Polyvinyl Alcohol Embolization Research Articles

Preparation and investigation of a novel iodine-based visible polyvinyl alcohol embolization material

Polyvinyl alcohol (PVA) embolization particles, currently used in clinical practice, have good expansibility and are capable of permanent embolization. However, the lack of adhesion of embolization particles contributes to facilitated recanalization after embolization, while the lack of visualization facilitates misembolization. At present, embolization materials with good expansion, adhesion, and visualization potential are urgently required in clinical practice. Here, we report the development of PVA/gelatin/iohexol (I) fiber blocks as a novel embolization material for liver embolization in rats. In our work, electrospun PVA/gelatin/I nanofibrous mats were first prepared, homogenized, centrifuged in a gradient manner, and freeze-dried to obtain fiber blocks (fiber diameter ​= ​296.2 ​± ​74.23 ​nm, length 99.6 ​± ​17.0 ​μm ​× ​width 46.9 ​± ​13.3 ​μm). The fiber blocks exhibited excellent cytocompatibility and hemocompatibility. Fiber blocks with a PVA/gelatin/I mass ratio of 8:2:10 were selected due to their excellent expansibility and adhesive properties. The PVA/gelatin/I fiber blocks display excellent liver embolic effects and computed tomography (CT) imaging potential due to a combination of the following characteristics: expansibility of PVA and gelatin, adhesive property of gelatin, and CT imaging potential of I. The developed fiber block material is an embolic material that may potentially be used in interventional medicine.

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.

Prostate artery embolization for the treatment of urinary retention caused by large (>80 ​mL) benign prostatic hyperplasia: Results of 21 patients

ObjectiveA large prostate size (>80 ​mL) of benign prostatic hyperplasia (BPH) is technically challenging to treat surgically. This study aimed to investigate the safety and efficacy of super-selective prostatic artery embolization (PAE) for the treatment of urinary retention caused by large BPH. MethodsA total of 21 patients with urinary retention, indwelling urinary catheter, or suprapubic cystostomy as a consequence of giant BPH (prostate volume [PV] ​> ​80 ​mL) who sought treatment between January 2013 and December 2017 were enrolled. A microcatheter (1.9–2.7 Fr) and a “two-step embolization” combining 50-μm and 100-μm polyvinyl alcohol embolization particles were used in all patients. International Prostate Symptom Score (IPSS), quality of life (QoL), PV, and prostate-specific antigen (PSA) were evaluated at 3, 6, and 12 months post-PAE. Clinical success was defined as removal of urinary catheter or suprapubic cystostomy and ability to void spontaneously. ResultsThe clinical success rate was 95.2% (20/21). Compared with pre-procedural values, IPSS, QoL, PV, and PSA showed statistically significant differences at 3, 6, and 12 months post-PAE (P ​< ​0.05). There were no serious complications after PAE. ConclusionsPAE was safe and effective for the treatment of urinary retention caused by large BPH in patients without surgical treatment options.

&lt;p&gt;Transcatheter arterial embolization combined with hypoxia-replicative oncolytic adenovirus perfusion enhances the therapeutic effect of hepatic carcinoma&lt;/p&gt;

