Repeat Embolization Research Articles

OGC SO30 - Radiological thoracic duct embolisation for post oesophagectomy chyle leak: A single centre retrospective review

Abstract Background Chyle leak is a recognised complication of oesophagectomy associated with increased length of hospital stay, morbidity and is potentially fatal. Chyle leak management is controversial, and lacks a standardised or validated approach. Interventional radiological approaches are well described and routinely able to identify and embolise these thoracic duct leaks reducing need for return to theatre. The aim is to retrospectively evaluate outcomes of lymphangio-embolisation and in patients post Ivor Lewis oesophagectomy for oesophageal carcinoma. Method Data was analysed retrospectively from 168 patients who underwent Ivor Lewis oesophagectomy for oesophageal carcinoma from June 2020 to June 2024, of which 15 patients had chyle leak post operatively. Chyle leak was suspected when chest drain output >500ml in 24 hours and confirmed by high biochemical levels of chylomicrons and triglycerides within the drain fluid. Conservative management involved keeping the patient nil by mouth, total parenteral nutrition and monitoring intercostal drain output. Thoracic duct lymphangiogram was carried out to confirm location of chyle leak-embolisation was carried out using the femoral approach with lipidiol and/or microcoils and/or glue. Results 15 out of 168 (9%) patients had post operative chyle leaks. Four resolved with conservative management within <14 days. 11 chyle leaks persisted after a median of 17 days (range 14-30 days) conservative management and went onto have thoracic duct embolisation. Of those embolised, six chyle leaks resolved within three days post procedure. Two resolved 5-7 days post embolization. One had repeat embolization seven days post primary embolisation. Two patients required thoracoscopic ligation of thoracic duct, due to obesity making embolisation technically impossible and lack of interventional radiology capacity respectively. No patients had adverse outcomes. Conclusion Thoracic duct embolisation is an effective and safe approach for routine management of post oesophagectomy chyle leaks and may reduce return to theatre.

Repeat uterine artery embolization for uterine leiomyomas: Indications, strategies, and outcomes – A case report

Uterine leiomyoma is a frequent cause of abnormal uterine bleeding, especially among African Americans. It is also associated with dysmenorrhea, pelvic pain, infertility, and complicated pregnancies. While hysterectomy and myomectomy are more common forms of treatment for uterine leiomyoma in the United States, uterine artery embolization (UAE) offers a uterus-preserving alternative, with lower rates of major complications, although with an increased risk of reintervention. This case study presents a 45-year-old African American female with persistent abnormal uterine bleeding post-initial UAE, underscoring the importance of strategic techniques during repeat embolization to ensure efficacy. The patient underwent a successful repeat UAE procedure, demonstrating its safety and effectiveness in treating abnormal uterine bleeding while preserving fertility. In this case, the presence of collateral vessels may have contributed to the previous treatment failure. Specific procedural techniques are discussed, and long-term monitoring is recommended for optimal outcomes.

Uterine Artery Embolization for Iatrogenic Uterine Vascular Injuries

Abstract Purpose Uterine curettage or surgery can lead to uterine vascular injuries such as arteriovenous malformations (AVMs) or pseudoaneurysms (PsAs), and patients may present with life-threatening uterine bleeding. The purpose of our study is to evaluate the effectiveness of uterine artery embolization (UAE) in patients with abnormal uterine bleeding due to iatrogenic vascular injuries. Methods This is a retrospective review of 22 patients who underwent UAE at our institution between January 2019 and January 2023. Sixteen patients had a history of iatrogenic procedures. Uterine curettage was done in 12 patients, manual vacuum aspiration in 1 patient, and cesarean surgery in 3 patients. The outcomes were assessed in the form of technical feasibility, cessation of bleeding, recurrence, and pregnancy on follow-up. Results Eighteen (18/22) patients had vascular malformations and 4 (4/22) had PsA on computed tomography. Eight patients had typical AVM features with early draining vein and 10 patients had hypertrophied vessels with no early draining veins. A total of 35 uterine arteries were embolized in 22 patients. The most commonly used embolic material was polyvinyl alcohol particles (28/35 arteries). Postembolization, bleeding symptoms subsided in 19 patients (86.4%). Three patients had recurrence of bleeding symptoms for which they underwent repeat embolization. Six patients (27%) became pregnant during the follow-up period of 15 months. Conclusion UAE is a safe and effective treatment for iatrogenic uterine vascular injuries. This procedure allows for the preservation of uterine function with the possibility of future pregnancy and should be considered as a primary treatment option.

