Particle Embolization Research Articles

Некротический папиллит как редкая причина тотальной гематурии: клиническое наблюдение

We report a rare case of acute unilateral renal papillary necrosis in a 45-year-old female patient with acute pyelonephritis, which led to recurrent gross hematuria. During the first episode of inpatient treatment, the patient started conservative therapy after the exclusion of the most common causes of hematuria. After 10 days, the patient was discharged and continued her treatment at an outpatient department. However, 6 days after the discharge from hospital, she developed bladder tamponade followed by profuse bleeding after 2 more days (when the patient was hospitalized for the second time). Emergency angiography with subsequent superselective catheterization of the inferior renal polar artery and embolization of the bleeding source with PVA embolization particles (foamed polyvinyl alcohol) stopped the bleeding. After a course of comprehensive symptomatic therapy, the patient was discharged for outpatient treatment. Follow-up examination after 1 month showed that her condition was satisfactory; there was no evidence of latent bleeding.

Comparison of different embolic particles for superior rectal arterial embolization of chronic hemorrhoidal bleeding: gelfoam versus microparticle

BackgroundWhether different embolic particles with comparable diameter lead to similar beneficial effects in endovascular embolization of hemorrhoidal disease remains to be established. We sought to evaluate the efficacy and safety of different types of agents for superior rectal arterial embolization (SRAE) in patients with bleeding hemorrhoids.MethodsPatients with recurrent episodes of internal hemorrhoidal bleeding and chronic anemia treated by SRAE in three tertiary hospitals between March 2017 and June 2020 were retrospectively evaluated. The patients were divided into two study groups based on the embolic materials: embolization with coils (2–3 mm) + gelfoam particles at 350–560 μm (Group A, n = 23), embolization with coils (2–3 mm) + microparticles at 300–500 μm (Group B, n = 18). The technical success, preliminary clinical efficacy (percentage of patients without hematochezia), postoperative complications and short-term follow-up outcomes were analysed.ResultsA total of 41 patients (27 males) with symptomatic hemorrhoids were included in the study, mean age was 47 ± 12 years (range 25–72). 39% (16) patients with grade II hemorrhoids while 61% (25) patients with grade III. The technical success rate of the embolization procedure was 100%, and the preliminary clinical efficacy (87.0% vs 88.9%) showed no significant difference between the 2 groups (p = 0.098). No patients reported post-procedural and short-term serious complications, such as infection, intestinal ischemia or massive hemorrhage during the follow-up period (range 6–15 months).ConclusionsBoth gelfoam particles and microparticles with comparable diameter in the endovascular treatment of hemorrhoidal bleeding demonstrated similarly good short-term efficacy and safety profile.

Safety Profile of Particle Embolization for Treatment of Acute Lower Gastrointestinal Bleeding

PurposeTo assess ischemic adverse events following particle embolization when used as a second-line embolic to coil embolization for the treatment of acute lower gastrointestinal bleeding (LGIB). Materials and MethodsThe single-institution retrospective study examined 154 procedures where embolization was attempted for LGIB. In 122 patients (64 men; mean age, 69.9 years), embolization was successfully performed using microcoils in 73 procedures, particles in 34 procedures, and both microcoils and particles in 27 procedures. Particles were used as second-line only when coil embolization was infeasible or inadequate. Technical success was defined as angiographic cessation of active extravasation after embolization. Clinical success was defined as the absence of recurrent bleeding within 30 days of embolization. ResultsTechnical success for embolization of LGIB was achieved in 87% of the cases (134/154); clinical success rate was 76.1% (102/134) among the technically successful cases. Clinical success was 82.2% (60/73) for coils alone and 68.9% (42/61) for particles with or without coils. Severe adverse events involving embolization-induced bowel ischemia occurred in 3 of 56 (5.3%) patients who underwent particle embolization with or without coils versus zero of 66 patients when coils alone were used (P = .09). In patients who had colonoscopy or bowel resection within 2 weeks of embolization, ischemic findings attributable to the procedure were found in 3 of the 15 who underwent embolization with coils alone versus 8 of 18 who underwent embolization with particles with or without coils (P = .27). ConclusionsParticle embolization for the treatment of LGIB as second-line to coil embolization was associated with a 68.9% clinical success rate and a 5.3% rate of ischemia-related adverse events.

