Percutaneous Coil Embolization Research Articles

Ectopic Varices in the Gastrointestinal Tract: Short- and Long-Term Outcomes of Percutaneous Therapy

To evaluate the results of percutaneous management of ectopic varices, a retrospective review was carried out of 14 patients (9 men, 5 women; mean age 58 years) who between 1992 and 2001 underwent interventional radiological techniques for management of bleeding ectopic varices. A history of prior abdominal surgery was present in 12 of 14 patients. The interval between the surgery and percutaneous intervention ranged from 2 to 38 years. Transhepatic portal venography confirmed ectopic varices to be the source of portal hypertension-related gastrointestinal bleeding. Embolization of the ectopic varices was performed by a transhepatic approach with coil embolization of the veins draining into the ectopic varices. Transjugular intrahepatic portosystemic shunt (TIPS) was performed in the standard fashion. Eighteen procedures (12 primary coil embolizations, 1 primary TIPS, 2 re-embolizations, 3 secondary TIPS) were performed in 13 patients. One patient was not a candidate for percutaneous treatment. All interventions but one (re-embolization) were technically successful. In 2 of 18 interventions, re-bleeding occurred within 72 hr (both embolization patients). Recurrent bleeding (23 days to 27 months after initial intervention) was identified in 9 procedures (8 coil embolizations, 1 TIPS due to biliary fistula). One patient had TIPS revision because of ultrasound surveillance findings. New encephalopathy developed in 2 of 4 TIPS patients. Percutaneous coil embolization is a simple and safe treatment for bleeding ectopic varices; however, recurrent bleeding is frequent and reintervention often required. TIPS can offer good control of bleeding at the expense of a more complex procedure and associated risk of encephalopathy.

Ruptured Internal Iliac Artery Aneurysm Treated by Percutaneous Transcatheter Embolisation

Ruptured internal iliac artery aneurysms (IIAA) are rare. Operative treatment carries a high morbidity and mortality while endovascular treatment offers an alternative option. We report a case of ruptured IIAA treated successfully treated by an alternative form of percutaneous coil embolisation. Selective catheterization of all the outflow branches was impossible and the volume of the aneurysm sac precluded embolisation with conventional coils. The sac was, therefore, packed with 10cm lengths of guidewire with the central mandrel removed.

Ruptured Internal Iliac Artery Aneurysm Treated by Percutaneous Transcatheter Embolisation

Ruptured internal iliac artery aneurysms (IIAA) are rare. Operative treatment carries a high morbidity and mortality while endovascular treatment offers an alternative option. We report a case of ruptured IIAA treated successfully treated by an alternative form of percutaneous coil embolisation. Selective catheterization of all the outflow branches was impossible and the volume of the aneurysm sac precluded embolisation with conventional coils. The sac was, therefore, packed with 10cm lengths of guidewire with the central mandrel removed.

Percutaneous Coil Embolization in the Management of Mycotic Aneurysms of the Superior Gluteal Artery

Mycotic superior gluteal artery aneurysms are very uncommon but potentially life threatening because of the risk of rupture. Traditional surgical therapy for peripheral mycotic aneurysms included debridement, ligation, and bypass. We report a case of Staphylococcus aureus mycotic superior gluteal artery aneurysm in an injection drug user with prosthetic valve endocarditis managed with percutaneous coil embolization. We review the literature and discuss the use of percutaneous coil embolization in the treatment of gluteal artery mycotic aneurysms.

Percutaneous transcatheter coil embolization of a ventricular septal defect in a dog

A 4-month-old male French Bulldog weighing 5.0 kg (11 lb) was referred for a heart murmur. A grade 3/6 systolic murmur was detected at the left heart base and a grade 4/6 systolic murmur was detected at the right heart base. By use of color-flow Doppler ultrasonography and cardiac catheterization, a diagnosis of supracristal ventricular septal defect (VSD) with accompanying aortic regurgitation was made. Percutaneous transcatheter coil embolization was used to close the VSD. Because residual shunt was detected via echocardiography after coil implantation, the residual shunt was followed periodically via echocardiography to detect spontaneous closure of the VSD. Volume overload in the left ventricle was detected in the dog 131 days after admission. Additional coils were placed 137 days after admission. Hemolysis resulting in hemoglobinuria was detected, but this complication was mild. In the dog of this report, results of coil occlusion for correction of VSD were promising. Thus, coil occlusion should be considered as an alternative treatment for VSD in dogs.

