Required Repeat Embolization Research Articles

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.

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.

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.

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.

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.

Embolization for acute gastrointestinal bleeding

Purpose: To retrospectively evaluate the clinical success and complication rates following interventional embolization for treatment of acute gastrointestinal bleeding (GIB) at a tertiary care centre. The secondary purpose was to evaluate results of practice change whereby multiphase CT angiography was requested prior to conventional angiograms.&#x0D; Methods: A retrospective chart review and analysis of 38 patients undergoing Interventional Radiology guided embolization for acute GIB was performed. Clinical success was defined as patient stability 30 days’ post embolization and complications included subsequent bleeding requiring endoscopy, surgery or additional embolization, or death.&#x0D; Results: Overall clinical success rate was 86.8% (33/38). Complications included 14 patients (36.8%) experiencing continued bleeding, 6 patients (15.8%) requiring repeat endoscopic evaluation, 8 patients (21.1%) requiring surgery, 3 patients (7.9%) requiring repeat embolization, and 4 deaths (10.5%). These results were not inferior to clinical success rates reported in the literature for GIB regardless of location. Positive predictive value for multiphase CT angiogram was 92.3% and the negative predictive value was 57.1%.&#x0D; Conclusions: Interventional angiography and embolization is an effective treatment for GIB with the most common complication being recurrent bleeding which may require additional endoscopic evaluation, surgical intervention or additional embolization. Clinical success and complication rates at this centre are similar to those reported in the literature. Continued evaluation of the utility of multiphase CT angiography prior to conducting embolization should be considered to determine its impact on rates of negative angiogram studies.

Complications and recovery patterns after blunt splenic injury: Recommended duration and follow-up methods.

Splenic artery embolization (SAE) is commonly employed as a non-operative management technique for splenic injury. Nonetheless, information on follow-up duration and methods, and the natural course of splenic infarction after SAE is limited. Thus, this study is aimed to analyze the patterns of complications and recovery of splenic infarction after SAE and to determine the appropriate follow-up duration and method. Medical records of 314 patients with blunt splenic injury admitted at the Pusan National University Hospital, Level I Trauma Centre were analyzed to identify patients who underwent SAE between January 2014 and November 2018. Computed tomography (CT) scans that were obtained after SAE in patients who were followed up were compared with all their previous CT scans to identify any changes in the spleen and the occurrence of complications such as sustained bleeding, pseudoaneurysm, splenic infarctions, or abscess formation. Of the 314 patients, 132 who underwent SAE were included in the study. In total, 30 complications were noted among the 132 patients; of these, 7 (5.30%) required repeat embolization and 9 (6.82%) required splenectomy. Splenic infarction of <50% occurred in 76 patients and that of ≥50% including total and near-total infarctions occurred in 40 patients. Among patients with splenic infarction of ≥50%, 3 (2.27%) patients had abscesses between 16 and 21 days after SAE, and the range of infarctions increased as the AAAST-OIS grade increased. After SAE, repeat abdominal CT scans for >14 days were obtained in 75 patients; among these, 67 pre-sented with recovery of splenic infarction. The median period of recovery was 43 days after SAE. The present findings suggest that patients with ≥50% infarction may need 3 weeks of closed observation, with or without a follow-up CT scan, to rule out infection after SAE, follow-up CT follow-up at 6 weeks after SAE may be necessary to confirm the recovery of the spleen.

Bilateral internal iliac artery embolization for pelvic trauma: Effectiveness and safety

IntroductionBilateral internal iliac artery embolization (BIIAE) with temporary embolic materials epitomizes damage-control principles in the treatment of exsanguinating hemorrhage from pelvic trauma. However, instances of ischemic complications have been reported. The aim of our study was to assess safety and effectiveness of BIIAE. MethodsAll patients who received BIIAE for pelvic trauma at a Level I Trauma Center between 1998 and 2018 were reviewed. Effectiveness was assessed by radiographic bleeding control and clinical bleeding control, i.e. stabilization of vital signs and reduction in blood transfusion. Safety was assessed by any evidence for ischemic damage of pelvic organs or tissues. ResultsOf 61 patients undergoing BIIAE, bleeding control was confirmed radiographically in 60 (98%) and clinically in 55 (90%), including 4 (7%) patients who required repeat embolization. Six (10%) patients died due to insufficient pelvic bleeding control. No BIIAE-related complications were identified. ConclusionThe overall clinical effectiveness and safety rates of BIIAE for pelvic bleeding control, when combined with other methods of hemostasis, were 90% and 100% respectively.

Empiric Transcatheter Arterial Embolization for Massive or Recurrent Gastrointestinal Bleeding: Ten-year Experience from a Single Tertiary Care Center.

