Gelfoam Particles Research Articles

Interventionelle Behandlung der Hämobilie

Aim of the study was to assess the use of embolisation in cases of iatrogenic haemobilia. In 18 patients with severe haemobilia after percutaneous biliary system drainage or stent implantation, an embolisation with minicoils (17 x) or gelfoam particles, was performed. To achieve a sufficient vascular obstruction, Histoacryl (4 x) or Ethibloc (1 x) were additionally used in five cases. A transarterial approach was used in 17 cases. In one patient, an approach through the biliary system was possible. In all cases, the bleeding source was identified (5 false aneurysms, three biliary leaks, 9 irregularities at the junction of the artery and drainage catheter, 1 multiple collaterals at the proximal end of the stent). In 17 out of 18 cases, haemorrhage ceased definitely. In one case of a patient with pancreas carcinoma and obstruction of the portal vein as well as a simultaneous high grade stenosis of the hepatic artery propria, it was only possible to embolise small collaterals to avoid liver necrosis. This resulted in an incomplete bleeding of control. An infected haematoma was the only complication. It was treated by drainage over 10 days. During an observation period ranging approximately 7.6 months, 10 of the patients died due to their basic illness. Embolisation is an effective procedure in the treatment of haemobilia, with a low complication rate.

Histopathological changes in rabbit uterus carcinoma after transcatheter arterial embolization using cisplatin.

The effects of chemoembolization with cisplatin on gynecological malignancy were investigated using rabbit uterine tumors. A group of 20 rabbits were subjected to inoculation of the uterus with 5 x 10(7) VX2 carcinoma cells and 4 weeks later were divided into four groups, each consisting of five rabbits: an untreated control group, a group given cisplatin intraarterially (IA), a group subjected to transcatheter arterial embolization (TAE) with Gelfoam particles and a group subjected to transcatheter chemoembolization (TACE) with Gelfoam particles plus 1 mg/kg cisplatin. All groups were examined histologically 2 days after treatment. The untreated control group was further investigated 4 weeks after inoculation. In the untreated control group, the tumor cell nuclei varied in size and were irregular in form, and multiple nuclei and nuclear division were also observed. No necrotic zones were found up to 4 weeks after inoculation. The IA group showed no necrosis, but a few apoptotic cells were scattered throughout the tumor. In the TACE group, necrosis was observed in the center of the tumors, but proliferating cells persisted at the periphery. In the TACE group, necrosis was observed in the central part with many apoptotic cells surrounding the necrotic region in layers. The proliferating cell nuclear antigen (PCNA) index was 95.88% in the untreated control group, 86.6% in the IA group, and 8.62% in the TACE group, indicating a significant reduction in cell proliferation in the TACE group. These findings suggest that TACE results in more effective cytotoxicity than the other two treatments in uterine cancer tumor transplants.

Evaluation of embolization effect of hepatocellular carcinoma by hepatic arterial flow study with Tc-99m MAA SPECT.

The degree of hepatocellular carcinoma vascularity in eight patients was assessed with Tc-99m MAA radionuclide angiography before and after treatment. For chemoembolization therapy, lipiodol and doxorubicin hydrochloride were administered intraarterially along with Gelfoam particles. The ratio of radioactivity in the hepatocellular carcinoma compared to that in the surrounding uninvolved tissue before therapy was 6.5-19.0 with a mean of 12.0. After therapy, the ratio dropped to 0.5-1.3. Because survival improved significantly after the therapeutic regimen used in these patients, radionuclide Tc-99m MAA angiography appears to be an accurate method for demonstrating successful embolization of the vascular supply in hepatocellular carcinoma.

A Case of the Bronchial Artery-Pulmonary Vein Malformation

The bronchial artery-pulmonary vein malformation should be called the systemic artery-to-pulmonary vein arterioveonus malformation in the lung. Although pulmonary arteriovenous malformation has been well documented in intrapulmonary arteriovenous malformation, the systemic artery-to-pulmonary vein arteriovenous malformation is rare. Most patients with systemic artery-to-pulmonary vein arteriovenous malformation is asymptomatic and the diagnosis of these anomaly may be done by continuous murmur or abnormal chest X-ray on the physical examination. The pathogenesis of this condition is congenital malformation which explains these anastomoses between the pulmonary vein and accessory brachial arteries and acquired malformation which explains development of new blood vessel to supply large enough to cause significant systemic-pulmonary shunts due to inflammation secondary to infection, trauma, or previous surgery. We experienced a case of the bronchial artery-pulmonary vein malformation which was detected on angiography in 20-year-old women whose chief complain is hemoptysis. This massive hemoptysis was controlled by selective brachial artery embolization with Gelfoam and Ivalon particles.