Embolization with or without portal vein stenting for bleeding ectopic jejunal varices in hepatopetal portal collaterals due to extrahepatic portal vein occlusion or stenosis after hepatobiliary and pancreatic surgery

PurposeTo evaluate the efficacy and safety of embolization with or without portal vein stenting for bleeding ectopic jejunal varices in the hepatopetal portal collateral due to extrahepatic portal vein occlusion or stenosis after hepatobiliary and pancreatic surgery.Materials and methodsThis study included consecutive patients who underwent embolization for bleeding ectopic jejunal varices in the hepatopetal collateral due to extrahepatic portal vein occlusion or stenosis after hepatobiliary and pancreatic surgery between September 2012 and December 2020. The safety, technical and clinical success rates (no re-bleeding within 1 month) and re-bleeding-free survival after the first therapy and overall survival were assessed.ResultsFourteen sessions in 11 patients were included. Four patients (7 sessions) underwent variceal embolization only, and the remaining seven patients (7 sessions) underwent portal vein stenting and variceal embolization. Technical success was achieved in all 14 sessions (100%). Clinical success was achieved in 13 of 14 sessions (92.9%). No treatment-related serious complications including liver failure were observed. One-year and 2-year re-bleeding-free survival rate after the first endovascular therapy in all 11 patients was 90.9 and 60.6%, respectively. Two patients who experienced re-bleeding had repeat embolization treatment. There was no significant difference in re-bleeding-free survival after endovascular therapy between the combination with stenting and embolization group and the embolization-only group (p = 0.13).ConclusionEmbolization with or without portal vein stenting of bleeding ectopic jejunal varices in the hepatopetal portal collateral due to extrahepatic portal vein occlusion or stenosis after hepatobiliary and pancreatic surgery can be considered a safe, effective, and repeatable therapy for long-term hemostasis of uncontrollable bleeding.

Uterine Vascular Anomalies: Management and Treatment Overview.

Uterine vascular anomalies (UVAs), while rare, can result in severe, life-threatening hemorrhage. An understanding of the presentation and management options for UVAs is important for interventional radiologists to appropriately evaluate and care for these patients. The authors propose a standardized terminology for UVAs to avoid confusion and conflating congenital from acquired vascular lesions, which have a different pathophysiology. Limited high-level evidence and no definitive guidelines for UVA management exist, although endovascular treatment with uterine artery embolization has generally become the first-line approach for symptomatic or persistent UVAs with high technical and clinical success rates. There is also no consensus on the optimal embolization technique; the authors propose an initial approach to first embolize the dominant uterine artery supplying the UVA with gelatin sponge, with the option to embolize the contralateral side at the time of initial embolization if there is persistent supply (avoiding bilateral empiric embolization). Repeat embolization is feasible and recommended in the setting of recurrence, and both clinical and imaging follow-up is important. Ultimately, a multidisciplinary approach with individualized patient management is needed, particularly in the face of a lack of consensus guidelines for the management of symptomatic UVAs.

Efficacy of Embolization in Acquired Uterine Vascular Malformations: An Experience in Tertiary Care Centre in India.

To determine the efficacy of Uterine Artery Embolization in patients with bleeding acquired uterine arteriovenous malformations (AVMs). A prospective review of all patients who underwent Uterine Artery Embolization at our institution between July 2015 and April 2022 was performed. 225 patients were diagnosed with a uterine vascular malformation on doppler and corresponding MRI imaging. All patients underwent transcatheter embolization of the uterine arteries. Embolic agents in the 375 procedures included Histoacryl glue only (n = 326), polyvinyl alcohol (PVA) particles and Histoacryl glue (n = 29), PVA particles (n = 5), Gelfoam (n = 5), coils (n = 4), PVA particles and coils (n = 3), Histoacryl glue and Gelfoam (n = 2), and Histoacryl glue and coils (n = 1). A total of 375 embolization procedures were performed in 225 patients. 90 patients required repeat embolization for recurrence of bleeding. The technical success rate of embolization was 100%. The clinical success rate was 92%: bleeding was controlled in 222 of 225 patients and three patients underwent a hysterectomy. 60 of the 225 patients had uneventful intrauterine pregnancies carried to term. The 210 patients who underwent successful embolization had no recurrence of bleeding at a median follow-up of 53 months (range, 5-122 months) after treatment. 15 patients were eventually lost to follow-up. One minor complication (0.4%) of non-flow-limiting dissection of the internal iliac artery occurred. Uterine Artery Embolization is a safe, effective, minimally invasive method to treat uterine AVMs with long-term efficacy, which can provide the preservation of fertility.