A Complicated Percutaneous Coil Embolisation of a Large Coronary Artery Fistula

A coronary artery fistula is a rare cause of cardiac symptoms or signs in an adult. We report here the successful percutaneous treatment of a large fistula in an adult who had suffered an acute myocardial infarction peri-operatively due to a steal phenomenon. Due to the fistula size, a specially constructed occlusion device was utilised for effective treatment.

P0384 THREE CASES OF CONGENITAL INTRAHEPATIC PORTOSYSTEMIC VENOUS SHUNT IN NEONATES.

Introduction: Congenital intrahepatic portosystemic venous shunt (CIHPSS) are very unusual abnormalities. Only 50 publications have been counted. They are defined as macroscopic communications between the portal and the systemic venous circulation. They are entirely or partially located within a heathy liver that functions without portal blood. When discovered early in life, they are in favour of a malformative origin of the shunt. HEREIN, we report three neonate observations with their icon-çography. For the case n°1, it was a color Doppler and ultrasound scanning for a fever checkup,, which diagnosed the CIHPSS. between the right portal vein and the right-sus hepatic vein. In the two other one, it was the antenatal color Doppler and ultrasound scanning which diagnosed shunts during the third term of pregnancy. Those three shunts were considered as type II, according to the PARK’s classification system for IHPSS anormalies, because they link up a portal branch to an hepatic vein in a same parenchymal segment. Methods: Case n°1 is now 6 years old and is still asymptomatic. A clinical, biological and ultrasonographic examination, once a year is sufficient. The vascular fistula resolved spontaneously when case n°2 was 28 months old and when case n°3 was 8,5 months old. Results: DISCUSSION: Normally, toxic metabolites of nutrients and residual activity of pancreatic enzymes are degraded by the liver. Here, due to the shunt, they bypass directly into the systemic circulation. Then, hyperammoniemia, trimethylaminuria, hyperinsulinemia, pulmonary hypertension or congestive heart failure can appear. THERAPY: Because of the rarity of this disorder, the choice of treatment is controversial. It depends on the natural course of the disease, but the majority of patients did not have symptoms until their 6th decade. Initially, the spontaneous resolution is expected. If hepatic encephalopathy or heart failure progress, some treatment may indicate: angiographic intervention with percutaneous coil embolisation, surgical intervention such as shunt ligation and hepatic resection or realisation of an alternative portosystemic shunt. Conclusion: CIHPSS have been thought to be uncommon, but improvement of imaging (US, CT, MRI) have shown even asymptomatic intrahepatic shunts in an increasing number of patients. Spontaneous resolution is frequent. Metabolic and hemodynamic repercussions will guide the management in other cases.

Coil Embolization of an Inferior Pancreaticoduodenal Artery Aneurysm Associated with Celiac Artery Occlusion

Pancreaticoduodenal arcade aneurysms are rare. Untreated, these lesions enlarge progressively and have the potential for spontaneous rupture. Aneurysmal degeneration of pancreaticoduodenal arcade vessels is known to be associated with celiac artery occlusion, vasculitis, and certain connective tissue disorders. Given their precarious location, surgical expiration is a challenging endeavor. Innovations in endovascular techniques offer a possible alternative. We report a case of a 55-year-old gentleman with a 2.2 × 2.1 - cm aneurysm of one of the inferior pancreaticoduodenal arteries and a concomitant finding of occlusion of the celiac artery trunk. Percutaneous coil embolization of the aneurysm was employed as the treatment in this case with the successful exclusion of the aneurysm sac, while maintaining continuity of the native circulation. This case report demonstrates that, due to the success rate of aneurysm exclusion and the relatively low morbidity and mortality rates seen with endovascular repair as compared to surgical intervention, endovascular treatment has become the treatment of choice for pancreaticoduodenal artery aneurysms.

Endovascular Management of a Peroneal Artery Injury Due to a Military Fragment Wound

A healthy 29-year-old male suffered bilateral lower extremity fragment wounds resulting in a tense right calf shortly following a wound that required a four-compartment fasciotomy. During treatment of other injuries after medical evacuation he complained of increasing right calf pain. A peroneal pseudoaneurysm (PSA) with a concomitant arteriovenous fistula (AVF) was diagnosed. The distal one-third of the peroneal artery was not visualized, and the posterior tibial and anterior tibial arteries were normal. The patient underwent percutaneous coil embolization of the pseudoaneurysm. Completion arteriography demonstrated no evidence of the PSA and AVF. The patient's bruit and pain resolved.