Efficiency and safety of ethanol sclerotherapy for labial arteriovenous malformations

BackgroundLabial arteriovenous malformations (AVMs), usually with accompanying cosmetic defects, pain, and bleeding, are aggressive with a high risk of recurrence and the absence of effective treatment. In the present report, we have described a technique of sclerotherapy for labial AVMs. MethodsPatients with labial AVMs were treated with percutaneous ethanol sclerotherapy with or without polyvinyl alcohol particle embolization. The efficiency, complications, and recurrence rate were analyzed with imaging studies and clinical follow-up data. ResultsAll 15 patients had received one or more treatment sessions, of whom 8 had experienced a cure (53.3%) and 5 had experienced remission (33.3%). The two patients who had not experienced an effective result were awaiting further treatment at the last follow-up examination. Four patients (26.7%) who had undergone ethanol sclerotherapy combined with polyvinyl alcohol particle embolization had experienced recurrence. No patient who had undergone only sclerotherapy had developed recurrence at a mean follow-up of 17.2 ± 8.1 months. Thirteen patients had experienced transient complications, including swelling, mild bleeding, and blistering. One patient had a postoperative scar of ∼0.5 cm. ConclusionsEthanol sclerotherapy appears effective as a treatment of labial AVMs. Careful application of the treatment could reduce the occurrence of complications.

Abstract 1122‐000082: Outcomes of Chronic and Subacute Subdural Hemorrhages Treated with Middle Meningeal Artery Embolization

Introduction : Chronic subdural hematoma (cSDH) is a common neurosurgical condition with a high recurrence rate. Middle meningeal artery (MMA) embolization has been shown to reduce the incidence of re‐bleeding and prevent recurrence of cSDH by devascularizing the subdural membranes and shifting the balance from continued leakage and accumulation of blood and proteinaceous material to reabsorption. We report our single center experience of MMA embolization for treatment of chronic and subacute subdural hematoma. Methods : We performed a retrospective chart review of all patients ≥18 years who underwent MMA embolization between 01/01/2020‐03/01/2021 for cSDH. We looked at the outcomes, rate of recurrence and possible complications after MMA embolization. A descriptive analysis for continuous and categorical variables was performed using SAS 9.4 version. Results : A total of 41 MMA embolizations were performed on 32 patients with a median age of 75 (Q1‐Q3 70–83). Median hematoma thickness was 12 mm. Among them, 52% patients underwent particle embolization while 48% underwent liquid embolization. One patient had recurrence on follow up imaging and required drainage with burr hole. Three patients underwent hematoma evacuation after MMA embolization without evidence of recurrence on imaging. Three cases were aborted due to high risk or difficult access. There were no procedure related complications in the whole study population. 65% patient achieved mRS 0–2 on 90 day follow up visit. There was no significant difference between particles and liquid embolizations. Conclusions : Middle meningeal artery embolization could be used as a safe and effective intervention for prevention of recurrence and improving outcomes of subacute or chronic subdural hematoma.

Temporal reverse flow by proximal femoral artery occlusion during drug-coated balloon dilatation: a technique to minimize downstream particle embolization and systemic adverse effects.

Downstream paclitaxel particle embolization for nonhealing ischemic ulcers and systemic adverse effects caused by a paclitaxel drug-coated balloon are of concern, and safety measures to prevent these adverse risks are needed. To reduce distal particle embolization and movement of the paclitaxel particles to systemic blood flow during drug-coated balloon inflation, proximal balloon occlusion using a sheathless temporary occlusion balloon-guiding catheter and extraction by manual aspiration of the paclitaxel-containing blood through the catheter are good treatment options to overcome these risks. Here, we introduce this method with tips and tricks, and demonstrate initial experience of this technique.

Transarterial embolization of dural arteriovenous fistulas of the lateral sinuses with stent-assisted sinus protection

BackgroundThe balloon-assisted sinus protection technique has been described as a sinus-preserving technique during transarterial embolization (TAE) of dural arteriovenous fistulas (DAVFs). However, some serious complications of this technique have been...

PULMONARY EMBOLISM - BLOOD VS OTHER?

