Gelatin Sponge Embolization Research Articles

Feasibility of revascularization after gelatin sponge embolization for hemoptysis during balloon pulmonary angioplasty

BackgroundVessel injury is a common complication during balloon pulmonary angioplasty (BPA). For persistent hemoptysis, gelatin sponge embolization (GSE) is considered, but its impact on subsequent perfusion in embolized vessels remains unknown. This study explores the feasibility of revascularization in vessels post-GSE. MethodsWe included 64 vessels from 50 patients with chronic thromboembolic pulmonary hypertension who experienced hemoptysis during BPA in 2012–2023. Twenty-four vessels were treated conservatively (conservative group), while 40 were treated with GSE for persistent hemoptysis or desaturation despite conservative treatment (GSE group). We assessed hemoptysis-related parameters, perfusion of injured vessels pre- and post-treatment, and hemodynamic parameters through multiple BPA sessions. ResultsHemoptysis resolved immediately after the procedure in 67% of patients, including 70% of those in the GSE group, and all cases resolved by the next day. Of 37 embolized vessels, 41% showed spontaneous perfusion improvement in subsequent sessions. BPA was reperformed in 22 embolized vessels, with 86% showing further improvement, resulting in 70% of all embolized vessels finally showing improvement in perfusion. In both groups, clinical and hemodynamic parameters significantly improved after BPA. ConclusionsPerfusion of embolized vessels improved after GSE, suggesting that GSE is safe for the treatment of severe persistent hemoptysis after conservative treatment.

Treatment of Vascular Injury During Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension.

Treatment strategy for vascular injury during balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) was uncertain. This study aimed to identify an optimal therapeutic strategy for vascular injury during BPA in patients with CTEPH. This study reviewed 207 patients with CTEPH and 956 BPA procedures between November 1, 2012 and November 30, 2015. Patients who were diagnosed with vascular injury during BPA, which was defined as angiographic signs or sudden respiratory and hemodynamic defects were included in this study. The study investigated the safety and efficacy of the hierarchically systematic treatment strategy including gelatin sponge embolization (GSE). More than one-half of the 79 patients and 133 procedures with vascular injury were improved by general treatment with reversal of heparin and high-flow oxygen administration. The investigators performed conventional treatment of proximal vessel occlusion using a guiding or balloon catheter in 47 procedures (35%) in which the culprit vessels could be detected under patients' stable conditions. In 32 procedures (24%) without detected culprit lesions or improvement by conventional treatment, GSE could significantly improve patient condition. The treatment strategy obtained successful bailout in 98% of procedures with vascular injury. No patients who underwent GSE died within 30days after the treatment. There was no significant difference in cumulative mortality rate (median follow-up: 6.6years) between groups with or without GSE (15.6% vs 8.2%; adjusted HR: 1.47; 95%CI: 0.25-8.69; P = 0.67). Treatment strategy including GSE would be promising for vascular injury during BPA in patientswith CTEPH.

Immediate Renal Denervation After Acute Myocardial Infarction Mitigates the Progression of Heart Failure via the Modulation of IL-33/ST2 Signaling.

Objective: Previous studies have demonstrated the protective effects of renal denervation (RDN) in pre-existing heart failure, but the effects of immediate RDN after acute myocardial infarction (AMI) on subsequent cardiac remodeling have not been reported. This study aimed to investigate the cardioprotective effects of immediate RDN after AMI and its underlying mechanism.Methods: AMI was induced by intracoronary gelatin sponge embolization in 14 Shanghai white pigs that were randomized to undergo either renal angiography (AMI+sham group) or RDN (AMI+RDN group) after 1 h of hemodynamic monitoring. Cardiac function of the two groups was measured at baseline, 1 h post-AMI and at the 1 month follow-up (1M-FU) by transthoracic echocardiography (TTE). Plasma NT-proBNP, soluble ST2 (sST2), norepinephrine (NE), and renin-angiotensin-aldosterone system activity were detected simultaneously. The renal cortex was harvested for NE measurement after the 1M-FU, and the renal arteries were stained with tyrosine hydroxylase for the evaluation of sympathetic activity. Heart tissues in the non-ischemic areas were collected to assess histological and molecular left ventricular (LV) remodeling by pathological staining, RT-PCR, and western blotting.Results: There was no difference in the hemodynamic stability or cardiac function between the two groups at baseline and 1 h post-AMI. Six pigs from each of the two groups completed the 1M-FU. TTE analysis revealed the improved cardiac function of immediate RDN in the AMI+RDN group and circulating NT-proBNP levels were lower than those in the AMI+sham group. Further analysis showed significantly less interstitial fibrosis in the remote non-ischemic myocardium after immediate RDN, together with decreased cardiomyocyte hypertrophy and inflammatory cell infiltration. sST2 levels in circulating and myocardial tissues of animals in the AMI+RDN group were significantly higher than those in the AMI+sham group, accompanied by corresponding alterations in IL-33/ST2 and downstream signaling.Conclusions: Immediate RDN can improve cardiac function and myocardial remodeling after AMI via modulation of IL-33/ST2 and downstream signaling.