Coil embolization of an inferior pancreaticoduodenal artery aneurysm associated with celiac artery occlusion

Pancreaticoduodenal arcade aneurysms are rare. Untreated, these lesions enlarge progressively and have the potential for spontaneous rupture. Aneurysmal degeneration of pancreaticoduodenal arcade vessels is known to be associated with celiac artery occlusion, vasculitis, and certain connective tissue disorders. Given their precarious location, surgical expiration is a challenging endeavor. Innovations in endovascular techniques offer a possible alternative. We report a case of a 55-year-old gentleman with a 2.2×2.1-cm aneurysm of one of the inferior pancreaticoduodenal arteries and a concomitant finding of occlusion of the celiac artery trunk. Percutaneous coil embolization of the aneurysm was employed as the treatment in this case with the successful exclusion of the aneurysm sac, while maintaining continuity of the native circulation. This case report demonstrates that, due to the success rate of aneurysm exclusion and the relatively low morbidity and mortality rates seen with endovascular repair as compared to surgical intervention, endovascular treatment has become the treatment of choice for pancreaticoduodenal artery aneurysms.

Mechanism of failure in the treatment of type II endoleak with percutaneous coil embolization

Purpose: Type II endoleak after endovascular abdominal aortic aneurysm repair is a failure of aneurysm sac exclusion with unknown long-term consequences. Elevated aneurysm sac pressures documented in these patients have led us to aggressively treat type II endoleaks with percutaneous transluminal coil embolization (PTCE). The purpose of this study was to evaluate the results and the mechanisms of failure of PTCE for type II endoleak. Methods: One hundred ninety-one patients underwent endograft repair of infrarenal aortic aneurysms. Twenty-three of 28 patients with persistent primary (>3 months) or secondary (new-onset) endoleak underwent angiography; 14 of these patients had type II endoleaks. We reviewed our endovascular registry data, hospital charts, and radiologic studies of patients with type II endoleaks and analyzed the results in those treated with PTCE of the inflow vessel. Results: All 14 patients with type II endoleaks were men, with a mean age of 76.7 years and a mean preoperative maximal aneurysm diameter of 5.7 ± 1.0 cm. The type II endoleak was primary in 12 patients (86%) and secondary in two patients (14%) and iliolumbar in 11 patients (78%) and mesenteric in three patients (21%). Although a dominant affluent collateral channel (inosculation) was apparent in eight patients (57%), six patients (43%) showed a network of collateral vessels (retiform anastomosis). In six patients (43%), angiography revealed a second or “outflow” vessel indicative of a complex endoleak. In four patients with retiform iliolumbar type II endoleaks, PTCE was not attempted because of the retiform nature of the endoleak. The remaining 10 patients underwent PTCE, with coil deployment in all 10 and apparent initial technical success in nine patients. Follow-up computed tomographic scans revealed persistent endoleaks in six patients (60%). Mechanisms of failure included persistent flow through the coils in the treated vessel in two patients, development of a retiform anastomosis around the coiled vessel in three patients, and development of a new mesenteric endoleak after successful occlusion of an iliolumbar endoleak in one patient. Two patients underwent repeat PTCE with successful aneurysm sac exclusion in one. Internal iliac artery injury complicated one of the 12 PTCEs, and the resulting pseudoaneurysm was successfully treated with PTCE. Angiographic visualization of an outflow vessel (complex endoleak) was associated with PTCE failure ( P = .008). Conclusion: PTCE of type II endoleaks has a high failure rate because of multiple anatomic mechanisms. (J Vasc Surg 2002;36:485-91.)

Pulmonary arteriovenous malformations: effect of embolization on right-to-left shunt, hypoxemia, and exercise tolerance in 66 patients.

This study assessed the effect and safety of percutaneous transcatheter coil embolization of pulmonary arteriovenous malformations. In 58 (88%) of 66 patients, all malformations with feeding vessels greater than or equal to 3 mm in diameter were embolized with steel coils. Arterial oxygen saturation at rest and exercise, intrapulmonary right-to-left anatomic shunt fraction ((99m)Tc-macroaggregate injection), maximum exercise capacity (incremental work rate test), and pulmonary function were measured before and after embolization. Complications were analyzed. Three categories of patients were identified. Patients in group 1 (27%) had complete occlusion of all angiographically visible pulmonary arteriovenous malformations; patients in group 2 (61%) had complete occlusion of all malformations with feeding vessels greater than or equal to 3 mm in diameter, but with smaller lesions persisting; and patients in group 3 (12%) had incomplete embolization, with feeding vessels greater than or equal to 3 mm in diameter remaining. The mean right-to-left shunt after embolization was least in group 1 (7%), intermediate in group 2 (10%), and greatest in group 3 (19%). Arterial oxygen saturation and right-to-left shunt fraction returned to normal levels (>96% and <3.5%, respectively) in 33% of patients. A significant improvement occurred after embolization in carbon monoxide diffusing capacity per unit of alveolar volume and in exercise capacity in 16 and 10 patients, respectively. In 93 procedures, 12 complications (13%) occurred. Coil embolization of pulmonary arteriovenous malformations is effective in reducing right-to-left anatomic shunt fraction and in improving arterial oxygenation. Coil embolization of pulmonary arteriovenous malformations is well tolerated and has a low complication rate.