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Fat embolism syndrome (FES) is a rare etiology with poor prognosis and high mortality rate. The more common causes include orthopedic surgery. Here we present an extremely rare case of FES due to an outpatient elective surgery of fat grafting. Currently there is no other treatment for FES other than supportive care. CASE PRESENTATION: Patient is a 43 year old female with a past medical history for obesity with a strong family history of breast cancer and underwent prophylactic bilateral mastectomy. Patient presented for elective outpatient reconstruction of the right breast fat grafting harvested from the abdomen. During surgery, became hypoxic, requiring emergent intubation with full support. Patient was evaluated by a chest x-ray which ruled out pneumothorax. In the emergency room, she was hypotensive requiring vasopressors. Patient underwent chest CT with findings for bilateral segmental pulmonary embolism visualized with acute right heart strain with elevated right sided heart pressures and >2:1 ratio of right ventricle size to the left ventricle. She was noted to have a negative hounsfield unit of bilateral thrombi, highly suspicious for fat embolism. Given the lack of treatment options other than supportive care for fat embolism, the patient underwent VA-ECMO emergently as salvage therapy. Bedside transesophageal echocardiogram showed multiple masses in the right ventricle extending into the tricuspid chordae and into the right ventricle with severe dysfunction, largest mass measured up to 1.0 cm in size. Patient was managed with full support of VA-ECMO for a total of seven days before transitioning to mechanical ventilation and decannulation and cardiac support was weaned off. Patient's neurological status was back to baseline post ECMO. Ultimately, patient required a tracheostomy and was discharged to inpatient rehabiliation. DISCUSSION: FES is a systemic disorder with embolization of fat particles causing cytotoxin production and inflammatory state from the free fatty acids resulting in multiorgan dysfunction presenting with tachypnea, tachycardia, fever, possible rash. Pulmonary circulation is affected upto 75% of patients leading to ARDS requiring prolonged mechanical ventilation. Development of fat pulmonary embolism has a significantly high mortality. Treatment with ECMO allows for cardiopulmonary life support with severe respiratory failure bu replacing deoxygenated blood with oxygenated blood. Most commonly noted cases are related to orthopedic surgeries or trauma. To our knowledge, FES as a complication from liposuction requiring VA-ECMO as a successful treatment option has not yet been reported. CONCLUSIONS: Here we present one of the first cases of a successfully treated patient with VA-ECMO who developed florid shock secondary to acute fat embolism syndrome due to an elective breast fat grafting surgery. The important learning to identify is diagnosing fat embolism. REFERENCE #1: https://pubs.asahq.org/anesthesiology/article/89/3/782/36964/Early-Fat-Embolism-after-Liposuction REFERENCE #2: https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2020.201.1_MeetingAbstracts.A5188 REFERENCE #3: https://pubmed.ncbi.nlm.nih.gov/18509699/ DISCLOSURES: No relevant relationships by Pranav Mahajan, source=Web Response No relevant relationships by TEMITOPE SHODUNKE, source=Web Response No relevant relationships by Abdul Siddiqui, source=Web Response No relevant relationships by Riddhi Upadhyay, source=Web Response

Adjunctive Coil Embolization of the Prostatic Arteries After Particle Embolization for Prostatic Artery Embolization.

PurposeTo describe the feasibility, safety and short-term results of prostatic artery embolization (PAE) performed with adjunctive coil embolization of the main prostatic arteries (PA) following particle embolization.Materials and MethodsA total of 95 patients who underwent PAE with adjunctive bilateral coil embolization of the PAs following particle embolization between September 2018 and May 2021 were included. The patients had a mean prostate size of 115 ± 64 ml, 18/95 with hematuria symptoms, and 16/95 with indwelling urinary catheters. Coil embolization was performed in the main PAs prior to the bifurcation into the anteromedial and posterolateral branches using detachable microcoils. International Prostate Symptoms Score (IPSS), quality of life (QOL), maximum flow rate (Qmax) and adverse events were recorded.ResultsIPSS were improved by − 11.2 ± 7.9 (n = 49, P < 0.001) and QOL by − 2.4 ± 1.8 (n = 49, P < 0.001) over a mean follow-up of 10.7 ± 7.9 weeks. Qmax did not demonstrate statistical significance. Twelve patients with hematuria (67%) showed improvement or resolution and twelve patients with indwelling or intermittent catheters (75%) were no longer catheter dependent. Two patients underwent a repeat PAE. There were no adverse events which were attributable to coil embolization.ConclusionAdjunctive coil embolization of the main PAs following particle embolization is a technically feasible technique with similar short-term clinical outcomes compared to prior studies. This novel technique warrants further prospective investigation with controls.