Liver parenchymal changes after transcatheter arterial embolization therapy for hepatoma: CT evaluation.

We retrospectively reviewed computed tomographic (CT) findings of 118 patients with hepatoma who received sequential follow-up CT after transcatheter arterial embolization (TAE). Thirty-five patients received TAE using Gelfoam particles with cisplatin, 37 patients using Gelfoam particles and iodized oil (Lipiodol) with cisplatin, and 46 patients using iodized oil with cisplatin. Liver atrophy was observed in 33 patients, lobarly or focally, depending on the embolized area. It was frequently associated with portal vein occlusion by the tumor, usage of iodized oil, and repeated embolization therapy. The lobar atrophy was seen in patients who had portal vein occlusion and/or received repeated embolization therapy. The focal atrophy was observed in patients who were administered iodized oil. Infarction developed in four patients who had a thrombus in the portal vein and received peripheral embolization therapy using iodized oil. We conclude that liver parenchymal changes occur frequently in patients who have portal vein occlusion and/or receive peripheral embolization using iodized oil.

Segmental embolotherapy for hepatic cancer: keys to success.

Transcatheter chemoembolization using Lipiodol (Lp) mixed with chemotherapeutic agents followed by Gelfoam particle injection only to the tumor-bearing hepatic segment (segmental Lp transcatheter hepatic artery embolization) (TAE) was applied to more than 100 patients with hepatocellular carcinoma and metastatic liver cancer. For segmental Lp-TAE, knowledge of the variations of intrahepatic arterial anatomy is important. Furthermore, the catheters and guidewires, volume of Lp, kinds and dose of chemotherapy, preparation of the mixture of Lp and chemotherapy (Lp-emulsion), method of injection of Lp-emulsion and Gelfoam particles, as well as the follow-up computed tomography examination are key items to the success of the procedure and are reviewed.

Emergent embolotherapy of small intestine hemorrhage

The efficacy of emergent embolotherapy was evaluated in six patients suffering hemorrhage from the small intestine. Hemorrhage was from the jejunum in four patients, from the ileum in one, and from Meckel's diverticulum in one. Superselective embolization of the arcade of the small intestine artery branch was performed in all patients with a coaxial catheter. Embolic materials used were Gelfoam particles alone or Gelfoam particles plus coils in earlier cases and microcoils in recent cases. Complete hemostasis was immediately achieved in all patients, but one patient died of disseminated intravascular coagulation. After stabilization of the patient's condition by hemostasis, elective surgery was performed on three patients suffering small intestine ulcer. Histopathologically, no bowel infarction was noted but mild mucosal inflammation with submucosal edema was found in the jejunum of two patients. We recommend embolization for life-threatening small intestine hemorrhage, preferentially in situations where the blood vessel involved can be super-selectively occluded at the nearest level of the arcade of the vasa recta, lest the vasa recta should be occluded.

Embolotherapy of massive duodenal hemorrhage.

Eleven patients with massive duodenal hemorrhage were treated by emergent embolization. Bleeding originated from duodenal ulcer in three patients, from duodenal tumor in one, from ruptured pancreaticoduodenal artery pseudoaneurysm in three, and from ruptured gastroduodenal artery pseudoaneurysm in four. Complete hemostasis was obtained immediately after embolotherapy in all cases. Three of these patients died during the hospitalization period, one of whom from duodenal infarction and pancreas necrosis induced by embolization. In three patients with duodenal ulcer, complete hemostasis was obtained only by the gastroduodenal artery embolization with Gelfoam particles. Seven patients with pseudoaneurysms of the gastroduodenal artery or its branches required not only blockage of blood flow from the celiac artery but also the superior mesenteric artery for complete hemostasis. Therefore, in patients presenting with duodenal hemorrhage, the possibility of dual blood supply to the duodenum should be considered. Emergent embolization represents a useful alternative to surgery for massive duodenal hemorrhage, but it carries a risk of complications in patients with previous gastroduodenal surgery or significant visceral atherosclerosis.