Percutaneous coil embolization of postcatheterization arterial femoral pseudoaneurysms

Study Design: This study was a prospective monocentric study to assess the safety and effectiveness of percutaneous embolization with coils of postcatheterization femoral pseudoaneurysm (PCFP). Patients and Methods: Seventeen PCFPs of 32-mm mean diameter in 16 patients were embolized while anticoagulant or antiplatelet therapy was maintained. Ultrasound scan-guided compression repair failed at least one time in 13 cases and was contraindicated in the four remaining cases. With ultrasound-Doppler scan guidance, the PCFPs were percutaneously punctured with a 16-gauge intravenous catheter. An angiogram was performed through the catheter to ensure its location within the sac. Stainless steel spring coils with synthetic fibers were introduced within the PCFP with fluoroscopic control. Successful thrombosis was checked with ultrasound-Doppler scan and was repeated at days 1, 30, and 180 when possible. Results: All PCFPs of 32-mm mean diameter were successfully treated with two to nine coils. After embolization, gentle additional compression was necessary for complete occlusion, with a mean duration of 6.3 minutes (range, 0 to 15 minutes), except in one case with treatment with abciximab in which it was 45 minutes. All procedures were uneventful and painless. The mean follow-up period was 9.5 months (range, 1 to 21 months). Two recurrences (11.7%) were observed, and one was successfully treated with a second embolization. Conclusion: Percutaneous embolization with coils appears to be a safe and effective method for treatment of PCFP. It may be performed in patients undergoing anticoagulant or antiplatelet therapy and must be attempted when ultrasound scan-guided compression repair has failed or is contraindicated. (J Vasc Surg 2002;36:127-31.)

Treatment of abdominal aortic anastomotic pseudoaneurysm with percutaneous coil embolization

Intraabdominal anastomotic pseudoaneurysms continue to be a late complication of aortic reconstructive procedures. Early surgical repair is critical but is associated with high operative mortality rates. We present a patient who was diagnosed with a distal anastomotic pseudoaneurysm 13 months after transabdominal repair of a symptomatic abdominal aortic aneurysm. Because of the poor operative risk, the patient was considered for a less invasive approach and underwent coil embolization of the abdominal aortic anastomotic pseudoaneurysm. The patient remains without recurrence of pseudoaneurysm 3.5 years later. (J Vasc Surg 2002;35:811-4.)

Renal Artery Aneurysm: Improved Renal Function after Coil Embolization

To describe a case of improved renal function and renovascular hypertension after percutaneous treatment of a renal artery aneurysm. A 72-year-old hypertensive woman with a hilar saccular aneurysm of the right renal artery underwent percutaneous coil embolization under local anesthesia. Four individual, soft, detachable platinum embolization coils were successfully inserted in the aneurysm with incomplete aneurysm exclusion. Nonetheless, the patient's blood pressure and renal function returned to normal. The arteriogram at 3 months demonstrated complete exclusion of the lesion and good renal perfusion. The patient remains normotensive with documented improved renal function at 18 months after treatment. Superselective coil embolization is an effective treatment for renal artery aneurysms that display proper morphological features. The long-term outcome of this less invasive therapy still must be assessed, but it appears plausible that embolotherapy of renal artery aneurysms can correct secondary hypertension and deteriorating renal function.

Balloon-expandable common iliac artery occluder device for endovascular aneurysm repair.