PurposeTranscatheter arterial embolization or transcatheter arterial chemoembolization has become a critical therapy for unresectable hepatocarcinoma. Although hypoxia caused by embolization can induce apoptosis and necrosis of the majority of tumor cells, a small proportion of cells can survive with hypoxia and chemotherapy resistance. HIF-1α induced by hypoxia is the key factor rendering surviving tumor cells invasive and metastatic properties. Thus, we generated a synthetic hypoxia-replicative oncolytic adenovirus (HYAD) expecting to further eliminate the surviving tumor cells, which expressed HIF-1α.Materials and methodsIn our study, we detected protein expression, proliferation, apoptosis, and necrosis of hepatic tumor cell line when infected with HYAD under hypoxia and normoxia. And we constructed VX2 hepatic cancer rabbit models to explore the therapeutic effect of transcatheter arterial embolization combined with HYAD perfusion under digital subtraction angiography. Inhibition of tumor growth and invasion was detected by histopathological examination and contrast-enhanced CT scan.ResultsExperiments in vitro verified that HYAD expressed and replicated along with HIF-1α expression or hypoxia. Compared with wild adenovirus type 5 (WT), HYAD expressed much more under hypoxia, which was the main principle of HYAD killing surviving tumor cells posttransarterial embolization. In vivo experiment of VX2 models, HYAD perfusion combined with polyvinyl alcohol (PVA) embolization achieved the highest expression quantity and the longest expression duration compared with simple HYAD perfusion, WT perfusion combined with PVA embolization, and simple WT perfusion. Because adenovirus expression protein E1A had the properties of promoting apoptosis, inhibiting invasion, and inhibiting metastasis, HYAD perfusion combined with PVA embolization group efficiently repressed tumor growth and intrahepatic metastases compared to other processing groups.ConclusionHYAD can overcome the hypoxic tumor microenvironment postembolization and target the surviving tumor cells with specificity. In turn, HYAD perfusion combined with PVA embolization can bring out the best effect in each other.

Durable Benefit of Particle Occlusion of Systemic to Pulmonary Collaterals in Select Patients After Superior Cavopulmonary Connection.

Systemic to pulmonary arterial collaterals (SPC) are commonly found in patients undergoing staged operative palliation for single ventricle heart disease. Occlusion of SPC as part of pre-Fontan catheterization has been shown to improve hemodynamics acutely. Anecdotally, the effect of this intervention appears to be transient, and to our knowledge there is no data supporting its durability in these patients. Between 1/1/2016 and 5/1/2017, 24 children underwent Glenn operations at our institution. Of these, 3 patients had signs and symptoms deteriorating clinical status suggestive of volume overload in the period between their Glenn operation and Fontan completion, prompting heart catheterization. SPC were occluded with a combination of polyvinyl alcohol embolization particles, and in some cases coils or vascular plugs. Clinical course and data from echocardiograms and serial catheterizations are presented. SPC occlusion was performed over 6 procedures in 3 subjects with technical success in each case. Hemodynamic evaluation was repeated in 2/3 patients with improvement in collateral burden and hemodynamics in both cases. One patient previously thought to be unsuitable for Fontan completion improved sufficiently to undergo late Fontan completion, which was ultimately successful. In all patients, there was improvement in clinical status. In patients with severe SPC collateral durable benefit was seen, suggesting that in certain cases intervention on SPC remote from Fontan completion may have clinical benefit.

Comparative efficacy of Glubran and polyvinyl-alcohol particles in the embolization of meningiomas

Purpose: Preoperative embolization of meningiomas decreases intraoperative bleeding and shortens operation time. However, in meningiomas predominantly vascularized by the internal carotid artery (ICA) or vertebral artery (VA) branches, embolization of external carotid artery feeder branches may lead to a hemodynamic increase in blood supply from the ICA or VA, whereas embolization of ICA or VA feeder branches with particle embolic agents may be associated with complications. This study investigated the safety and efficacy of Glubran, a liquid embolic agent, for the embolization of this type of meningioma compared with polyvinyl-alcohol (PVA) particles. Materials and methods: From January 2006 to June 2015, 157 consecutive patients (98 females; mean age = 48.3 years) who suffered from meningiomas and were preoperatively referred for embolization were retrospectively analyzed. Glubran (n = 40) and PVA (n = 55) were used to devascularize tumors. Sixty-two patients were not embolized because of dangerous anastomosis or other tumor characteristics. Intraoperative blood loss, intraoperative time, degree of angiographic devascularization and embolization-related complications were analyzed. Results: The intraoperative blood loss and operative time were significantly lower in the Glubran-embolized versus non-embolized group. Furthermore, Glubran embolization significantly reduced intraoperative blood loss and operative time for meningiomas that received their primary blood supply from the ICA and/or VA compared with PVA embolization. Conclusions: Preoperative meningioma embolization with Glubran decreases intraoperative blood loss and operative time. Furthermore, embolization with Glubran produces more effective devascularization compared with PVA for meningiomas supplied by the ICA and/or VA. Thus, Glubran may represent a better embolic agent for this meningioma subtype.