Lymphatic Embolization for the Management of Post-operative Chyle Leaks Following Solid Tumor Resection in Pediatric Patients

Chyle leaks are a common post-operative complication following solid-tumor resection in pediatric patients. Current treatments for persistent chyle leaks are limited, leading many patients to experience prolonged hospitalization, nutritional deficits and/or delays in cancer therapies. Lymphatic embolization is an emerging treatment option for chyle leaks, however, limited reports exist of its use in pediatric populations. We conducted a retrospective review of pediatric patients (<18) who underwent lymphangiogram with intent for lymphatic embolization for the management of chyle leaks following solid-tumor resection between 2017 and 2022. Seven patients underwent a total of 11 attempted lymphatic embolization procedures after current standard of care treatments failed to resolve the leak. Lymphangiograms identified a chyle leak in 6 of 7 patients and embolization had a technical success rate of 73%. The complication rate was 9% and complications were limited to one episode of inadvertent gastric wall perforation that did not result in a gastric leak. Lymphatic embolization was ultimately associated with chyle leak resolution in 100% of patients within a median of 24 days, however, repeat embolization was required in 5 of 7 patients (83%). Lymphatic embolization appears to be a safe and effective treatment for persistent chyle leaks in pediatric patients, leads to a direction reduction in chyle output, and has high rates of technical and clinical success. Complete resolution of the chyle leak may require multiple embolization procedures. Further work is needed to determine whether earlier intervention may offer benefit for the management of pediatric chyle leaks. IV.

Endovascular embolization of inferior pancreaticoduodenal artery pseudoaneurysm post-laparoscopic cholecystectomy in a patient with celiac artery stenosis – A case report

Inferior pancreaticoduodenal artery (iPDA) pseudoaneurysms are mostly secondary to pancreatitis, abdominal trauma, or iatrogenic procedures. We present a rare case of iPDA pseudoaneurysm secondary to laparoscopic cholecystectomy in a patient with celiac artery stenosis. A 50-year-old man who underwent laparoscopic cholecystectomy 7 days back presented with abdominal pain, blood in drain output, and tachycardia. Abdominal computed tomography (CT) showed a large retroperitoneal hematoma adjacent to head of pancreas with a pseudoaneurysm likely arising from gastroduodenal artery. Proximal stenosis of celiac artery was also present. Digital subtraction angiography (DSA) showed pseudoaneurysm arising from posterior branch of iPDA. Coil embolization was performed with complete obliteration of the aneurysm. However, the patient presented again with increasing abdominal pain and hemoglobin drop after 8 days. CT showed migration of coil loop into the hematoma and residual filling of pseudoaneurysm. Repeat embolization was planned and the pseudoaneurysm with iPDA branch was embolized with 33% glue-lipoidal mixture. On follow-up 3 months later, the patient was found to be stable with no further complications. iPDA pseudoaneurysm is less commonly encountered visceral artery pseudoaneurysm. Trapping of pseudoaneurysm with both proximal and distal vessel occlusion is ideal method for embolization to prevent recurrence.

Geniculate Artery Endovascular Embolization Post-Total Knee Arthroplasty for Hemarthrosis Treatment: A Systematic Review of the Literature

Purpose: To provide an updated systematic review on the use of geniculate artery embolization (GAE) in the management of recurrent hemarthrosis post-total knee arthroplasty (TKA). Materials and Methods: A systematic literature review was conducted, and all clinical reports in the English language from inception to July 2022 were identified. References were manually reviewed to identify additional studies. Demographics, procedural techniques, post-procedural complications, and follow-up data were extracted and analyzed using STATA 14.1. Results: A total of 20 studies (9 case reports, 11 case series; n= 214) were included for review. In all cases, patients underwent coil embolization of one or more geniculate arteries. Procedure success was reported in 94.8% (n=203/214) of cases without perioperative adverse events. Improvement of symptoms was seen in 72.6% (n=119/164) of cases, with 30.7% (n=58/189) of cases requiring repeat embolization. Recurrent hemarthrosis occurred in 22.2% (n=22/99) of cases over a mean follow-up of 48 months. Conclusion: GAE appears to be a safe and effective treatment for recurrent hemarthrosis following TKA. Future studies in the form of randomized controlled trials should be conducted to further evaluate such embolization techniques and compare outcomes between GAE and standard techniques. Clinical Impact Conservative management of post total knee arthroplasty (TKA) hemarthrosis is successful in only one third of cases. Geniculate artery embolization (GAE) has recently gained attention due to its minimally invasive nature compared to open or arthroscopic synovectomy promising faster rehabilitation, decreased infection rates and less additional surgeries. The purpose of this article was to summarize current literature, provide an updated review on the use of GAE in the management of recurrent hemarthrosis post-TKA and describe immediate and long-term outcomes in an effort to help optimize current treatment algorithms.