This study was performed to evaluate the efficacy of a balloon-expandable Palmaz stent common iliac artery occluder device for endovascular stent-graft repair of aortoiliac aneurysms. Eighty-four patients (79 men, 5 women; age range 60-95 yr; mean age, 76 yr) with aortoiliac aneurysms underwent endovascular stent-graft repair. The repair consisted of a stent-graft extending from the abdominal aorta to the iliac or common femoral artery, a cross-femoral bypass graft, and an endovascular arterial occluder device within the contralateral common iliac artery. The occluder device consisted of a 5-cm segment of 6-mm diameter polytetrafluoroethylene (PTFE) graft with a purse-string suture occluding the leading end and a Palmaz stent sutured to the trailing end. The occluder device was delivered through a 17F catheter via an arteriotomy. Eighty-three of the 84 patients received aortic endografts. In one case, infrarenal aortic rupture occurred during deployment of the aortic stent requiring conversion to an open surgical repair. Initial technical success for occluder device insertion was achieved in 78 of the remaining 83 patients. Failure to advance the occluder device delivery sheath through a diseased iliac artery occurred in one patient. Common iliac artery rupture occurred during balloon expansion and occluder device deployment in two patients. Two patients required additional coil embolization of the common iliac artery adjacent to the occluder device at the time of stent-graft insertion to correct incomplete iliac occlusion. Delayed occluder device-related complications included one patient with a postoperative iliac endoleak who required percutaneous coil embolization and one patient with a postoperative iliac endoleak in whom a contained aortic aneurysm rupture developed that was treated by surgical ligation of the common iliac artery. Use of the Palmaz stent-based iliac artery occluder device is an effective technique to induce common iliac artery thrombosis to facilitate endoluminal stent-graft aneurysm repair.

Endovascular Management of Visceral Artery Aneurysm

Purpose:To retrospectively review our experience with visceral artery aneurysms (VAAs) treated with percutaneous coil embolization techniques.Methods:Patient records were retrospectively reviewed b...

Endovascular management of visceral artery aneurysm.

To retrospectively review our experience with visceral artery aneurysms (VAAs) treated with percutaneous coil embolization techniques. Patient records were retrospectively reviewed between 1988 and 1998 for VAA cases treated with catheter-based techniques. Nine patients (5 women; mean age 64 +/- 11 years) with 12 (8 false and 4 true) VAAs were identified. The majority (67%) of these patients presented with symptoms of aneurysm rupture. The etiology of the aneurysm was iatrogenic in 4, pancreatitis in 4, and idiopathic in 4. Ten cases involved the hepatic artery; the other 2 aneurysmal arteries were the middle colic and the gastroduodenal. Selective and superselective catheter techniques were used to obtain access to the VAA. A variety of microcoils were delivered to entirely fill saccular aneurysms, whereas fusiform aneurysms were thrombosed by occluding the inflow and outflow vessels. Aneurysm exclusion was achieved in 9 (75%) of the 12 cases. The 3 technical failures resulted from the inability to cannulate the aneurysm neck. Coil embolization of the neck of the aneurysm sac did not result in occlusion of the native vessel, with a single exception. No procedure-related complications or deaths were noted. All patients remained symptom free during a mean follow-up of 46.0 +/- 29.6 months. Percutaneous transcatheter coil embolotherapy is an effective alternative to open surgery for the management of VAAs. This therapy may decrease the morbidity and mortality associated with an open surgical procedure in patients with ruptured aneurysms and pseudoaneurysms, selectively thrombosing the aneurysm while preserving flow in the native vessel.

Tratamiento de seudoaneurisma pancreático por punción directa y embolización

We report the case of a patient with recurrent acute pancreatitis who developed a pseudoaneurysm of the hepatic artery, leading to hemorrhage and biliary obstruction due to compression. Given that treatment by endovascular embolization and surgery was impossible, following percutaneous biliary drainage, embolization was performed by direct percutaneous coil embolization with spongostan, under color Doppler ultrasound guidance. After a follow-up period of five years, the patient presents no evidence of disease.

Successful Double Percutaneous Alcohol and Coil Embolization of Bilateral Coronary‐to‐Pulmonary Artery Fistulas

We report the case of a 70‐year‐old man with recent myocardial infarction who was admitted for further evaluation of his effort angina. Cardiac catheterization and selective coronary angiography excluded significant coronary atherosclerotic disease of the coronary arteries. Double coronary‐to‐pulmonary artery fistulas, one originating from the proximal right, the other from the left anterior descending coronary arteries, and draining into the right and left branch of the pulmonary artery, respectively, were observed. A left‐to‐right shunt was visualized at angiography. The patient was successfully treated with percutaneous alcohol and coil embolization of both coronary artery fistulas with total resolution of clinical symptoms. At 6‐month follow‐up a coronary angiography confirmed complete disappearance of the fistulas. We conclude that a “coronary steal” phenomenon caused by the fistulas induced myocardial ischemia in this patient and that percutaneous transcatheter exclusion with chemical and mechanical devices is a safe. effective, and reasonable alternative to traditional cardiac surgery.