Percutaneous Embolization Technique Research Articles

Embolização percutânea de fístulas arteriovenosas pulmonares

Pulmonary arteriovenous malformation is an abnormal communication between an artery and a vein, causing clinical manifestations, such as chronic hypoxemia and embolic events. Arteriovenous malformations were treated surgically, with a significant rate of complications. In the 1970 ́s, the first percutaneous catheter embolization was performed with coils. We describe three cases in which percutaneous embolization techniques were effective to prevent embolic, hemorrhagic, and hypoxemic events in the follow-up of patients.

Lymphatic Intervention, the Frontline of Modern Lymphatic Medicine: Part II. Classification and Treatment of the Lymphatic Disorders.

Lymphatic disorders encompass a broad spectrum of diseases involving the lymphatic system, ranging from traumatic lymphatic leaks to lymphatic malformations. Lymphatic disorders can be categorized into traumatic and non-traumatic disorders according to their etiology. These two categories may be further divided into subgroups depending on the anatomical location of the lymphatic pathology and their association with clinical syndromes. Thoracic duct embolization was a milestone in the field of lymphatic intervention that encouraged the application of percutaneous embolization techniques to treat leaks and reflux disorders in the lymphatic system. Additional access routes for embolization, including retrograde thoracic duct and transhepatic lymphatic access, have also been developed. This article comprehensively reviews a variety of options for the treatment of lymphatic disorders, from conservative management to the most recent embolization techniques.

Glubran- 2 Acrylic Glue for Percutaneous Embolization of Intramuscular Vascular Malformations of Lower Limbs: Preliminary Experience

Aims: Vascular anomalies (VA) represent a heterogeneous and rare group of pathologies. Ethanol is considered the gold standard in endovascular embolization procedures, but its use exposes to the risk of major complications. Glubran-2 is a new glue agent, used mainly for catheter-based cerebral embolization. Our study reported preliminary experiences with a group of 13 patients treated for intramuscular VA of limbs with Glubran-2 solution by venous retrograde percutaneous embolization.
 Methods: Through an Angiographic CT/MRI we selected 13 adult patients (6 males, 7 females), seven with limb AVMs and six with limb VM, all intramuscular. All patients reported pain and functional limitation as presenting symptoms. Glubran-2 was injected under fluoroscopic guidance through multiple percutaneous punctures, to cover the entire extension of the lesion.
 Results: In the 6-month follow-up, all patients reported pain reduction, rapid recovery of function, favourable post-operative course and absence of major complications. Angio-RMI control was performed in all patients. It showed Glubran-2 in place and the exclusion of the malformation. Percutaneous retrograde embolization with Glubran-2 permanently excluded muscle malformations from circulation: only one embolization procedure was, in 12 of 13 patients, sufficient for a complete and definitive treatment. Rapid polymerization of Glubran-2 glue, after its injection, cancelled the risk of pulmonary embolisms and skin necrosis. Secondary surgical removal was never necessary to complete treatment of these deep muscle malformations.
 Conclusions: This study showed that the percutaneous embolization technique with Glubran-2 glue can be considered favorable in the treatment of the VA of the limbs for its easier handling and promising outcome.

Early-Term Outcomes for Treatment of Saphenous Vein Insufficiency with N-Butyl Cyanoacrylate: A Novel, Non-Thermal, and Non-Tumescent Percutaneous Embolization Technique.

The purpose of this study was to present early-term outcomes of VariClose® Vein Sealing System, which is a novel, non-thermal, and non-tumescent percutaneous embolization technique for treatment of saphenous vein insufficiency. Between March 2014 and July 2015, 189 saphenous veins in 141 patients were treated with Variclose Vein Sealing System containing n-butyl cyanoacrylate. Pre-, intra-, post-procedural, and follow-up data of patients were collected and retrospectively reviewed. Mean age of patients was 42.5 ± 14.0 years, of which 53% were female. Technical success rate of intervention was 98.9%. Mean procedure time was 14.3 ± 7.5 minutes. Eighty-nine percent of patients (n = 126/141) were available at mean follow-up time of 6.7 months. Mean Venous Clinical Severity Score was significantly improved from 8.3 ± 2.2 at pre-procedure period to 3.3 ± 1.8 at follow-up. No complete recanalization was observed, but 2 patients were presented with partial recanalization during follow-up. The complete occlusion rate was 98.4%. No serious adverse event related to procedure was observed. Variclose Vein Sealing System appears to be safe and effective in treatment of saphenous vein insufficiency. Further randomized studies with long-term outcomes are required for determining optimal treatment modality in patients with saphenous vein insufficiency.

Management of a ruptured pseudoaneurysm of the uterine artery using a modified percutaneous embolization technique

Management of a ruptured pseudoaneurysm of the uterine artery using a modified percutaneous embolization technique

Management of spinal epidural arteriovenous fistulas: interventional techniques and results

BackgroundSpinal epidural arteriovenous fistulas (SEDAVF) are rare and poorly understood clinical entities.Materials and methodsWe report a series of five (three men, two women) consecutive cases treated at our center to...