Acquired Uterine Vascular Anomaly: Experience from a tertiary care centre in Pakistan.

This study aimed to retrospectively review imaging findings and the outcomes of uterine artery embolisation (UAE) in symptomatic uterine vascular anomalies (UVA). This study included a total of 15 patients with acquired UVA admitted to the Aga Khan University Hospital in Karachi, Pakistan, from 2010 to 2020. These patients were evaluated using ultrasound, computed tomography and magnetic resonance imaging, either alone or in combination. All patients had a history of dilatation and curettage or uterine instrumentation and underwent angiography and embolisation of the uterine arteries. The primary outcome post embolisation was assessed clinically and/or in combination with ultrasound. Post-procedure pregnancies were also recorded. Non-invasive imaging was abnormal in all patients; however, this pre-intervention imaging was unable to accurately classify the type of vascular anomaly, except in the case of a pseudoaneurysm. Conventional angiography showed uterine artery hyperaemia in six patients, arteriovenous malformation in seven patients and pseudoaneurysm in two patients. The technical success rate was 100% and no repeat embolisation was needed. The follow-up ultrasound in 12 patients revealed a resolution of the abnormal findings, while the remaining three were found to be normal on clinical follow-up. Seven patients (46.7%) had a normal pregnancy 15.7 months after the procedure (range: 4-28 months). UAE is a safe and effective management option for intractable severe bleeding in patients with UVA post instrumentation and it was found that the procedure does not impair future pregnancy.

Outcomes of Hemorrhoidal Artery Embolization from a Multidisciplinary Outpatient Interventional Center

PurposeTo evaluate the safety and efficacy of outpatient transarterial embolization for symptomatic refractory internal hemorrhoids. Materials and MethodsRetrospective analysis of 134 patients who underwent hemorrhoidal artery embolization (HAE) for symptomatic internal hemorrhoids between August 2021 and June 2022 (76 men and 58 women) was performed. The mean age was 54.9 years, with a mean Goligher hemorrhoid grade (HG) of 2.1. Branches of the superior rectal artery (SRA) or middle rectal artery supplying the corpus cavernosum recti were embolized with both spherical particles and microcoils. Standard-of-care evaluations were performed at baseline and the 1 month follow-up, which included hemorrhoid-related pain (HRP) (0–10), hemorrhoid symptoms score (HSS) (5–20), quality of life (QoL) (0–4), French bleeding score (FBS) (0–9), and HG (0–4). Clinical success was defined as improvement of symptoms without additional treatment. ResultsEmbolization of at least 1 hemorrhoidal artery was achieved in 133 (99%) of the 134 patients. The mean number of SRA branches embolized per patient was 2.9 ± 1.0. Clinical success was seen in 93% (124 of 134) of patients at the 1-month follow-up, with 10 patients requiring repeat embolization. There were significant improvements in all mean outcomes at 1 month: HSS (11–7.8; P < .01), HRP (4.1–1.3; P < .01), QoL (2.2–0.8; P < .01), FBS (4.4–2.2; P < .01), and HG (2.3–1.2; P < .05). There were no severe adverse events. ConclusionsHAE is a safe and effective outpatient treatment for refractory symptomatic internal hemorrhoids in the short term.

Visceral artery pseudoaneurysm: predictive factors for clinical success after transarterial embolization.