Abstract 12974: Successful VT Ablation Utilising Intracoronary Gelatin Sponge Injection

Introduction: We report two cases of recurrent ventricular tachycardia (VT) successfully treated by intra-coronary Gelatin sponge embolization where initial endocardial ablation was unsuccessful and epicardial approaches were unfavourable. Case Histories: (1) A 75-year-old male with Inferior STEMI who underwent PCI to oRPDA developed VT storm that required DCCV 11 times. The VT was hemodynamically unstable, hence only substrate modification was performed. He still had recurrent episodes of VT and a second ablation attempt localised VT circuit breakout to the infero-apical septum, but ablation was unsuccessful due to a deep intramural circuit. Epicardial ablation was not attempted due to a 1cm pericardial effusion after the first procedure. Unipolar signals from selective wiring of the distal rPDA with a percutaneous coronary intervention guidewire and microcatheter showed early local electrograms. 5ml of Gelatin sponge injection was injected after a 5x2mm coil failed to occlude the distal rPDA. Post occlusion, VT was not inducible with double ventricular extra-stimuli. He has been VT free for 5 months (2) A 41-year-old female with dilated cardiomyopathy, previous left ventricular assist device and revision was admitted for VT storm. The VT map identified earliest activation with far-field pre-systolic potentials at the baso-lateral LV segment. Pre-systolic far field ventricular EGMs were also seen in the adjacent coronary sinus, consistent with a likely epicardial exit site of the VT. Endocardial ablation failed, and epicardial access was not feasible due to adhesions. Coronary angiography revealed a small calibre non dominant left circumflex artery supplying the VT exit site. Cold saline injection down the mLCX terminated the VT and the vessel was occluded with 5 ml of Gelatin sponge. VT was subsequently not inducible. Discussion & Conclusion: Critical portions of VT circuits may course epicardially or intramurally 3 , limiting successful endocardial catheter ablation. Epicardial access was risky. Coronary vessel embolization using coils 4 and ethanol 5 have been performed. Use of absorbable Gelatin sponge has been described in managing coronary perforation 6 , but to the best of our knowledge these are the first cases of its use in VT ablation.

Effects of renal denervation on left ventricular remodeling and cardiac oxidative stress after myocardial infarction in canine

Objective To investigate the effects of renal denervation (RDN) on left ventricular remodeling and cardiac oxidative stress due to myocardial infarction (MI) in canine. Methods Anterior myocardial infarction was produced by gelatin sponge embolization of the left anterior descending artery. Eighteen canines were randomly divided into three groups. Sham group (renal arteriography performed a week after coronary angiograph, n=6), MI group (renal arteriography performed a week after MI, n=6), and RDN group (RDN performed a week after MI, n=6). Four weeks post-MI, left ventricular function was measured by hemodynamics. Echocardiography examination was administered to identify left ventricular end-diastolic dimension (LVEDD), left ventricular end systolic diameter (LVESD), fraction shortening (FS), and left ventricular ejection fraction (LVEF). Anti-superoxide anion free radical (ASAFR) activity was detected by colorimetry. Thiobarbituric acid method was used to measure the concentration of malonaldehyde (MDA). Results Compared to Sham group, the LVEF, FS and left ventricular systolic pressure (LVSP) in MI group and RDN group were decreased obviously (all P 0.05). There were no significant difference in heart rate (HR) among three groups (P>0.05). Although the levels of MDA, ASAFR, and p47phox mRNA were higher in MI group and RDN group, compared to the Sham group (all P<0.05), they were all significantly decreased in RDN group compared to the MI group (all P<0.05). Conclusions RDN was able to improve heart function and myocardial remodeling and inhibit cardiac oxidative stress. Key words: Sympathectomy; Kidney/IR; Myocardial infarction/CO/SU; Ventricular remodeling; Oxidative stress; Myocardium/PA

Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Management of Gastric Varices: Comparative Effectiveness between Gelatin Sponge Embolization and Permanent Sclerosant

Upper gastrointestinal endoscopy is usually the first-line diagnostic and management tool for bleeding gastric varices (1). When endoscopy fails to control gastric variceal bleeding, a transjugular intrahepatic portosystemic shunt (TIPS) is recommended to decompress the portal circulation (1, 2). However, TIPS may not be suitable for some patients with poor hepatic reserve, portal vein thrombosis, hepatic encephalopathy, or severe thrombocytopenia (1-3). Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular technique that was refined in Japan as a therVascular Plug-Assisted Retrograde Transvenous Obliteration for the Management of Gastric Varices: Comparative Effectiveness between Gelatin Sponge Embolization and Permanent Sclerosant 위정맥류 관리에서 Vascular Plug를 이용한 역행성 경정맥 폐쇄술의 효과: 젤폼을 사용한 색전술과 영구경화제의 효과 비교

Vascular Plug Assisted Retrograde Transvenous Obliteration (PARTO) for Gastric Varix Bleeding Patients in the Emergent Clinical Setting

PurposeTo evaluate the technical feasibility and safety of vascular plug assisted retrograde transvenous obliteration (PARTO) for bleeding gastric varix performed in the emergent clinical setting and describe the mid-term clinical results.Materials and MethodsFrom April 2012 to January 2015, emergent PARTO was tried in total 9 patients presented with active gastric varix bleeding. After initial insufficient or failure of endoscopic approach, they underwent PARTO in the emergent clinical setting. Gelatin sponge embolization of both gastrorenal (GR) shunt and gastric varix was performed after retrograde transvenous placement of a vascular plug in GR shunt. Coil assisted RTO (CARTO) was performed in one patient who had challenging GR shunt anatomy for vascular plug placement. Additional embolic materials, such as microcoils and NBCA glue-lipiodol mixture, were required in three patients to enhance complete occlusion of GR shunt or obliteration of competitive collateral vessels. Clinical success was defined as no variceal rebleeding and disappearance of gastric varix.ResultsAll technical and clinical success–i.e., complete GR shunt occlusion and offending gastric varix embolization with immediate bleeding control–was achieved in all 9 patients. There was no procedure-related complication. All cases showed successful clinical outcome during mean follow up of 17 months (12–32 months), evidenced by imaging studies, endoscopy and clinical data. In 4 patients, mild worsening of esophageal varices or transient ascites was noted as portal hypertensive related change.ConclusionEmergent PARTO is technically feasible and safe, with acceptable mid-term clinical results, in treating active gastric varix bleeding.

Vascular Plug–Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Varices and Hepatic Encephalopathy: A Prospective Multicenter Study

PurposeTo evaluate technical and clinical outcomes of vascular plug–assisted retrograde transvenous obliteration (PARTO) for the treatment of gastric varices (GVs) and hepatic encephalopathy (HE). Materials and MethodsFrom March 2012 to June 2014, 73 consecutive patients (47 men, 26 women; mean age, 59 y; range, 28–79 y) who had undergone PARTO were evaluated in a prospective multicenter study. Among 57 patients with GVs, 28 had GVs in danger of rupture, 23 had experienced recent bleeding, and 6 had active variceal bleeding. The 16 patients with HE had been treated unsuccessfully with medical therapies. ResultsPlacement of the vascular plug and subsequent gelatin sponge embolization were technically successful in all 73 patients. There were no procedure-related complications. Follow-up CT obtained within 1 wk after PARTO showed complete thrombosis of GVs and portosystemic shunts in 72 of 73 patients (98.6%). Sixty patients who underwent follow-up longer than 3 mo showed complete obliteration of GVs and portosystemic shunts. There were no cases of variceal bleeding or HE at the end of follow-up (mean, 544 d). Improvement in Child–Pugh score was observed in 24 patients (40%) at 1-mo follow-up. Worsening of ascites and esophageal varices was observed in 14 (23.3%) and 16 (26.7%) patients at 3-mo follow-up. ConclusionsThe present results of PARTO indicate that it can be rapidly performed with high technical success and durable clinical efficacy for the treatment of GVs and HE in the presence of a portosystemic shunt. Therefore, PARTO might be considered a first-line treatment in appropriate patients.