Effect of Transcatheter Intra-Arterial Therapies on Tumor Interstitial Fluid Pressure and Its Relation to Drug Penetration in a Rabbit Liver Tumor Model

PurposeTo determine the change in tumor interstitial fluid pressure (IFP) after transcatheter intra-arterial (IA) therapies and its relation to drug penetration in liver cancer. Materials and MethodsVX2 tumors were grown in the livers of 16 rabbits. The rabbits were treated with intravenous injection of doxorubicin (group 1; n = 4), hepatic IA injection of doxorubicin (group 2; n = 4), hepatic IA injection of doxorubicin followed by embolization with polyvinyl alcohol particles (group 3; n = 4), or hepatic IA injection of doxorubicin mixed with Lipiodol followed by polyvinyl alcohol embolization (group 4; n = 4). Tumor IFP was measured with a Mikro-Tip pressure catheter before and 1 hour after treatment. Doxorubicin penetration was evaluated by immunofluorescence. ResultsTumor IFP after treatment decreased by 5.0% ± 2.8, 3.9% ± 9.0, 27.1% ± 5.2, and 31.8% ± 7.4 in groups 1–4, respectively. The difference in IFP reduction between embolization-treated groups (groups 3 and 4) and nonembolized groups (groups 1 and 2) was significant (P < .001). Doxorubicin penetration distances were 20.3 μm ± 3.7, 45.7 μm ± 10.5, 69.5 μm ± 9.3, and 47.9 μm ± 6.4 in groups 1–4, respectively. IFP reduction was significantly correlated with doxorubicin penetration distance (r = .671, P = .004). ConclusionsA greater reduction of tumor IFP was associated with embolization in a preclinical liver tumor model, and embolization may indirectly contribute to increased drug penetration.

Transarterial Embolization Using Pingyangmycin Lipiodol Emulsion and Polyvinyl Alcohol for the Treatment of Focal Nodular Hyperplasia of the Liver

Surgical resection is the current treatment for focal nodular hyperplasia of the liver (FNH) when indicated. However, tumor location and size, patient comorbidities, and risk of complications may limit surgical options in some cases. Our goal was to evaluate the therapeutic effect of transarterial embolization (TAE) using pingyangmycin lipiodol emulsion (PLE) and polyvinyl alcohol particles to treat FNH. Four patients with FNH, who experienced dull pain in the upper abdomen or liver area and confirmed by biopsy, were treated by TAE with PLE and polyvinyl alcohol (diameter: 500µm-700µm). Therapeutic effects including changes in lesion diameter and symptomatic improvement, and occurrence of complications, were evaluated for a follow-up period ranging from 12 to 42 months after the procedure. All of four patients were successfully treated with PLE and polyvinyl alcohol embolization. One month after the procedure, dull pain in the upper abdomen or liver area vanished completely. Follow-up examination by CT or MRI revealed complete resolution in two cases and an obvious decrease in the other two cases. No immediate or delayed postembolization complications were encountered. Transarterial embolization using PLE and polyvinyl alcohol should be considered as a safe and effective method for the treatment of FNH.