Visceral artery pseudoaneurysm (VAPA) may result from trauma, operation, infection, inflammation, vasculitis, or malignancy. Factors associated with clinical success transarterial embolization (TAE) of VAPA have never been reported. The aim of this retrospective monocentric study was to describe clinical presentation and outcomes for patients treated for VAPA with TAE, and to identify factors associated with clinical success. We retrospectively reviewed data from all patients referred to the University Hospital of Saint-Etienne treated with TAE for VAPA between October 2012 and January 2023. Inclusion criteria included: all patients treated by TAE for VAPA arising from branches of the coeliac trunk, superior mesenteric artery, and renal artery. We considered pre- and per-procedure clinical data, biological data, outcomes, and complications. Post-operative data included early mortality (≤30 days), repeat embolization, and complications. Predictive factors associated with clinical success were evaluated. Our sample included 89 patients (68 males). The median age was 65 [49-74] [median (Q1-Q3)] years, and the median hemoglobin level was 9 (7.6-11) g/dL. On pre-operative computed tomography (CT), active bleeding was detected in 31 (34.8%) patients. Coils were used in 58 (65.2%) procedures. Clinical success was achieved in 77 (86.5%) patients. There were 11 (12.4%) minor complications. Five (5.6%) patients died within the first 30 days. In univariate analysis, hemoglobin levels were associated with clinical success (P=0.027) and number of red blood cell (RBC) transfusions (P=0.007) and gastrointestinal bleedings (P=0.005) were associated with clinical failure. No factors were statistically significant in multivariate analysis. Low hemoglobin levels, high numbers of RBC transfusions, and gastrointestinal bleedings were associated with clinical failure after TAE for VAPA. Multicentre studies are needed to investigate further.

N-butyl 2-Cyanoacrylate (NBCA) in Nephron Sparing Superselective Embolization of Iatrogenic Renovascular Injuries: A Single Centre Experience.

Purpose To evaluate the safety and efficacy of N-butyl-2-cyano-acrylate (NBCA) for endovascular management of iatrogenic renal-vascular injuries and effects on renal function. Material & Methods Fifteen patients with diagnosed or suspected iatrogenic renal vascular injuries, following percutaneous procedures formed the study group. All the patients were having retroperitoneal hemorrhage or hematuria, with hemodynamic instability at the time of presentation. Pseudoaneurysms, active extravasation of contrast, and the arteriovenous fistula were identified as the cause of bleeding on digital subtraction angiography. Patients underwent trans arterial super-selective embolization. Renal function was monitored using serum creatinine, estimated glomerular filtration rate (eGFR), and mean blood pressure of all the patients at immediate post-procedure and two months intervals. Results Technical and clinical success was achieved in all the cases using NBCA alone. Patients improved hemodynamically. None of the patients required repeat embolization. No derangement in renal function was observed immediately after the procedure and at interval follow-up. Conclusion NBCA can be used as a safe embolizing agent to provide a quick and effective cure for iatrogenic renovascular injuries. Renal parenchymal loss can be minimized by super selective technique.

Complications and Outcomes of Endovascular Embolization for Intractable Epistaxis: A Systematic Review and Meta-analysis.

Endovascular embolization has emerged as an effective treatment for intractable epistaxis. This systematic review and meta-analysis aimed to calculate the rates of success, rebleeds, and complications and to identify the etiologies and complications of patients who undergo endovascular embolization. This systematic review and meta-analysis was conducted per the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were extracted from Scopus, PubMed, Web of Science, and Cochrane Central and were filtered by a systematic review process using Rayyan software. A random-effects model was used to quantify the rates success, rebleeds, and complications. Forty-two studies were included, totaling 1660 patients. The pooled success rate was 89% (95% confidence interval [CI] 86%-92%) and the pooled rebleed rate was 19% (95% CI 16%-22%). The pooled minor complication rate was 18% (95% CI 11%-27%). The most common major complication was soft tissue necrosis followed by stroke. The most common minor complication was facial pain. No minor complications were reported to be permanent. Of the patients who failed initial embolization, 42% underwent repeat embolization and 34% underwent surgical arterial ligation. Endovascular embolization is an effective treatment for intractable epistaxis. The decision to perform embolization should be carefully weighed given the rare but significant major complications.

Spontaneous Retroperitoneal Hematoma: A Deadly Complication for Patients Awaiting Liver Transplant.