Hemorrhoid embolization: A review of current evidences

Hemorrhoids are local vascular structure dilations in the lower rectum, associated with morbidity and reduced quality of life. Endovascular coil or particle embolization of the superior rectal arteries, known as Emborrhoid technique, is a minimally invasive, image-guided therapy that targets the hemorrhoidal plexus and reduces hemorrhage. The purpose of this review was to analyze the results of published studies to determine the efficacy, clinical outcomes, and morbidities associated with the endovascular occlusion of hemorrhoidal arteries for the treatment of internal hemorrhoids. Current evidences suggest that hemorrhoids treated by Emborrhoid technique using microcoils, embolic particles or a combination is safe with no reported serious complications. Hemorrhoid embolization can preserve the anal tone without direct anorectal trauma and maintain the hemorrhoidal tissue in place requiring minimal local wound care on an outpatient basis. However, due to the paucity of high-quality trials, further research is warranted to evaluate its long-term outcomes, compare its efficacy with other treatment modalities, and fully assess its role in the treatment of hemorrhoid.

Osteoarthritis-Related Knee Pain Treated With Genicular Artery Embolization: A Systematic Review and Meta-analysis.

Background:Genicular artery embolization (GAE) is an innovative technique that has been investigated as a supplementary treatment method for chronic pain secondary to knee osteoarthritis (OA).Purpose:To evaluate the current evidence on the effectiveness and safety of GAE for OA-related knee pain.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic literature search was conducted in the PubMed, Web of Science, EMBASE, and Scopus databases to identify studies related to knee OA treated with GAE. Treatment agents were categorized as Embozene, imipenem/cilastatin, resorbable microspheres, and polyvinyl alcohol. The main outcomes were the mean difference (MD) in pre- and postembolization pain based on the visual analog scale (VAS) or the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores as well as changes in the need for pain medication. Random- and fixed-effects models were applied for data analysis.Results:Of 379 initially inspected publications, 11 (N = 225 patients; 268 knees) were included in the final review. The quality of the studies was fair in 8 and poor in 3—categorized according to the National Institutes of Health quality assessment tool. Overall, 119, 72, 13, and 21 patients were treated with imipenem/cilastatin, Embozene, resorbable microspheres, and polyvinyl alcohol, respectively. Symptomatic improvement was reported in all studies. The pooled effect size, characterized by MD, showed a significant improvement in the VAS and WOMAC pain scores, with better functional status after GAE. Pre- versus postembolization MDs in VAS scores ranged from 32 within the first week to 58 after a 2-year follow-up (equivalent to 54% and 80% improvement, respectively). There was a similar trend in the overall WOMAC scores, with MDs ranging from 28.4 to 36.8 (about 58% and 85% improvement, respectively). GAE resulted in a decreased need for pain medication for knee OA, with a 27%, 65%, and 73% decline in the number of patients who used opioids, nonsteroidal anti-inflammatory drugs, and intra-articular hyaluronic acid injection, respectively (P < .00001 for all). No significant difference between embolic agents was seen with regard to post-GAE pain reduction. No severe or life-threatening complications were reported.Conclusion:OA treated by GAE using different embolic particles can be considered generally safe, with good efficacy and no reported serious complications.

Endovascular interventions in the management of acute extremity trauma: a narrative review.

Minimally invasive endovascular interventions including stenting and embolization have been widely adopted for the treatment of emergent and traumatic thoracoabdominal injuries. In recent years, these techniques have been utilized in the setting of extremity vascular trauma with promising outcomes. By allowing for the rapid diagnosis and subsequent treatment of penetrating or blunt vascular extremity trauma, these techniques can help to minimize blood loss, reduce operative complications, and potentially prevent limb amputation. Here, we present a narrative review of the ever-increasing role of minimally invasive interventions in the management of extremity trauma and compare its use and outcomes to open surgical repair. A special focus is placed on diagnostic imaging modalities in trauma and the role of interventional radiologists in the work-up and treatment of extremity trauma. We discuss diagnostic imaging modalities that aid in the triaging of extremity trauma, such as Doppler sonography, CT angiography, and catheter-based angiography. We present an overview on the literature related to endovascular interventions such as embolotherapy and stent grafting as well as the technical challenges associated with each technique. Finally, we present our own cases on the workup and endovascular treatment of extremity trauma, including CT angiography, particulate and coil embolization, and stent graft placement.

