Impact Of Preoperative Embolization Research Articles

An analysis from the CAPACITY database of outcomes of preoperative embolization before carotid body tumor surgery compared with resection alone

Objective: There is no definitive consensus on the impact of preoperative embolization on carotid body tumor (CBT) treatment. The objective of this study was to compare surgical outcomes of patients who underwent preoperative embolization before CBT resection vs patients who underwent resection alone.

An analysis from the CAPACITY database of outcomes of preoperative embolization before carotid body tumor surgery compared with resection alone

There is no definitive consensus on the impact of preoperative embolization on carotid body tumor (CBT) treatment. The objective of this study was to compare surgical outcomes of patients who underwent preoperative embolization before CBT resection vs patients who underwent resection alone. The CAPACITY registry included 1432 patients with CBT from 11 medical centers in four different countries. The group of patients undergoing CBT resection with preoperative embolization was matched in a 1:6 ratio from a pool of patients from the CAPACITY database, using a generated propensity score with patients who did not underwent preoperative embolization. A total of 553 patients were included for analysis. Mean patient age was 56.23± 12.22years. Patients were mostly female (n= 469; 84.8%). Bilateral CBT was registered in 60 patients (10.8%). Seventy-nine patients (14.3%) underwent preoperative embolization. Embolized patients had larger CBT sizes than non-embolized patients (33.8mm vs 18.4mm; P= .0001). Operative blood loss was lower in the embolized group compared with the non-embolized group (200mL vs 250mL; P= .031). Hematomas were more frequent in the non-embolized group (0% vs 2.7%; P= .044). Operative time, rates of stroke, cranial nerve injuries, and death were not statistically significant between groups. Embolization before CBT resection was associated with significantly lower blood loss and lower neck hematomas than patients who underwent resection alone. Operative time, stroke, cranial nerve injuries, and death were similar between groups.

Impact of Pre-operative Embolization With Onyx for Brain Arteriovenous Malformation Surgery.

ObjectiveTo clarify the safety and efficacy of pre-operative embolization using Onyx liquid embolic agent (Onyx; ev3) compared with N-butyl cyanoacrylate (NBCA; Cordis Neurovascular, Inc.) or coils in cerebral arteriovenous malformation (AVM) surgery.MethodsThis was a retrospective review of a prospectively collected clinical database of brain AVMs treated at our institute from January 2005 to March 2021. A total of 38 consecutive patients who underwent AVM resection after pre-operative embolization were included. Based on pre-operative embolization materials, the patients were divided into the pre-Onyx group (n = 16), in which NBCA or coils were used for embolization, and the Onyx group (n = 22). Patient characteristics and treatment results were compared between the two groups.ResultsPatient characteristics were comparable between the two groups in terms of age, sex, and rupture status. While the Spetzler–Martin grade was also similar between the two groups, the location of the AVM nidus in the eloquent area was slightly higher in patients in the Onyx group (72.7%) than in patients in the pre-Onyx group (43.8%) (P = 0.09). The embolization rate was higher in the pre-Onyx group (mean: 63.0%; range: 12.7–100%) than in the Onyx group (mean: 50.0%; range: 15.8–100%), but the difference was not statistically significant (P = 0.06). The time needed for surgical removal was shorter in the Onyx group (mean: 354.8 min; range: 144–884 min) than in the pre-Onyx group (mean: 457.9 min; range: 240–1,294 min); however, this difference was not statistically significant (P = 0.13). The amount of intraoperative bleeding was significantly lower in the Onyx group (mean: 129.8 ml; range: 20–540 mL) than in the pre-Onyx group (mean: 448.8 mL; range: 120–1,550 ml) (P = 0.0008). The surgical complication rates were comparable between the two groups (pre-Onyx group, 18.8%; Onyx group, 4.5%; P = 0.29).ConclusionsPre-operative embolization with Onyx can significantly reduce the amount of intraoperative bleeding in AVM resection and may contribute to safe AVM surgery.

Impact of Preoperative Embolization on Carotid Body Tumor Surgery

The aim of this study is to investigate the effect of preoperative carotid body tumor embolization (CBTE) on the amount of bleeding, and vascular and neurological complications in carotid body tumors. Fifty patients treated for 51 carotid body tumors in 2 clinics, between 2005 and 2020, were evaluated. Polyvinyl alcohol embolization of the carotid body tumor was performed in 23 patients before the surgical excision. The results were compared with the remaining 28 patients, in whom CBTE was not performed, in terms of neurological complications, requirement of additional vascular interventions, bleeding amount, and length of hospital stay. Mean bleeding amount was significantly lower in the CBTE group (406-217mL, P<0.05). Median erythrocyte suspension transfusion was significantly lower in the CBTE group (0.3 units vs. 1.1 units, P<0.05). Neurological deficits developed in a total of 13 patients: 6 in the CBTE group and 7 in the non-CBTE group, in the early postoperative period (P=0.90). No significant difference was observed between the groups in terms of additional vascular interventions and length of hospital stay (P=0.79 and P=0.61). Carotid body tumors are rarely encountered tumors. However, their surgical excision is challenging for surgeons regarding intraoperative and postoperative bleeding. This study demonstrates that preoperative CBTE significantly reduces the amount of bleeding, especially in Shamblin type II/III tumors.