Patients with end-stage liver disease (ESLD) are at increased risk for hemorrhage and spontaneous retroperitoneal hematoma (sRPH) and also carry a high mortality rate. We sought to review the natural history of sRPH in patients with ESLDat a single center. All patients admitted to a single transplantation intensive care unit (TICU) at Froedtert and the Medical College of Wisconsin Transplant Center between June 2016 and August 2018 were retrospectively reviewed. Six ESLD patients with sRPH were studied. Clinical outcome measures were liver disease severity, sRPH treatment, and patient survival. Six patients were included, four male and two female patients, with a median age of 56.5 years (range 30-67 years). All had alcohol-induced liver cirrhosis. The median Model for End-Stage Liver Disease (MELD) score at the time of sRPH diagnosis was 40 (range 30-43). The most commonly identified source of bleeding was from lumbar arteries. One patient had recurrent bleeding after embolization and underwent repeat embolization. Five patients died. The median time to death from the diagnosis of sRPH was 7.2 days (range 2-12 days). The patient who survived following embolization had the lowest MELD score. Critically ill cirrhotic patients with sRPH have a significant mortality rate. Embolization is successful, albeit seldom. This is the largest retrospective series of sRPH in cirrhotic patients in theliterature.

A deceptive mass on neonatal ultrasound and a fetal brain MRI-confirmed complex dural arteriovenous fistula postnatally: illustrative case.

Dural arteriovenous fistulas (dAVFs) are direct, aberrant connections between dural arteries and cerebral veins. In neonates, delayed diagnosis results in grim outcomes. Treatment involves endovascular management because of its success and tolerability. Here, the authors present a case of a complex dAVF initially recognized with an in utero neurosonogram and fetal magnetic resonance imaging (MRI). A 21-week fetal ultrasound of a nonspecific brain mass was confirmed with fetal MRI as a 2.7-cm T1-hyperintense posterior fossa mass. Although a large flow void in the left middle cranial fossa was present, postnatal computed tomography angiography ultimately revealed a high-flow dAVF communicating with the left transverse sinus. In the early postnatal period, the patient developed hydrocephalus. After successful partial embolization, 6-week postangiogram brain MRI indicated disease progression with the development of a venous varix causing brainstem compression. Repeat embolization resulted in complete cessation of early venous drainage. Neonatal dAVFs are exceedingly rare and result in futile outcomes; however, detection in utero is possible. Although definitive therapy must be performed postnatally, constant monitoring and early delivery can prevent complications. Attention to fetal ultrasound is essential, and knowledge of fetal MRI in the detection of these complex lesions can significantly improve outcomes.

Risk Factors Associated with Clinical Failure of Uterine Artery Embolization for Postpartum Hemorrhage

PurposeTo identify risk factors for clinical failure of uterine artery embolization (UAE) for postpartum hemorrhage (PPH), with particular attention to the uterine artery diameter. Materials and MethodsThis retrospective study included 47 patients who underwent UAE for PPH between January 1, 2010, and January 31, 2021. Technical success was defined as the completion of embolization of the arteries thought to be the cause of the bleeding. Clinical success was defined as no recurrent bleeding or need for additional therapeutic interventions. Univariate and multivariate analyses were performed to examine the risk factors associated with clinical failure of UAE. ResultsOf the 47 patients, 6 had recurrent bleeding. Of the 6 patients, 4 underwent hysterectomy, and 2 underwent repeat embolization. The clinical success rate was 87.2% (41/47), with no major adverse events such as uterine infarction or death. In univariate analysis, there were slight differences in multiparity (P = .115) and placental abruption (P = .128) and a significant difference in the findings of a narrow uterine artery on digital subtraction angiography (DSA) (P = .005). In multivariate analysis, only a narrow uterine artery on DSA was a significant factor (odds ratio, 18.5; 95% confidence interval, 2.5–134.8; P = .004). ConclusionsA narrow uterine artery on DSA was a risk factor for clinically unsuccessful UAE for PPH. It may be prudent to conclude the procedure only after it is ensured that vasospasm has been relieved.

Dual-vessel intervention treatment for massive hemoptysis caused by lung cavitary lesions