EFFICACY OF INTRA-ARTERIAL LIDOCAINE FOR PAIN CONTROL RESULTING FROM TRANSARTERIAL CHEMOEMBOLIZATION OF HEPATOCELLULAR CARCINOMA

Objective: To assess the efficacy of intra-arterial lidocaine in peri &amp; post-procedural pain control and the dose of narcotic analgesic required in hepatocellular carcinoma patients undergoing transarterial chemoembolization.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Armed Forces Institute of Radiology and Imaging Rawalpindi, from Jan to Jun 2019.&#x0D; Methodology: A total of 60 patients included in this study where 42 males and 18 were females, age range 45-85 years who underwent transarterial chemoembolization for hepatocellular carcinoma, were included in the study. patients were equally divided into two groups, group a (30 patients) who underwent transarterial chemoembolization, received 60 mg of intraarterial lidocaine each and group b (30 patients) who underwent transarterial chemoembolization, intra-arterial lidocaine was substituted with normal saline.degree of post-procedural pain was assessed using a subjective method (visual analogue scales score) and an objective method (amount of post-procedural analgesics).&#x0D; Results: Average peri-procedure visual analogue scale score was 5.06 in group A patient versus 7.2 for those in group B patients (p=0.037). Post-procedure visual analogue scale score in the group A was 2.7 ± 0.520 and that for group B was 4.2 ± 0.761 (p=0.025). Mean of total dose of nalbuphine in group A was 4.96 ± 0.764 mg versus 8.3 ± 1.34 mg for patients in group B (p=0.036). Average length of post procedure hospital stay was 0.9 ± 0.203 and 1.41 ± 0.373 days for group A and group B respectively (p=0.002).Conclusion: Intra-arterial administration of lidocaine before infusing the embolization particles for transarterial chemoembolization.....................

Roles of Angioplasty With Drug-Coated Balloon for Chronic Ischemia in Wound Healing

Purpose: Clinical trials have demonstrated sustained benefits of drug-coated balloon (DCB) angioplasty compared with noncoated balloon angioplasty in symptomatic peripheral artery disease (PAD) presenting with femoropopliteal (FP) artery disease. However, there is still controversy whether particulate embolization caused by crystalline paclitaxel, the so-called “downstream effect,” is adversely associated with clinical outcomes after use of FP DCB among chronic limb-threatening ischemia (CLTI) patients. The current RADISH (Roles of Angioplasty with Drug-coated balloon for chronic ISchemia in wound Healing) study investigated wound healing following DCB therapy vs non-DCB therapy for real-world CLTI patients presenting with FP lesions. Materials and Methods: This multicenter, retrospective study analyzed 927 patients with CLTI (mean age, 76±10 years; male, 57.8%; diabetes mellitus, 64.5%; dialysis, 50.7%) presenting with FP lesions and treated endovascularly via DCB (138 patients) vs non-DCB therapy (789 patients) between April 2014 and March 2019. The primary outcome measure was 1-year wound healing, while the secondary outcome measure was 1-year primary patency. Clinically-driven target lesion revascularization (CD-TLR), limb salvage and overall survival were also analyzed by using propensity score matching analysis. Results: The propensity score matching extracted 111 pairs (as many patients in the DCB group and 629 patients in the non-DCB group). The 1-year cumulative incidence of wound healing (95% CI) was 74.4% (62.6% to 82.5%) in the DCB group and 71.9% (60.4% to 80.1%) in the non-DCB group, with no significant intergroup difference (p=0.93). The DCB group had a higher rate of primary patency (p=0.002) and freedom from CD-TLR (p=0.010) than the non-DCB group, whereas there was no significant intergroup difference in limb salvage (p=0.21) or overall survival (p=0.93). Conclusion: The current analysis of data from the RADISH study demonstrated that DCB therapy did not lead to delayed wound healing and reduced restenosis rate in CLTI patients presenting FP lesions. From this results, DCB therapy would be a reasonable treatment option for CLTI patients.