Unusual Case of Recurrent Carotid-Cavernous Fistula after 47 Years, Treated with Direct Clip Ligation of the Petrous Internal Carotid Artery

Introduction: Carotid-cavernous fistulas (CCFs) are arteriovenous fistulas (AVFs) between the carotid artery or its branches and the adjacent cavernous sinus. The purpose of this report is to present a case of recurrent indirect CCF presenting 47 years after previous operative trapping of the ICA for traumatic direct CCF, the longest reported recurrence to date. Methods: A spontaneous recurrence of indirect carotid-cavernous fistula presented 47 years following initial surgical trapping of the internal carotid artery for traumatic direct carotid-cavernous fistula. Results: The patient was successfully treated with an orbitozygomatic extended middle cranial fossa approach for direct petrous internal carotid artery clip ligation after failure of percutaneous embolization techniques. Conclusions: CCFs can be difficult entities to treat, requiring extensive knowledge and experience with both potential endovascular and surgical options. In addition, recurrences are not uncommon and may present remotely from initial treatment and with different anatomical configurations. This also represents, to our knowledge, the first case reported that required direct petrous carotid ligation to treat the fistula after all endovascular and standard approaches were attempted or not plausible. Clinicians must be aware of these possibilities and ensure close follow-up to guarantee long-term occlusion.

Percutaneous embolization of persistent low-output enterocutaneous fistulas

To present and retrospectively evaluate the technique of percutaneous embolization of chronic enterocutaneous fistulas (ECFs) using n-butyl-2-cyanoacrylate and Lipiodol under fluoroscopic guidance. Six patients with a total of seven post-operative low-output ECFs of the large intestine were treated. After fistulography a hydrophilic guide wire and a catheter were advanced through the ECF into the intestine. After dilation of the bowel with saline and contrast medium, the catheter was withdrawn into the enteric orifice and glue together with Lipiodol was injected while simultaneously pulling the catheter. Complete closure of all seven fistulas was achieved. There were no peri-procedural complications. In one patient 1 month following embolization a low-output enteric discharge was observed, but the ECF spontaneously healed 5 days later. In one patient 18 months after the embolization a new perforation due to diverticulitis close to the embolization site occurred and resection of the sigmoid colon was performed. One patient needed reoperation due to a recurrence of rectal carcinoma. In our series of patients, the presented technique of percutaneous embolization proved to be efficacious and easy to perform. It may have potential as a first-line treatment of low-output ECFs but a prospective study with a larger series of patients and a longer follow-up is required.

E-018 Preliminary experience with the percutaneous embolization of paragangliomas at the carotid bifurcation using only Onyx

Introduction and purposeSurgical resection of hypervascular paraganglioma can be difficult due to intraoperative blood loss. Preoperative endovascular embolization with particulate material facilitates safe and complete surgical resection. However, complete devascularization...

Editorial Comment

The authors report a single-institution series of percutaneous transarterial embolization (TAE) in the management of non-neoplastic renal hemorrhage. In their series, they review 41 patients who had undergone TAE for postprocedural (92.7%) and spontaneous (7.3%) bleeding refractory to conservative management. Of the 41 patients, 35 (85.4%) were successfully treated with endovascular embolization and 6 required nephroscopy, open tract exploration, or nephrectomy for definitive treatment. ReplyUrologyVol. 74Issue 3PreviewWe would like to thank the editorial board for their positive reception of our work. Full-Text PDF Management of Non-neoplastic Renal Hemorrhage by Transarterial EmbolizationUrologyVol. 74Issue 3PreviewTo assess the role of transarterial embolization (TAE) and critically appraise its feasibility and efficacy in the management of non-neoplastic renal hemorrhage. Percutaneous TAE is an effective method for the control of hemorrhage, irrespective of the cause. Injury to the renal artery or its branch, after trauma or during open or percutaneous urologic procedures, can be accurately diagnosed using angiography and treated by percutaneous embolization techniques. Because the technique and technology have evolved, it is now possible to perform highly selective embolization of the injured vessel while preserving vascularity of the rest of the renal parenchyma. Full-Text PDF