PurposeTo evaluate the outcome of dual-vessel intervention (DVI), including bronchial or pulmonary arterial embolization (B/PAE), in managing massive hemoptysis caused by cavitary lung lesions (with or without aspergilloma) and identify cavitary angiographic features influencing DVI procedures. MethodA retrospective analysis of the medical records and angiograms of 15 patients who underwent DVI for massive hemoptysis was performed. ResultsThe most frequent causes of cavitary lung lesions were tuberculosis (TB) (8/15, 53%) and bronchiectasis (6/15, 40%). Eight patients were diagnosed with aspergilloma (8/15, 53%). In all, 24 systemic arteries, including the orthotopic and ectopic bronchial arteries and 1 pulmonary artery branch, were embolized in 16 procedures. Clinical success and immediate cessation of hemoptysis were achieved in 12 patients (80%). Hemoptysis was controlled in 10 patients (67%) and recurred in 2 patients (17%), while 1 patient (7%) required repeat embolization. The bronchopulmonary fistula (shunting) rate was 73.3% (11/15). The average fistula emergence time was 1.28 ± 1.27 s (M ± SD), and the average vessel diameter was 3.974 ± 1.57 mm. There were no significant differences in angiographic features, clinical success, or recurrence of cavitary lesions with or without aspergilloma. The complication rates were low, with only transient chest pain and ventricular arrhythmia reported. ConclusionsBAE is an effective and safe procedure for most cavitary lesions causing massive hemoptysis, and DVI is needed under certain circumstances. High bronchopulmonary fistula rates and early fistula emergence times were observed for cavitary lesions. The DVI strategy depends on the culprit vessel diameter, fistula type, and fistula emergence time.

Endovascular embolisation of external carotid artery system haemorrhage in radiated nasopharyngeal carcinoma.

To review the effectiveness and safety of embolisation in managing haemorrhage from the external carotid artery (ECA) system in radiated nasopharyngeal carcinoma (NPC) patients. Radiated NPC patients who presented with severe oronasal bleeding and underwent digital subtraction angiography that excluded blowouts from the internal carotid artery from 2011 to 2021 were reviewed. Those who subsequently underwent embolisation of the ECA system were analysed for technical success rate, post-embolisation re-bleeding rate and complications. Seventeen embolisations were performed in fifteen patients during the 10-year period. The technical success rate was 100%, however the early haemostatic rate (no re-bleed within 7days of embolisation) was 70.6% (12/17) and the overall long-term haemostatic rate was 58.8% (10/17). The re-bleed rates of targeted and empiric embolisations were 33.3% (3/9) and 50.0% (4/8), respectively. The re-bleed rates with liquid agents, coils and particles were 0% (0/7), 33.3% (1/3) and 85.7% (6/7), respectively. Amongst the embolisations utilising liquid agents, 71.4% (5/7) were targeted, distal embolisations. All re-bleeds underwent surgical ligation or repeat embolisation; half of them further experienced recurrent bleeding. There were no significant complications with embolisation. Although embolisation of the ECA system in NPC has a high technical success rate and is safe, re-bleeding appears to be common. Targeted, distal embolisation with liquid embolics appear to have good haemostatic effect. Clinicians should be aware that patients may need repeated procedures to secure haemostasis.

Recurrent postpartum hemorrhage at subsequent pregnancy in patients with prior uterine artery embolization: angiographic findings and outcomes of repeat embolization.

To evaluate angiographic findings and outcomes of uterine artery embolization (UAE) for recurrent postpartum hemorrhage (PPH) in a subsequent pregnancy in patients with a history of prior UAE. Between March 2004 and February 2021, UAE was performed for PPH with gelatin sponge slurry in 753 patients. Among these, 13 underwent repeat UAE for recurrent PPH after subsequent delivery. The causes of PPH, angiographic findings, hemostasis, and adverse events were evaluated. The causes of recurrent PPH included retained placental tissue (n = 9) and uterine atony (n = 4). On angiography, unilateral or bilateral uterine arteries were obliterated due to prior UAE in 10 patients (76.9%). The uterine collateral vessels were embolized (anterior division of the internal iliac artery [n = 10], round ligament [n = 5], and ovarian [n = 4] artery). In the remaining three patients with recanalized or patent (not embolized at prior UAE) uterine arteries, both uterine arteries were embolized. Immediate hemostasis was achieved in nine patients (69.2%). The remaining four patients (30.8%) with obliterated uterine arteries required hysterectomy. There were three mild adverse events (pelvic pain [n = 2] and fever [n = 1]). UAE with gelatin sponge slurry frequently causes permanent uterine artery obliteration. In cases of recurrent PPH occurring in subsequent pregnancy, repeat UAE may be less likely to achieve hemostasis (69.2%). 1. UAE with gelatin sponge slurry frequently caused permanent uterine artery obliteration.2. In recurrent PPH occurring in subsequent pregnancy, the repeat UAE may be less likely to achieve hemostasis than initial UAE.