Maxillomandibular Vascular Malformations: Report of Four Cases

AbstractMaxillomandibular or dental arcade arteriovenous malformations (AVMs) are uncommon lesions with potential for life-threatening bleeding. We report three cases of vascular malformations and a case of pyogenic granuloma and propose a contrast-enhanced computed tomography (CT)-based workup of these lesions for definitive treatment. Four cases of orodental bleeding were diagnosed based on CT angiography (CTA) and treated using endovascular means. Three of them were subsequently operated and confirmed by histopathology. Two were low-flow AVMs, the third one a case of pyogenic granuloma, and one high-flow AVM. The first three lesions were embolized with polyvinyl alcohol particles and subsequently operated and the fourth high-flow one embolized using liquid embolic agent n-butyl cyanoacrylate (Glue). CTA can be used to show separate lesions of arterial vascularity and those of delayed/ venous enhancing lesions. Arterial phase-enhancing lesions are again subdivided in digital subtraction angiography into those of low-to-moderate vascularity and those with high flow, which are treated using particle embolization and liquid glue/onyx (± coil) embolization, respectively. The delayed venous phase enhancing lesions may mimic neoplasms and after tissue biopsy may be managed by sclerotherapy.

Flow-Directed Catheters in Hepatic Embolization Therapy—A Review with Clinical Cases

AbstractTransarterial embolization with chemotherapy and radiation is well-documented forms of treatment for liver cancers but reflux of embolic particles to nontarget tissues can result in unintended consequences such as gastrointestinal ulceration. Traditionally, operators have used coil embolization of hepatoenteric collaterals to prevent reflux. Antireflux microcatheters that contain expandable baskets (Surefire) or inflatable balloons have recently been developed as tools to avoid these side effects. We describe cases where antireflux catheters were used instead of coil embolization. Using antireflux catheters, we eliminated particle reflux into nontarget vessels. We also review the literature on antireflux catheters involved in preventing reflux during chemo- and radioembolization.

Abstract No. 163 Feasibility of pancreatic particle embolization: a proof of safety study in a porcine model

Although particle embolization is a common treatment of hypervascular neuroendocrine metastases of the liver, this treatment is not considered an option for the originating pancreatic neuroendocrine tumor(s) due to theoretical concern for pancreatitis. The purpose of this study was to explore the safety of pancreatic embolization in a porcine model. Approval for this study was obtained from the Institutional Animal Care and Use Committee. A total of 6 domestic swine weighing between 90 and 110 pounds were obtained. A single nonsurvival animal underwent infusion of methylene blue dye into the dorsal pancreatic artery using a microcatheter followed by particle embolization to stasis using 100-300 μm Embosphere particles to confirm technical feasibility. Immediate laparotomy confirmed blue staining of pancreatic parenchyma without evidence of non-target embolization. Five survival animals underwent baseline serum lipase level assay, and particle embolization of the dorsal pancreatic artery was performed under general anesthesia. Animals were observed postoperatively for one week with monitoring of behavior, activity, food intake, and observation for signs of pancreatitis. After one week, repeat serum lipase was obtained, the animals were euthanized, and their pancreata excised for gross pathologic analysis. Technical success with embolization was achieved in all study animals. In the five survival animals that were monitored after embolization, behavior, activity levels and food intake returned to baseline by postoperative day #1. All animals survived to 7 days without signs or symptoms of significant pain, systemic infection or decline. There was no significant change in serum lipase levels comparing pre-procedure to day 7, with average serum lipase levels of 56.8 U/L and 40.2 U/L, respectively. At necropsy, regions of lobular expansion and discoloration were identified in all pancreata that are compatible with inflammation. These findings suggest that particle embolization of the dorsal pancreatic artery in swine is technically feasible and results in adequate ischemia to cause inflammation of target pancreatic tissues, but without biochemical signs of pancreatitis, systemic sequelae, or mortality after one week of observation. Based on this early data, further evaluation of particle embolization of the pancreas in animal models may be justified to further clarify safety and physiologic sequelae.

Abstract No. 521 Safety and efficacy of coil embolization of the prostate arteries post-particle embolization for lower urinary tract symptoms