Chemoembolisation of hepatocellular carcinomas: personal experience

Transcatheter arterial chemoembolisation (TACE) using antiblastic agents in association with occlusion of tumour-feeding arteries seems currently to be the most suitable treatment for unresectable hepatocellular carcinomas (HCC) larger than 3 cm in diameter. From July 1989 to January 1991, 21 patients with HCC and a previous history of liver cirrhosis were treated by TACE. The drugs used were doxorubicin and mitomycin C mixed with Lipiodol UF. The arterial occlusion was obtained using Gelfoam or Spongostan particles; in 16 patients it was limited to tumour-feeding arteries to avoid diffuse parenchymal liver damage, while in 5 patients either the main right or left hepatic artery was embolised. Three patients were excluded from the study after TACE because of too short a follow-up; 4/18 died within 3–9 months and 14/18 are still alive with follow-up ranging from 3 to 19 months. A tumour size reduction of more than 50% was observed in 9 patients (50%), with a median survival of 9.8 months. Transient and well-controlled side effects (fever, abdominal pain, nausea and vomiting) were related to the post-embolisation syndrome and could be reduced by using a superselective occlusion procedure.

Angiographic management of massive hemobilia due to iatrogenic trauma

Ten patients with massive hemobilia in shock or preshock status were treated with angiography. The hemobilia had been induced by iatrogenic trauma: biliary drainage in seven patients, and surgery, liver biopsy, and angiography in one patient each. Angiography was performed on all patients. Embolization was performed in nine, and in the one remaining patient, spasm of the right anterior hepatic artery and catheter manipulation injured the intima and obliterated the artery. In seven patients with hepatic artery pseudoaneurysm, gelfoam particles were injected in five, however, extravasation could not be prevented in four of these patients. Permanent embolic materials were added and complete hemostatis was obtained. Hemobilia never recurred in any patient. Emergency embolization should be considered as the initial treatment of choice for hemobilia and when pseudoaneurysms are discovered, they should be obliterated by permanent embolic materials. Moreover, tumor thrombus in the portal vein is not a contraindication for this procedure.

Embolotherapy for small bowel hemorrhage from metastatic renal cell carcinoma: Case report

Embolization for control of hemorrhage in the small bowel carries a significant risk of bowel infarction. A case is presented where severe gastrointestinal hemorrhage from a hypervascular renal cell carcinoma metastasis to the jejunum was effectively controlled by superselective embolization of mesenteric tumor supply arteries with Gelfoam particles. Adjacent normal mesenteric arteries remained open. It is concluded that in specific instances where direct mesenteric feeders to a tumor can be catheterized, such embolization can be performed safely.

Percutaneous Embolization of Ruptured Splanchnic Artery Pseudoaneurysms

The usefulness of emergent embolotherapy was evaluated in 17 patients with life-threatening hemorrhage from 18 ruptured splanchnic artery pseudoaneurysms. Complete hemostasis was obtained in 16 out of 17 patients by embolotherapy. Of the 12 initial embolization procedures with permanent embolic materials including stainless steel coils, microcoils, and Ivalon, complete cessation of bleeding was obtained in 11. On the other hand, 6 out of 9 initial embolization procedures with Gelfoam particles failed to halt bleeding, and additional embolization with permanent embolic materials was required. Emergent embolization with permanent embolic materials using superselective catheterization should be considered the initial treatment of choice for ruptured splanchnic artery pseudoaneurysms.

Life-Threatening Post-Nephrolithotomy Hemorrhage Resulting in Cessation of Kidney Function, Treated by Transcatheter Arterial Embolization with Subsequent Restoration of Excretory Function

A massive post-nephrolithotomy renal hemorrhage was successfully controlled by selective arterial embolization using Gelfoam particles. Prior to embolization, the kidney showed no excretory function due to complete obstruction of its collecting system by blood clots. Long-term observation revealed restoration of excretory function of the treated kidney and only minimal loss of its parenchyma.

Transcatheter hepatic segmental arterial embolization using lipiodol mixed with an anticancer drug and gelfoam particles for hepatocellular carcinoma

Transcatheter hepatic segmental arterial chemoembolization using Lipiodol mixed with an anticancer drug followed by the injection of Gelfoam particles, introduced into the tumor-bearing hepatic segment as the target area (segmental Lipiodol-TAE), was carried out in 54 patients with hepatocellular carcinoma (HCC), 7 of whom were later resected. In 5 of the resected 7 cases, complete necrosis was histologically verified. No death due to HCC was encountered in 47 nonoperated cases, and better therapeutic results were obtained with segmental Lipiodol-TAE. It was concluded that this technique does not adversely affect normal tissues, and it does reinforce the effect of TAE.