Retrograde Renal Ablation via the Renal Vein as a New Treatment Option for Renovascular Hypertension

Renovascular hypertension is a hormonal response to decreased renal blood supply. Treatments include medication, balloon angioplasty, arterial embolization, and nephrectomy. We attempted a new method, retrograde renal ablation via the renal vein. Our institutional review board approved this procedure. A 51-year-old man had uncontrolled hypertension for 3 years despite taking four antihypertensive drugs (calcium antagonist, angiotensin II receptor blocker, β-blocker, and α-blocker). The high serum renin level (4 20 ng/mL/h) and dynamic computed tomography (CT) findings (left renal arterial occlusion, renal atrophy, and parenchymal enhancement delay) suggested renovascular hypertension. Arterial embolization was attempted twice to eliminate the left renal function. Tortuous collateral arteries including lumbar and adrenal vessels supplied the kidney, so absolute ethanol and gelatin sponge embolization of these

Evaluation of arterial impairment after experimental gelatin sponge embolization in a rabbit renal model.

ObjectiveArterial stenosis is a major obstacle for subsequent interventional procedures. We hypothesized that the stenosis is caused by gelatin sponge embolization and performed an experimental study in a rabbit renal model.Materials and MethodsA total of 24 rabbits were embolized with porcine gelatin sponge particles injected into the renal arteries. Four rabbits were sacrificed on 1 day, 4 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after embolization. Microscopic evaluations were performed on hematoxylin-eosin and smooth muscle actin immunohistochemical stained sections.ResultsGelatin sponge particles were mainly observed in the segmental and interlobar arteries. Transmural inflammation of the embolized arterial wall and mild thickening of the media were observed 1 week after embolization. Resorption of the gelatin sponge and organization of thrombus accompanied by foreign body reactions, were observed from 2 to 4 weeks after embolization. Microscopic images of the 3 weeks group showed vessel lumens filled mostly with organized thrombi, resulting in severe stenosis. Additionally, vessels showed a thickened intima that contained migrating smooth muscle cells and accompanying interruption of the internal elastic lamina. The migrating smooth muscle cells were distributed around the recanalized arterial lumen.ConclusionGelatin sponge embolization may induce arterial stenosis by causing organized thrombus and intimal hyperplasia, which consists of migrating smooth muscle cells and intimal collagen deposits.

Post-Traumatic High-Flow Priapism Treated with Gelatin Sponge Embolization: A Case Report

A 41-year-old male presented with a one week of ongoing priapism subsequent to an injury in a traffic accident (blunt perineal trauma). A selective arteriography of the right internal pudendal artery demonstrated an arterio-corporal fistula. A 2.8 French (2.8 Fr.) Renegade Microcatheter (Boston Scientific) was advanced proximal to the fistula over a 0.014 flexible guidewire. The fistula was then embolized with a gelatin sponge (gelfoam). Post embolization showed the closure of the fistula and significant detumescence. At 12 weeks later: there was no recurrence of priapism and the patient reported normal erectile function. Transarterial embolization appears to be a safe and effective treatment for managing patients with high-flow priapism.

Gastric Varices and Hepatic Encephalopathy: Treatment with Vascular Plug and Gelatin Sponge–assisted Retrograde Transvenous Obliteration—A Primary Report

To evaluate technical safety, clinical safety, and effectiveness of vascular plug-assisted retrograde transvenous obliteration (RTO) for treatment of gastric varices (GV) and hepatic encephalopathy (HE). This retrospective study was approved by the institutional review board; written informed consent was waived. From April 2009 to December 2011, 20 patients (13, GV; seven, HE) who had undergone vascular plug-assisted RTO were retrospectively evaluated. After retrograde transvenous placement of a vascular plug in the left adrenal vein or gastrorenal shunt, subsequent gelatin-sponge embolization of both gastrorenal shunt and GV was performed. Follow-up computed tomography (CT) and upper gastrointestinal tract endoscopy were performed; clinical and laboratory data were collected to evaluate primary (technical success, complications, clinical success) and secondary (change of liver function by using the Child-Pugh score, worsening of esophageal varices) end points. Laboratory data before and after vascular plug-assisted RTO were compared (paired-sample t test). Placement of the vascular plug and subsequent gelatin-sponge embolization were technically successful in all 20 patients, with no procedure-related complications. Follow-up CT within 1 week after vascular plug-assisted RTO showed complete thrombosis of GV and gastrorenal shunts in all patients. Clinical symptoms of HE completely resolved in all seven patients with HE; mean serum NH3 level of 127.4 μmol/L ± 58 (standard deviation) before vascular plug-assisted RTO decreased significantly to 28.1 μmol/L ± 9.8 within 1 week after vascular plug-assisted RTO (P = .002). Eighteen patients who underwent follow-up longer than 2 months showed complete obliteration of GV and gastrorenal shunts at CT and endoscopy. There were no cases of variceal bleeding or HE during mean follow-up of 422 days. Improvement in Child-Pugh score was observed in 12 of 18 (67%) patients 1 month after vascular plug-assisted RTO. Worsening of esophageal varices was observed in four (22%) patients at mean follow-up of 9.4 months. Vascular plug-assisted RTO is technically simple and safe and seems to be clinically effective for treatment of GV and HE.