Prostate artery embolization (PAE) has been historically performed with particles of varying sizes, with coil embolization reserved for preventing nontarget embolization in collateral vessels. Coil embolization of the prostate arteries (PA) has not routinely been performed due to fear of technical complexity if repeat PAE is required. In this study, we present our interim results on the safety and feasibility of coil embolization of PAs after routine particle embolization in PAE. This feasibility study is a retrospective review, totaling 26 male patients who underwent bilateral PAE from September 2018 to August 020. Bilateral particle embolization of PAs to stasis was performed with 100 to 300 μm through a microcatheter. This was followed by coil embolization of the PAs through the microcatheter proximal to the bifurcation of anteromedial and posterolateral branches. Procedural details, pre- and post-procedure International Prostate Symptom Score (IPSS), Quality of Life (QOL), maximum urinary flow rate (Qmax) and adverse events (AE) were recorded. Mean IPSS decreased from 20.7 to 7.7 (↓63%, n = 26, P < 0.001) and mean QOL improved from 4.2 to 1.5 (↓64%, n = 25, P < 0.001) over a mean follow-up period of 10.4 weeks (range, 4–31 weeks, SD 7.6 weeks). 25/26 (96%) patients had reduction in IPSS score. 22/25 (88%) patients had reduction in QOL score. For patients with severe lower urinary tract symptoms (IPSS 20–35), mean IPSS decreased from 26.5 to 8.0 (↓70%, n = 15, P < 0.001) and mean QOL improved from 5.0 to 1.7 (↓67%, n = 14, P < 0.001). Mean Qmax increased from 7.2 to 11.3 (56%, n = 8, P < 0.001). 5/5 patients with hematuria had resolution in short-term follow-up. There was one episode (3.8%) of symptom recurrence for which a repeat PAE was performed. Three AE occurred (11.5%): two glans penis ulceration and one rectal bleeding, which resolved after supportive care, and are most likely attributed to nontarget particle embolization. The use of adjunctive coil embolization following particle embolization in PAE appears to be technically feasible and safe with significant improvement in clinical outcomes in short-term followup. This technique warrants further investigation.

Novel Non-Biodegradable Computed Tomography-Visible Embolization Particles Constructed from a Double Network Hydrogel Incorporated With Tantalum Powder

The double network (DN) gel is a rigid, tough, and safe hydrogel; however, like all hydrogels and existing particle embolization materials composed of a polymer, they lack X-ray visibility. Thus, it is not possible to locate the embolization material in the body. In this study, we successfully developed an X-ray-visible embolization material, a tough DN gel incorporated with biocompatible heavy metal powder. The DN gel particles, composed of poly(N,N'-dimethylacrylamide) and poly(2-acrylamido-2-methylpropanesulfonic acid) with tantalum powder, were synthesized via two-step suspension radical polymerization. The characteristics of the DN particles were evaluated by comparing them with Embosphere®, an existing embolization material. Furthermore, we used a rat carotid artery embolic model to evaluate the material’s X-ray computed tomography visibility in vivo. The developed embolization material was visible in X-ray computed tomography scans and safe for use in the body. Moreover, as it remained in the vessels for a long time, it is expected to be more effective than Embosphere®. Thus, the developed material is a promising DN particle embolization material with X-ray computed tomography visibility.

Initial experience with HydroPearl microspheres for uterine artery embolization for the treatment of symptomatic uterine fibroids

BackgroundUterine Artery Embolization (UAE) is a minimally invasive procedure used to treat symptomatic uterine fibroids. The HydroPearl Microsphere (Terumo Interventional Systems) is an embolic agent approved for UAE and other embolization procedures. The purpose of this article is to describe our initial experience with HydroPearl for UAE in patients with symptomatic uterine fibroids. Twenty-one patients who underwent UAE using HydroPearl Microspheres at a single institution from May 1, 2018 to December 31, 2019 were included in the study. The electronic medical record (EMR) was reviewed for documentation of short- and long-term complications, as well as improvements in menorrhagia and bulk-type symptoms. We also describe unique attributes of the HydroPearl Microsphere that should be considered when utilizing this embolization particle for UAE.ResultsOf the 21 patients, 18 had a 3-month or later post-procedure follow-up documented in the EMR and were included in the analysis. The average time between the UAE procedure and the most recent clinical note was 145 days. Sixteen patients reported symptoms of menorrhagia and 13 reported bulk symptoms prior to the UAE procedure. On follow-up, 13/16 patients (81%) and 12/13 patients (92%) experienced improvement in menorrhagia and bulk symptoms, respectively. The only recorded complication was amenorrhea in 4 patients (22%) who had an average age of 51 years.ConclusionsSeveral characteristics of HydroPearl Microsphere may prove helpful when considering these embolic particles for use in UAE. Our initial experience with this embolic agent suggest that the reatment response for menorrhagia and bulk symptoms are largely similar to success rates reported in the literature for other embolic agents. Larger studies are needed to evaluate the safety and efficacy of this embolic particle for this indication.