Impact of preoperative embolization on the outcomes of carotid body tumor surgery: A meta-analysis and review of the literature.

There is no consensus on the impact of preoperative embolization (EMB) on the surgical outcomes of carotid body tumor (CBT) resections. A systematic review and a meta-analysis were conducted to clarify the role of preoperative EMB in patients undergoing surgical removal of CBTs. Fifteen studies with a total number of 470 patients met the inclusion criteria. The results of the meta-analysis showed that there is no significant difference in estimated blood loss, operative time, length of hospital stay, or risks of cranial nerve injury, vascular injury, and stroke between the EMB and nonembolization (NEMB) groups. This systemic review and meta-analysis demonstrate that preoperative EMB does not confer any operative or postoperative advantage in patients scheduled for CBT surgery. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2386-E2394, 2016.

Impact of preoperative embolization on outcomes of carotid body tumor resections

This study assessed neurovascular complications in the surgical management of carotid body tumors (CBTs), with emphasis on those treated with and without preoperative embolization. We reviewed the clinical data of all consecutive patients with CBTs treated by surgical resection at our institution from 1985 to 2010. Outcomes were compared between Shamblin class II and III CBTs treated with preoperative embolization (EMB group) and with no preoperative embolization (NEMB group). A total of 131 patients (80 women, 51 men), who were aged 48 years (range, 16-84 years), had resection of 144 CBTs and 12 concurrent cervical paragangliomas. This included 18 patients who had bilateral resections and 29 with familial CBTs. Succinate dehydrogenase (SDHx) mutations were confirmed in 17 patients. Mean tumor volume was 20.5 cm(3) (range, 0.8-101.3 cm(3)), and there were two biochemically active CBTs (1%). There were 71 Shamblin II and 33 Shamblin III. The EMB group underwent 33 CBT resections, and the NEMB group underwent 71. There were more patients in the EMB group with bilateral (48% vs 22%; P = .01) and familial (34% vs 14%; P = .01) CBT; otherwise, patient demographics, Shamblin class, and tumor diameter and volumes were similar. No strokes or other major complications occurred after preoperative embolization with polyvinyl alcohol particles 1 day before surgery. The EMB group required less extensive procedures (simple excision in 97% vs 82%, P = .03; internal carotid artery clamping in 15% vs 37%, P = .04) and had less blood loss (mean estimated blood loss, 263 vs 599 mL; P = .002) than the NEMB group. However, there were no significant differences in operative time (250 vs 265 minutes; P = .49), temporary cranial nerve injury (52% vs 38%; P = .21), clinically apparent cranial nerve deficits after 1 year (12% vs 7%; P = .46), deaths (0% vs 0%; P > .99), stroke (0% vs 1%; P > .99), or postoperative length of stay (4.1 vs 4.2 days; P = .91). Large CBTs can be resected safely with or without preoperative embolization. Preoperative embolization may simplify the conduct of the operation and reduce blood loss but does not decrease rates of cranial nerve injury, although most are temporary.

PS74. Impact of Pre-Operative Embolization on Outcomes of Shamblin II and III Carotid Body Tumor Resections

Objectives: Blunt abdominal aortic injury (BAAI) is very rare. Current literature is limited to case series of single center experience. Through an analysis of the National Trauma Databank (NTBD), the largest aggregation of United States trauma registry data, our aim was to more accurately characterize the injury patterns, management strategy and mortality of patients with BAAI. Methods: We used a nested case-control design. The cohort was patients age 16 years, with injury severity score (ISS) 16, treated at a level 1 or 2 trauma center in years 2007-2009. Cases were patients with BAAI and were matched by age and mechanism to 1815 randomly selected controls without BAAI. Data collected included age, gender, comorbidities, ISS, associated injuries, type and timing of vascular interventions and hospital disposition. Results: We identified 363 patients with BAAI from 156 centers. The mean ISS was 34 15 and the average age was 49 21 years. Most patients were injured in motor vehicle crashes (84%). In comparison to controls, lumbar spine fractures, pelvic fractures as well as injuries to the kidneys, liver, spleen, pancreas, small bowel and colon were all more frequent in association with BAAI (p 0.001). Mortality was greater in patients with BAAI (32% vs. 10% in controls, p 0.001), with two thirds of deaths occurring in the first 24 hours. Of the 286 patients surviving beyond 24 hours, 249 (87%) were managed non-operatively, 26 (9%) underwent endovascular repair and 11 (4%) underwent open repair (9 with aortic interposition graft, 2 with extra-anatomic bypass). 81% of repairs were performed within 48 hours. 216 (86%) patients managed non-operatively survived to hospital discharge. Conclusions: The index of suspicion for BAAI should be raised in severely injured patients by the presence of lumbar and pelvic fractures as well as intra-abdominal injury. While endovascular repair is the most common intervention, most patients are managed non-operatively and survive to hospital discharge.