Roles Played by Chemolipiodolization and Embolization in Chemoembolization for Hepatocellular Carcinoma: Single-Blind, Randomized Trial

The aim of our study was to compare the efficacy and safety of: 1) transarterial chemolipiodolization with gelatin sponge embolization vs chemolipiodolization without embolization, and 2) chemolipiodolization with triple chemotherapeutic agents vs epirubicin alone. A single-blind, three parallel arm, randomized trial was conducted at three clinical centers with patients with biopsy-confirmed unresectable hepatocellular carcinoma. Arm 1 received triple-drug chemolipiodolization and sponge embolization, whereas Arm 2 received triple-drug chemolipiodolization only. Patients in arm 3 were treated with single-drug chemolipiodolization and sponge embolization. We compared overall survival and time to progression. Event-time distributions were estimated by the Kaplan-Meier method. All statistical tests were two-sided. From July 2007 to November 2009, 365 patients (Arm 1: n = 122; Arm 2: n = 121; Arm 3: n = 122) were recruited. The median tumor size was 10.9cm (range = 7-22cm), and 34.5% had macrovascular invasion. The median survivals and time to progression in Arm 1, Arm 2, and Arm 3 were 10.5 and 3.6 months, 10.1 and 3.1 months, and 5.9 and 3.1 months, respectively. Survival was statistically significantly better in Arm 1 than in Arm 3 (P < .001), whereas there was no statistically significant difference between Arm 1 and Arm 2 (P = .20). Objective response rates were 45.9%, 29.7%, and 18.9% for Arm 1, Arm 2, and Arm 3, respectively. Chemolipiodolization played an important role in transarterial chemoembolization, and the choice of chemotherapy regimen may largely affect survival outcomes. However, the removal of embolization from chemoembolization might not statistically significantly decrease survival.

Chronic post-traumatic high-flow priapism treated with temporary gelatin sponge embolization

We report the case of a 26-year-old man who presented with a non-painful priapism with a history of 3 months permanent erection after suffering a perineal trauma. An arteriocorporal fistula with a turbulent flow between the right cavernosal artery and the corpus cavernosum, conclusive for a high-flow priapism was initially detected by colour Doppler ultrasound. A superselective embolization with Gelatin sponge was safe and effective to treat the high-flow priapism. The use of gelatin sponge resulted in a temporary embolization with long-term effect of penile detumescence and preservation of erectile function.

Transarterial chemoembolization compared with conservative treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus: using a new classification

We aimed to compare the survival benefit of transarterial chemoembolization (TACE) with conservative treatment for patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT), furthermore, to reveal which PVTT types benefit from TACE treatment. From August 2007 to January 2010, a prospective controlled study was performed on consecutive patients with advanced HCC and PVTT. Of a total of 150 patients, 115 were treated with TACE (lipiodol and anticancer agents ± gelatin sponge embolization), and 35 who refused to accept the procedure were treated with conservative treatment. We performed survival analysis of the two treatment groups and then stratified by a new classification of PVTT that was divided into four types. Overall survival was significantly better in the TACE group than in the conservative group (8.67 months vs. 1.4 months, P<0.001). The overall median survival for types I-IV PVTT were 12.0, 8.3, 5.0, and 2.43 months (P<0.01). On subgroup analysis of PVTT, the median survival in the TACE group compared with conservative group for type I, II, III, and IV PVTT was 19.0 months versus 4.0 months, 11.0 months versus 1.43 months, 7.1 months versus 1.3 months, and 4.0 months versus 1.0 months, respectively (P<0.01). The TACE group had significantly better survival than the conservative group for different extent of PVTT. TACE is an effective treatment mode compared with conservative treatment for HCC and PVTT and may provide a significantly better survival benefit for different extent of PVTT.

Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Prospective Comparative Study

For patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT), the survival benefit of transarterial chemoembolization (TACE) compared with conservative treatment largely remains controversial. The objective of this study was to determine whether TACE confers a survival benefit to patients with HCC and PVTT, and to uncover prognostic factors. Between July 2007 and July 2009, a prospective two-arm nonrandomized study was performed on consecutive patients with unresectable HCC with PVTT. In one arm, patients were treated by TACE using an emulsion of lipiodol and anticancer agents ± gelatin sponge embolization. In another arm, patients received conservative treatment. A total of 164 patients were recruited for the study (TACE group, n = 84; conservative treatment group, n = 80). Patients in the TACE group received a mean of 1.9 (range, 1-5) TACE sessions. The overall median survival for all patients was 5.2months, and the 12- and 24-month overall survival rates were 18.3% and 5.6%, respectively. The 12- and 24-month overall survival rates for the TACE and conservative groups were 30.9%, 9.2%, and 3.8%, 0%, respectively. The TACE group had significantly better survivals than the conservative group (P < 0.001). On subgroup analysis of segmental and major PVTT, the TACE group also had significantly better survivals (P = 0.002, P = 0.002). The treatment type, PVTT extent, tumor size, and serum bilirubin were independent prognostic factors of survival on multivariate analysis. TACE was safe and feasible in selected HCC patients with PVTT and it had survival benefit over conservative treatment.

Postbiopsy Splenic Bleeding in a Dog Model: Comparison of Cauterization, Embolization, and Plugging of the Needle Tract

The purpose of our study was to compare radiofrequency cauterization, embolization using an absorbable gelatin sponge, and a Histoacryl-Lipiodol mixture plugging as postbiopsy bleeding reduction methods after splenic core needle biopsy in a dog model. Eleven mongrel dogs were randomly separated into nonheparinized (n = 5) and heparinized (n = 6) groups. Eight splenic biopsies per animal were performed using an 18-gauge automated core biopsy needle: two as controls, two ablated by radiofrequency, two embolized using an absorbable gelatin sponge, and two plugged using a Histoacryl-Lipiodol mixture. Procedure times and postbiopsy bleeding amounts were assessed. Statistically significant differences were determined by repeated measures analysis of variance; the Tukey-Kramer test for multiple comparisons was used for post hoc comparisons. Three-day follow-up CT scans were obtained to check for procedure-related complications or delayed bleeding. The postbiopsy bleeding reduction groups showed significantly less blood loss than the control group for both the nonheparinized (p < 0.0001) and heparinized groups (p < 0.0001). In the heparinized group, both radiofrequency cauterization (p < 0.01) and gelatin sponge embolization (p < 0.05) significantly reduced bleeding compared with Histoacryl-Lipiodol mixture plugging. Gelatin sponge embolization was the longest procedure (p < 0.001). On follow-up CT, no delayed bleeding was observed. However, multiple Histoacryl-Lipiodol emboli were observed in the splenic and portal veins in all the dogs we treated. Radiofrequency cauterization was found to be the most useful postbiopsy bleeding reduction method in terms of the amount of bleeding and the procedure time.

Transarterial chemoembolization in hepatocellular carcinoma: Can easy to use criteria determined after the first session predict survival? A multivariate analysis