Expanding role of emergency embolization in the management of severe blunt hepatic trauma

Emergency embolization using Gelfoam particles alone, or in combination with stainless steel coils or epinephrine, was attempted in 4 patients with severe blunt hepatic trauma complicated by hypovolemic shock to control exsanguinating hemorrhage. Angiography prior to embolization revealed extravasation in all cases. None of the patients rebled or required further intervention. Postembolization course was uneventful in each case. Embolization could become the treatment of choice for more unstable and complicated patients than previously considered.

Therapeutic embolization of aneurysmal bone cyst

Results of therapeutic embolization of aneurysmal bone cysts in five patients are described. Transcatheter arterial embolization was performed with Ivalon and Gelfoam particles and Gianturco coils. The postembolization period was characterized by complete relief of pain and decrease in size of the aneurysmal bone cyst in all patients. In patients whose follow-up was longer than 12 months, sclerosis and recalcification of bone were present. There were no complications.

Transcatheter arterial embolization therapy in cases of recurrent and advanced gynecologic cancer.

Transcatheter internal iliac arterial embolization therapy (TAE) using Gelfoam particles was performed in 24 patients with recurrent gynecologic cancer and ten patients with advanced gynecologic cancer who had previously undergone radiotherapy. The tumor showed complete response (CR) to the therapy in six patients, partial response (PR) in 12, minor response (MR) in three, and no changes (NC) in 13 patients, with the response rate (CR + PR) of 52.9% (18 of 34). No serious or prolonged side effects were encountered except for vesicovaginal fistula in three patients and renal failure in one. The median duration of survival was 299 days, and the 1-year cumulative survival rate was 32.5%. The factors that were associated with favorable outcome after TAE were good general condition, no distant metastases, tumors less than 5 cm in diameter, and responses to the therapy of PR or better. Thus, TAE appears useful for the treatment of recurrent and advanced gynecologic malignancies.

Therapeutic Angioinfarction of Renal Carcinoma

Computed tomographic findings in nine patients after renal tumor embolization are reported. All tumors were ablated using absolute alcohol, Gelfoam particles, and occlusion coils. A rim of peripheral enhancement surrounding a central low density area presumed to represent the necrotic infarcted tumor was a constant CT appearance. Intratumoral gas was seen in three patients, persisting for up to 6 months, with eventual resolution. Mild postinfarction syndrome was experienced in all patients. The exact role of preoperative or palliative renal embolization is still controversial, but if the procedure is performed, the natural course of the neoplasm can be best evaluated and followed by serial CT scans.

Combination chemoembolization therapy for hepatocellular carcinoma: mainly, using cisplatin (CDDP)

Chemoembolization therapy, using the arterial injection of mixtures of various anticancer agents and lipiodol along with gelfoam particles, was carried out on 77 cases of hepatocellular carcinoma between January 1985 and March 1987, and an assessment was made on the anticancer effects of this treatment method. For the patients receiving lipiodol, the value of the longitudinal dimension multiplied by the vertical length of the tumor was calculated using a computerized tomograph before and after chemoembolization to determine the rate of tumor regression. (a) Of the 30 patients receiving chemoembolization therapy using a simple mixture of 100 mg cisplatin (CDDP) and lipiodol, the tumor regression rate was 50% or more in 10 cases (31%). (b) Of the 14 patients receiving chemoembolization therapy with a suspension of 100 mg of cisplatin, adriamycin (10-30 mg) and lipiodol, the tumor regression rate was 50% or more in four cases (29%). (c) Of the 31 cases receiving chemoembolization therapy using a suspension of adriamycin (10-40 mg), mitomycin C (10-20 mg) and lipiodol, the tumor regression rate was 50% or more in four cases (13%). (d) From these results, it can be concluded that the antitumor effect of chemoembolization using cisplatin is more significant than with other drugs.

Transcatheter arterial embolization using iodized oil (lipiodol) mixed with an anticancer drug for the treatment of hepatocellular carcinoma

The therapeutic results of Lp-TAE (transcatheter arterial embolization with Gelfoam particles preceded by the infusion of a mixture of lipiodol and an anticancer drug via the proper hepatic artery) were evaluated in hepatocellular carcinomas (523 non-resected and 24 resected cases). Excellent therapeutic effects were confirmed not only for the main tumor but also for the daughter nodules by a histological examination of the liver tissues resected after Lp-TAE. The cumulative 1-year, 2-year and 3-year survival rates in the 523 non-resected cases were 60.4%, 42.9% and 28.0% respectively. These survival rates were all higher than those achieved by Gelfoam TAE. The above results suggest the usefulness of Lp-TAE in the treatment of hepatocellular carcinoma.