Hepatocellular Necrosis, Apoptosis, and Proliferation after Transcatheter Arterial Embolization or Chemoembolization in a Standardized Rabbit Model

Purpose To evaluate the effect of transcatheter arterial chemoembolization versus transcatheter arterial embolization on hepatocellular damage, apoptosis, proliferation, and proinflammatory response in a rabbit VX2 tumor model. Materials and Methods Rabbits implanted with VX2 tumors in left liver lobes were randomly divided into three groups: a control group (n = 9) that underwent infusion of distilled water into the left hepatic artery, an embolization group (n = 15) that underwent left hepatic artery embolization with polyvinyl alcohol (PVA) particles, and a chemoembolization group (n = 15) that underwent left hepatic artery infusion of a mixture of 10-hydroxycamptothecin and iodized oil followed by PVA embolization. Serum and liver samples were collected at 6 hours, 3 days, and 7 days postoperatively. Liver damage was measured by liver function tests and histologic analysis. Ki-67 immunohistochemistry and terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick-end labeling were performed to quantify proliferating and apoptotic cells. Serum tumor necrosis factor (TNF)–α levels were measured to assess proinflammatory response. Results Compared with embolization, chemoembolization caused liver injury with a greater increase in serum alanine aminotransferase and aspartate aminotransferase levels on days 3 and 7; histologic analysis showed increased hepatic necrosis in adjacent liver tissue beginning at day 3 and increased serum levels of TNF-α at 6 hours. By contrast, chemoembolization resulted in a slower increase in hepatocyte proliferation. Additionally, increased apoptotic hepatocytes were observed after embolization and chemoembolization. Conclusions In contrast to embolization, nonsuperselective transcatheter arterial chemoembolization increased hepatocellular damage and stimulated systemic proinflammatory cytokine release, but inhibited hepatocyte proliferation.

A randomized phase II/III trial of three weekly cisplatin based transarterial chemoembolization (TACE) versus embolization (TAE) alone for hepatocellular cancer (HCC).

4025 Background: TACE is regarded as the standard of care for intermediate stage HCC but evidence that TACE is superior to TAE is lacking. Methods: Eligible patients had previously untreated HCC based on histology or AASLD criteria; were unsuitable for resection; had multifocal disease or one lesion ≥ 3 cm, PS ≤ 2, Hb ≥ 9g/L, platelets ≥ 50x109/L, INR ≤ 1.5, GFR ≥ 50 mL/min, bilirubin ≤ 100 μ mol/L, and no extrahepatic disease or main branch portal vein occlusion. Patients were randomised to receive TAE with polyvinyl alcohol (PVA) particles alone or TACE in which cisplatin 50 mg was administered intrarterially 4-6 hours before PVA embolization. Treatment was repeated three weekly for a maximum of three treatments. The primary endpoint was overall survival (OS) and secondary endpoints were progression free survival (PFS), toxicity and response. Target sample size for phase II and III was 80 and 322 respectively. Results: Eighty-five patients were randomised (41 TAE, 44 TACE). Median age 62 years (range 30-80); 87% men; 81% Child-Pugh A cirrhosis; 82% PS 0/1, 64% multifocal disease. Etiology was Hep B in 16%, Hep C in 36% and alcohol in 20%. Currently 58% (TAE) and 57% (TACE) patients have received all three planned treatments. There was no significant difference in toxicity, with 24 (TAE) and 28 (TACE) patients reporting at least one grade 3/4 toxicity. Response rates according to RECIST for TAE vs. TACE were; PR 10% vs. 25%, SD 37% vs. 36%, PD 17% vs. 7% (p = 0.165). Eight vs. 9 patients subsequently had a liver transplant following treatment and were censored for survival at the date of surgery. Median PFS was 6.9 (TAE) vs 7.8 months (TACE) (p = 0.64) and median OS was 16.2 vs. 15.9 months (p = 0.82). When transplanted patients were excluded, the median survival was 14.6 vs 12.7 months (p = 0.76). Conclusions: Based on these results, the chance of seeing a survival difference of > 2 months between TACE and TAE in a phase III trial was < 20%. The trial was therefore terminated at phase II. No significant financial relationships to disclose.

