complications were post‐TAE syndrome in 12 (27%) patients, fever (11%), gluteus pain (14%), nausea (2%), and exterior genital oedema (5%). The 6‐ and 12‐month mortality rates were 66% (29 patients) and 18% (eight), respectively.CONCLUSIONSTAE should be considered as an alternative less‐invasive palliative measure and the treatment of choice in these situations. TAE should always be bilateral, the catheter should advance distally to the origin of the superior gluteal artery and the artery embolized with unresorbable particles. Our study confirms the efficacy and safety of TAE in patients with pelvic malignancy, and indicates that this technique should be considered before surgery. The procedure combines the benefits of a minimally invasive approach in decreasing the cost of surgery and operating time, while maintaining low blood loss and analgesia requirement.

Efficacy of Transarterial Embolization with Arsenic Trioxide Oil Emulsion in a Rabbit VX2 Liver Tumor Model

To investigate the anticancer activity of transarterial embolization with arsenic trioxide (As(2)O(3)) oil emulsion, as well as its hepatic and renal toxicity, in a rabbit VX2 liver model. VX2 carcinomas were grown in rabbit livers, followed by transarterial embolization with high-dose As(2)O(3) (5 mg/kg with 0.2 mL Lipiodol, n = 7), low-dose As(2)O(3) (1 mg/kg with 0.2 mL Lipiodol, n = 7), or control (0.2 mL Lipiodol, n = 7). The growth ratios and residual viable proportions of the tumors were estimated by multi-detector row computed tomography and histopathologic examination, respectively. Hepatic and renal toxicity was evaluated by means of blood biochemical analysis. The growth ratios of the tumors differed significantly among the three groups (P = .008). The high-dose As(2)O(3) group showed significantly lower tumor growth ratios than the control group (mean +/- SD, 14.8% +/- 78.6 vs 794.0% +/- 156.2; P = .008). The residual viable proportions of the tumors were significantly lower in the high-dose (9.5% +/- 8.8) and low-dose (13.0% +/- 9.1) As(2)O(3) groups than in the control group (44.5% +/- 5.2; P < .017). Blood chemical concentrations indicating hepatic and renal toxicity did not differ among the three groups before or after transarterial embolization (P > .05). Transarterial embolization with As(2)O(3) iodized oil emulsion in rabbit VX2 liver tumors has anticancer effects without significant increase in hepatic and renal toxicity.