The efficacy of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) is still a matter of debate because of conflicting results, explained in part by variations in treatment indications and modalities. The aim of the present study was to determine whether simple routine parameters evaluating the Ist session ofTACE can predict survival. Patients and methods: From January 90 to January 99, 251 patients with HCC were treated in our department. Patients were included only when they were treated at least with one session of TACE and completed evaluation one month after TACE with CT scan. TACE session included hepatic arteriography, lipiodol and doxorubicin (50 mg/sm) emulsion injection, followed by gelatin sponge embolization. The following variables were studied in univariate and multivariate analysis: i) patient parameters (age, cirrhosis etiology, Child-Pugh class; ii) tumor parameters (tumor number, largest lesion size, alpha-fetoprotein concentration, existence of associated treatment) iii) TACE evaluation (variation in alfa-fetoprotein concentration, presence of post-embolization syndrome, i.e. hyperthermia, andlor cytolysis occurring within 2 days following TACE, and tumor lipiodol uptake. This last parameter was determined by the same radiologist by reading all CT scan without being informed of the study aim or patients survival. Results: 72 patients (mean age 66 yrs) fulfilled the inclusion criteria. HCC diagnosis was cytological in 94% and clinical in the remaining cases (imaging, alfa-fetoprotein level). 96% of patients had liver cirrhosis with Child-Pugh class A, Band C in respectively 66.7%, 27.5% and 5.8% of cases. Mean tumor number was 1.9 and the largest lesion had a mean diameter of 4.6 cm. Patient received a mean of 3 TACE session. 31 patients had associated treatment during folllow-up, Mean follow-up was 22.7 months. Mean survival was 30.4 months (median 22 months). Actuarial survival at 1,2,3 and 5 years was respectively 67.5%, 47.5%, 32.5%, and 20%. The only independant prognostic factor in multivariate analysis was the Child-Pugh class (p<O.OOI). None of our criteria evaluating the lst TACE session significantly influenced survival. Conclusions: The 3 parameters (variation in alfa-fetoprotein, post-embolization syndrome and lipiodol uptake) after the l st TAC did not predict survival.They could not be used to determine patients that could benefit from repeated TACE session.

TRANSARTERIAL EMBOLIZATION AND ABLATION OF RENAL ARTERIOVENOUS MALFORMATIONS: EFFICACY AND DAMAGES IN 30 PATIENTS WITH LONG-TERM FOLLOWUP

Purpose We evaluate the long-term efficacy and side effects of transarterial embolization and ablation for renal arteriovenous malformations. Materials and Methods A total of 30 patients with cirsoid arteriovenous malformations causing massive hematuria underwent 34 procedures of embolization or ablation. We confirmed the ratios of occluded arteriovenous malformation areas on angiograms and those of infarcted areas on computerized tomography. All patients were followed for 4.1 to 15.0 years (mean 8.0 +/− 2.8) after the initial procedures. Results Hematuria ceased in all patients after the initial procedures, including partial embolization or ablation of the arteriovenous malformations in 8. Massive hematuria recurred in 4 patients, who had undergone absorbable gelatin sponge (2), embolization, combined alcohol and subselective absorbable gelatin sponge embolization (1) and polyvinyl alcohol particles embolization (1). In these 4 cases total ablation of the arteriovenous malformations with alcohol was successful. In 29 patients, including aforementioned 4, no hematuria recurred after 5 years following total or partial ablation with alcohol. Large nontarget embolization with reflux of subselectively infused absorbable gelatin sponge caused a nonfunctioning kidney in 1 patient. The remaining 33 procedures caused 6.3 to 48.0% (mean 15.7 +/− 6.9%) areas of renal infarction. Polyvinyl alcohol embolization caused pulmonary embolism and renin dependent hypertension. Conclusions Partial or total transarterial ablation of arteriovenous malformations with alcohol proved effective for long-term cessation of hematuria. However, this procedure as well as transarterial embolization has the potential risk of nontarget infarction.

Transcatheter Arterial Chemoembolization in Inoperable Hepatocellular Carcinoma: Four-year Follow-up

To evaluate the efficacy of repeated chemoembolization in patients with inoperable hepatocellular carcinoma (HCC). One hundred thirty-two patients with HCC underwent transcatheter arterial chemoembolization with an emulsion of iodized oil and cisplatin. In 104 patients, "light" gelatin sponge embolization was also used. Chemoembolization was repeated every 1.5-3.0 months in most patients (range, one to 18 chemoembolization sessions). In 74 patients, the HCCs became smaller or disappeared after chemoembolization. Decreases in size were seen in 55 of 76 HCCs 9 cm or smaller, 17 of 42 HCCs between 9 and 18 cm, and two of 14 HCCs larger than 18 cm. Use of gelatin sponge pledgets enhanced the response in tumors larger than 9 cm. Seven of 74 HCCs that responded to chemoembolization increased in size later. New daughter nodules that appeared at other sites responded to chemoembolization in 24 of 40 patients. Further new nodules appeared in 14 of 24 patients, and in six patients they responded to therapy. Median survival was 26 months for patients with responsive HCCs and 5 months for those with unresponsive lesions. Tumor size at the start of chemoembolization influenced the response to treatment and survival. The addition of gelatin sponge improved results only in tumors larger than 9 cm. Recurrence after an initial response was due more to the appearance of new daughter nodules in new locations rather than recrudescence of the presenting tumor.