Endometrial stromal sarcoma with selective polyvinyl alcohol embolization of a pulmonary metastasis after recurrent hemoptysis and expansive growth

Endometrial stromal sarcoma with selective polyvinyl alcohol embolization of a pulmonary metastasis after recurrent hemoptysis and expansive growth

Comparison of four embolic materials for portal vein embolization: experimental study in pigs

Different embolic materials for portal vein embolization (PVE) were evaluated. Twenty pigs received left and median PVE. Hydrophilic phosphorylcholine, N-butyl cyanoacrylate, hydrophilic gel, and polyvinyl alcohol (PVA) particles measuring either 50-150 microm or 700-900 microm were used in five pigs each. Portography and portal vein pressure measurement were performed before, immediately after PVE, and before being euthanized at day 7. Tissue wedges from embolized, and non-embolized liver were obtained for pathology. After complete embolization, recanalization occurred at 7 days in one gel and one 700-900 PVA embolization. Post-PVE increase in portal pressure was found in all groups (p = 0.01). The area of the hepatic lobules in non-embolized liver was larger than in the embolized liver in all groups (p = 0.001). The ratios of the areas between non-embolized/embolized livers were 1.65, 2.19, 1.57, and 1.32 for gel, NBCA, 50-150 PVA and 700-900 PVA, respectively; the ratios of fibrosis between the embolized and non-embolized livers were 1.37, 3.01, 3.49, and 2.11 for gel, NBCA, 50-150 PVA and 700-900 PVA, respectively. Hepatic lobules in non-embolized liver were significantly larger with NBCA than in other groups (p = 0.01). Fibrosis in embolized liver was significantly higher for NBCA and 50-150 PVA (p = 0.002). The most severe changes in embolized and non-embolized liver were induced by 50-150 PVA and NCBA PVE.

頬部から下顎にかけて発生した動静脈奇形の1例

Arteriovenous malformation（AVM）rarely occurs in the head and neck region as compared withother sites . In the oral and maxillofacial region, most cases of AVM, including hemangiomas, occur in soft tissue and rarely arise in the jaw. Embolization is currently used as a safer treatment method for mandibular AVM because profuse intraoperative bleeding can occur with traditional surgical procedures.We report favorable results obtained after conducting a 9-year follow-up study of a 14-year-old boy who underwent embolization for AVM that occurred from the buccal region to the body of the mandible. Abnormal bleeding developed after extraction of the right second premolar at a dental clinic, and the patient was referred to our department, where he underwent pressure hemostasis. As CT and MRI confirmed AVM from the buccal region to the mandible, we performed polyvinyl alcohol embolization of the main nutrient artery, as well as direct coil embolization of the varix. Subsequently, after 9 years of follow-up, blood flow has decreased, with no recurrence.

CT Angiography of a Gonadal Artery Collateral from an Inferior Accessory Right Renal Artery