Management of Non-neoplastic Renal Hemorrhage by Transarterial Embolization

To assess the role of transarterial embolization (TAE) and critically appraise its feasibility and efficacy in the management of non-neoplastic renal hemorrhage. Percutaneous TAE is an effective method for the control of hemorrhage, irrespective of the cause. Injury to the renal artery or its branch, after trauma or during open or percutaneous urologic procedures, can be accurately diagnosed using angiography and treated by percutaneous embolization techniques. Because the technique and technology have evolved, it is now possible to perform highly selective embolization of the injured vessel while preserving vascularity of the rest of the renal parenchyma. The medical records of all patients who underwent angioembolization for hemorrhagic urologic emergencies at our institute from January 1996 to December 2007 were reviewed. A total of 41 patients, aged 7-72 years, underwent TAE because of hemorrhage after percutaneous nephrolithotomy (n = 27), open pyelolithotomy (n = 3), renal biopsy (n = 8), and spontaneous occurrence (n = 3). All patients had a normal coagulation profile before surgery. A total of 35 patients (85.3%) underwent successful embolization and none required a postprocedural blood transfusion. Of those with postpercutaneous nephrolithotomy bleeding, angioembolization failed in 6 patients. Of these, only 2 required nephrectomy to save the patient's life. No serious procedure-related complications occurred. TAE is a minimally invasive, safe, simple, and highly effective modality, in expert hands, for the management of postprocedural renal bleeding. This option should be considered early in the management of these cases because it is not only a life-saving, but ultimately a kidney-sparing, procedure.

Percutaneous Embolization of Carotid Paragangliomas Using Solely Onyx

Paragangliomas are highly vascularized usually benign neoplasms arising from nerve tissue. Endovascular preoperative embolization is used to facilitate surgery but is often not complete, due to tiny feeding arteries not feasible for selective catheterization. Our purpose was to evaluate angiographic and clinical outcome using Onyx for percutaneous glomus tumor embolization. A consecutive series of 4 patients with 6 paragangliomas located at the bifurcation of the common carotid artery were treated with percutaneous embolization using Onyx as the sole embolic material. Complete devascularization of the 6 paragangliomas was achieved using a percutaneous embolization technique with Onyx as a sole agent, combined with an endovascular microballoon that offered protection of the internal carotid artery. Further documentation is necessary to prove the higher grade of devascularization of paragangliomas with Onyx compared with other embolic material and the associated potential to facilitate surgery. Nevertheless, Onyx seems to be safe when used percutaneously due to its lavalike pattern flow and its controllable properties, allowing slow tumor bed penetration.

Percutaneous angio-embolization of a post laparoscopy complex utero-adenexal vascular malformation

Vascular abnormalities are uncommon causes of uterine bleeding. Laparoscopic surgeries, however, require expertise and improper techniques can lead to major vascular complications. We report an unusual case of utero-adenexal arterio- venous fistula with arterio - venous malformation due to pelvic trauma caused during laparoscopic sterilisation procedure, which was treated by percutaneous embolisation technique. To the best of our knowledge, this is the first documentation of such a complex vascular injury caused by laparoscopic sterilisation and its endovascular management.

Treatment of congenital coronary arteriovenous malformations with micro‐particle embolization

The successful treatment of a symptomatic coronary arteriovenous malformation (CAVM) by a percutaneous embolization technique with micro-particles is described. Objective evidence of ischemia and its subsequent disappearance after embolization is presented. The embolization technique and possible indications and contraindications are discussed.

Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization.

Renal artery branch injury resulting from stab wounds of iatrogenic origin or street violence is an important cause of renal hemorrhage. Over a period of 10 years we accurately diagnosed the injury and successfully managed the associated hemorrhage in 15 patients by using angiography and percutaneous embolization techniques. Nine branch injuries in eight patients were due to street knifings and seven injuries were complications of invasive medical procedures (four from renal biopsy, two from nephrostolithotomy, and one from nephrostomy). All patients had gross hematuria at the time of angiographic evaluation. False aneurysms were present in six patients (one with associated frank extravasation), false aneurysm/arteriovenous fistula in three, false aneurysm/arteriocaliceal fistula in one, and isolated arteriovenous fistula in two. Frank extravasation without associated false aneurysm/arteriovenous fistula was present in two. One patient had two injuries, an upper-pole false aneurysm and a lower-pole false aneurysm/arteriovenous fistula. In the eight patients injured in street knifings, hematuria recurred after surgical exploration and treatment. None of the 16 injuries involved the main renal artery. Gelfoam was used for embolization of nine lesions and steel coils for four. Three others were treated with Gelfoam plus coils. Hemostasis was achieved in all and none required subsequent surgery. Renal tissue loss was small to moderate (less than 30%) in 12 patients and large (30-50%) in three patients. Transient postembolization hypertension occurred in one of the latter. We consider selective angiography/embolization to be an effective and safe means for diagnosing and treating wounds of the renal artery branches.

CONTROL OF HYPERTENSION AFTER RENAL TRANSPLANTATION BY EMBOLISATION OF HOST KIDNEYS

A percutaneous embolisation technique was used for host kidney ablation in 13 patients with renal allografts and hypertension. Markedly improved blood pressure control was achieved in 9 of them, and morbidity was minimal. All patients have been followed from 12 to 25 months. Embolisation of the host kidneys appears to be a simple, effective, and less hazardous alternative to surgery in the treatment of drug-resistant hypertension after renal transplantation in some patients.