stay was unremarkable, without any recurrence of bleeding. To date, the patient has not had any therapeutic complications or recurrent bleeding. The small intestine presents a challenge when bleeding occurs as a result of its approximate length of 5 meters, which limits endoscopic imaging. Several treatment options exist for the treatment of small-bowel AV malformations. Endovascular methods include localized vasopressin injection, coil embolization, and polyvinyl alcohol embolization. Before the development of embolization treatments, medical treatments with vasopressin and/or subsequent resection were the gold-standard treatment methods. The use of vasopressin to induce vasoconstriction and thereby arrest bleeding was found to be as low as 36% effective (1), and the incidence of recurrent bleeding was as high as 71% (1). Therefore, vasopressin is used temporarily for stabilization and preparation for surgery, and has been replaced in most institutions with superselective embolization of mesenteric vessels. The aim of embolization of AV malformations is to completely obliterate the entire network of abnormal vasculature comprising the malformation, as partial treatment may allow recurrence (2).The use of NBCA adhesive, a liquid monomeric agent that polymerizes and solidifies when in contact with blood, has been shown to be effective in the management of AV malformations in the cranium. It has a low viscosity and can therefore be delivered through microcatheters within diminutive vessels. NBCA has been used to treat acute arterial hemorrhage from gastrointestinal and other pathologic processes (3). Kish et al (3) used NBCA in one of 16 patients for treatment of a rectal carcinoma pseudoaneurysm. NBCA has been shown to be successful in the treatment of gastrointestinal bleeding from a jejunal artery pseudoaneurysm secondary to intestinal tuberculosis (4). Additionally, the combination of microcoils and cyanoacrylate glue has been used to embolize an AV malformation of the superior pancreaticoduodenal artery supplying the duodenum (5).The difficulties associated with the use of NBCA include nontarget delivery, failure to satisfactorily obliterate the nidus, and catheter adhesion and subsequent retention. These difficulties are reduced with careful procedural technique (2). In summary, this case demonstrates a novel use of glue embolization for successful treatment of an AV malformation in the distal SMA presenting with massive lower intestinal bleeding and hypovolemic shock. Future studies are necessary to examine long-term safety and efficacy of glue embolization in the mesenteric arterial system, including the incidences of recurrent bleeding and bowel ischemia.

Effect of Catheter-Directed Arterial Embolization and Laparoscopic Endovascular Stapling on Stapled Vessel Integrity in a Porcine Model

Arterial embolization is a frequently performed adjunctive maneuver prior to laparoscopic splenectomy or nephrectomy to facilitate laparoscopic dissection and reduce intraoperative bleeding. However, little is known regarding the effect of laparoscopic stapling across thrombosed vessels with imbedded embolic materials. This study analyzed the stapled line integrity by comparing visceral arteries treated with either platinum coils or polyvinyl alcohol (PVA) particles. Using a porcine model, 30 visceral vessels including splenic and renal arteries were treated with either coil or PVA embolization, which was followed by laparoscopic stapling. Vessel integrity and bursting pressure analysis was performed using an in vitro flow circuitry. The mean bursting pressure of the coil and the PVA group was 158 +/- 56 and 350 +/- 34 mm Hg, respectively (p < .001). The lowest bursting pressure in the coil and the PVA group was 70 and 280 mm Hg, respectively. The highest bursting pressure in the coil and the PVA group was 225 and 420 mm Hg, respectively. The bursting pressure in the splenic artery between the PVA and the coil group was 345 +/- 29 and 150 +/- 54 mm Hg, respectively (p < .001). Significant difference in the bursting pressure in the renal artery was noted in the PVA and the coil group, which was 350 +/- 40 and 160 +/- 40 mm Hg, respectively (p < .001). Our findings showed that preoperative coil embolization followed by laparoscopic vessel stapling sustained a poor busting pressure. Such a practice appears to be unsafe based on our findings and should be performed with caution in a clinical setting.

Polyvinyl alcohol embolization of the inferior epigastric artery as treatment for abdominal wall hemorrhage from multiple sites complicating enoxaparin therapy

We report a case in which a life-threatening subcutaneous abdominal wall hemorrhage complicated enoxaparin therapy. Computed tomography revealed contrast extravasation into the hematoma at multiple levels. Selective left inferior epigastric arteriograms showed multiple bleeding sites, which were treated at multiple embolization sessions. After global embolization of inferior epigastric artery with polyvinyl alcohol particles, bleeding stopped and no ischemic complications developed for a 7 months follow-up. The wall irregularity and small pseudoaneurysms of the branches of the inferior epigastric artery, possibly occurring as a complication of subcutaneous enoxaparin injections, were thought to be responsible for the spontaneous hemorrhage at multiple sites. Global embolization of the inferior epigastric artery with PVA proved to be effective and safe.

Vertebral Arteriovenous Fistula Following Attempt at Central Line Placement and Successfully Treated With Sequential Endovascular Coil Embolization

Vertebral arteriovenous fistulas are rare clinical entities. Most cases are trauma-related or iatrogenic in origin. Treatment options include endovascular occlusion or direct surgical closure. We report a case of an iatrogenic vertebral arteriovenous fistula, diagnosed because of a neck bruit in a patient following a subarachnoid hemorrhage, successfully treated with electrodetachable coil and polyvinyl alcohol embolization. The use of electrodetachable coils may be an effective alternative for the endovascular occlusion of such relatively large fistulas. Furthermore, parent artery occlusion by endovascular embolization seems to be an effective and safe procedure, especially when the ipsilateral posterior inferior cerebellar artery was positioned distal to the fistula and was fully supplied retrogradely by the contralateral vertebral artery.

Polyvinyl Alcohol Embolization Adjuvant to Oily Chemoembolization in Advanced Hepatocellular Carcinoma with Arterioportal Shunts

ObjectiveTo assess the feasibility and safety of polyvinyl alcohol (PVA) embolization adjuvant to transarterial oily chemoembolization (P-TACE) in advanced hepatocellular carcinoma (HCC) with arterioportal shunts (APS).Materials and MethodsNineteen patients who underwent PVA embolization for APS before a routine chemoembolization (TACE) procedure were retrospectively reviewed. 10 of these 19 patients underwent follow-up TACE or P-TACE after P-TACE (Group A), but nine patients underwent only initial P-TACE because of progression of HCC and/or underlying liver cirrhosis (Group B). Hepatic function tests, APS grades, and portal flow directions were evaluated before and after P-TACE sessions. Complications after procedures and survival days were also evaluated.ResultsIn group A, APS grade was improved in eight patients and five of six patients with hepatofugal flow showed restored hepatopetal flow postoperatively. No immediate complication was developed in either group. Transient hepatic insufficiency developed in eight (42.1%) of 19 patients after P-TACE, and seven (87.5%) of these eight recovered within two weeks under conservative care. The mean and median survival time all study subjects was 280 days and 162 days.ConclusionP-TACE is feasible and safe in advanced HCC patients with APS.

Papillary endothelial hyperplasia (Masson tumor) of the petrous and jugulare region: case report and literature review

Objective Intracranial papillary endothelial hyperplasia (PEH) is rare, and only 13 cases have been reported intracranially in the literature. In this article, we present a case of PEH involving petrous and jugular foramen region due to the uncommon incidence. Case Description A 49-year-old female patient with a 4-year history of left-sided hearing loss and facial palsy. Magnetic resonance (MR) imaging disclosed the presence of a 6 × 6 × 5 cm lobular mass occupying the left petrous and jugulare region. This mass was hyperintense on both T1 and T2 weighted MR images and was enhanced strongly with gadolinium. No edema was found around the lesion. Preoperative digital subtraction angiogram examination showed that the lesion had a rich blood supply. Therefore, polyvinyl alcohol embolization was carried out to reduce bleeding during operation. A left-sided suboccipital extreme lateral approach was applied for craniotomy. The lesion was extradural and highly vascular with extension into the petrous bone. It was subtotally removed. Postoperative course of the patient was stable. Her neurologic evaluation was the same as preoperatively. Conclusion Surgical excision of the lesion is the main therapy. Radiotherapy should be given to patients whose lesion cannot be totally removed.

Therapeutic Failure of Uterine Fibroid Embolization Caused by Underlying Leiomyosarcoma

The authors describe an unusual case in which continued growth of uterine fibroids in a postmenopausal patient after polyvinyl alcohol embolization therapy prompted hysterectomy, which revealed an underlying leiomyosarcoma. The surgery was nearly fatal as a result of venous bleeding, and parasitization of blood from adjacent bowel by the tumor was noted. The difficulty of preoperative diagnosis of leiomyosarcoma and the need for diligent follow-up after uterine fibroid embolization are discussed.