PurposeIn patients with massive or recurrent gastrointestinal bleeding (GIB) which is not amenable to endoscopic therapy, angiographic interventions are often employed. We report our ten-year experience of empiric transcatheter arterial embolization (TAE) for patients with massive or recurrent GIB.MethodsAll patients who had undergone empiric TAE at our hospital between March 2004 and June 2015 were identified using the institutional radiology information system. A retrospective chart review was performed using a structured pro forma. Technical success rate, 30-day clinical success rate, 30-day mortality rate, and rate of procedural complications were computed. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.ResultsA total of 32 patients had undergone empiric TAE for GIB during the study period. The median age of subjects was 56 years and two-thirds of them were male (68.7%). Gastroduodenal (n=24), ileocolic (n=3), left gastric (n=2), right gastroepiploic (n=1), and branches of superior and middle rectal arteries (n=1) were embolized using microcoils (n=25), polyvinyl alcohol particles (n=25), and gelatin sponge (n=3)--either alone or in combination. Technical and 30-day clinical success rates were 96.9% (31/32) and 71.9% (23/32), respectively. The 30-day mortality rate for our cohort was 21.9% (7/32). One patient developed re-bleeding at two days after the initial procedure and required repeat embolization. Coil migration (n=3) and access site hematoma (n=1) were the observed procedural complications.ConclusionEmpiric TAE can be a useful treatment option for selected patients with massive or recurrent GIB that is not amenable to endoscopic therapy.

Abstract No. 459 Technical success and safety of transradial approach for embolization in the setting of obstetrical and gynecological hemorrhage: a single-center experience

To retrospectively evaluate the efficacy and safety of using a transradial approach (TRA) for embolization in the setting of emergent obstetrical (OB) and gynecological (GYN) hemorrhage. TRA for management of pelvic hemorrhage may minimize patient discomfort and enhance ease of access relative to traditional femoral access in the presence of lithotomy positioning and recent pelvic surgery. All patients who underwent TRA embolization of refractory postpartum OB or GYN hemorrhage with significant hemodynamic compromise between 1/2013 and 12/2018 were retrospectively reviewed. Patient demographics, procedural details, technical success (defined as absence of extravasation on post-embolization angiography), adverse events (AEs) and clinical success (defined as hemodynamic stabilization) were reviewed. A total of 20 women (mean age 32, range 23-65) with acute uterine or vaginal hemorrhage were embolized using TRA. Indications for embolization included: post-partum hemorrhage (n=18), post gynecological surgery hemorrhage (1) and spontaneous bleeding from malignancy (1). A 4F 125cm VERT catheter was used in all cases to cannulate the internal iliac artery. Technical success was achieved in all patients. Clinical success was achieved in 95% of patients; 1 patient required repeat embolization for continued hemorrhage at 1 day. All patients received 3000 U intra-arterial heparin, 200ug nitroglycerin and 2.5 mg verapamil via radial sheath as per standard TRA technique. Patients were embolized with n-BCA liquid embolic (8), particles (8) or Gelfoam slurry (4). Embolized vessels included: unilateral uterine (4), bilateral uterine (13), hypogastric (4), internal pudendal (2) and vaginal (1). AEs included: minor radial arteritis (1) which resolved with conservative management. No major access site bleeding or ischemic AEs were noted. TRA for embolization of acute OBGYN hemorrhage, particularly in the setting of recent pelvic intervention is safe and effective.

Translumbar Infusion of N-Butyl Cyanoacrylate for the Treatment of Type II Endoleaks

PurposeTo evaluate long-term efficacy of translumbar embolization of type II endoleaks exclusively supplied by the lumbar arteries in patients with growing abdominal aortic aneurysm sacs using N-butyl cyanoacrylate (NBCA) instilled via percutaneous needle access. Materials and MethodsThe study included 25 patients who developed type II endoleak after endovascular aneurysm repair. Inclusion criteria for intervention were defined as sac expansion > 5 mm detected with CT angiography at 6-month follow-up or later. Translumbar infusion of NBCA directly into the patent portion of the aneurysm sac was performed in all cases. Duplex US was performed the day after the intervention, and CT angiography was performed within the first month. Subsequently, duplex US was performed at 3, 6, and 9 months, and CT angiography or CT was performed at 12 months and annually thereafter. ResultsTranslumbar embolization was achieved in all 25 patients. The endoleak resolved in 22 patients (88%) on duplex US performed 1 day after the embolization procedure. Three patients with persistent endoleak (12%) required repeat embolization. Two complications were detected and were managed conservatively. ConclusionsThis study demonstrates the safety and efficacy of NBCA injection for treatment of type II endoleaks. This technique provides another option for the management of type II endoleaks.

Liver Biopsy and Microwave Ablation Complicated by Hemorrhagic Shock and Massive Hemoperitoneum: A Root Cause Analysis

Case Summary: A 47 year-old man with Child-Pugh class B alcoholic cirrhosis was found to have an indeterminate 2 cm right hepatic lobe lesion concerning for hypovascular hepatocellular carcinoma. The patient underwent CT-guided percutaneous liver biopsy followed by microwave ablation. Post-procedure blood loss was minimal, with no immediate complications; however, the patient presented < 48 hours later with hypotension and abdominal pain. CT angiography demonstrated large volume hemoperitoneum with active contrast extravasation from a branch of the right hepatic artery. Distal right hepatic artery branch embolization was performed. Within 24 hours, the patient developed refractory hypotension requiring repeat embolization of the right hepatic artery with no further contrast extravasation. Later that day, the patient developed elevated intra-abdominal pressure, worsening hypotension, and profound lactic acidosis with persistent coagulopathy. The patient was taken emergently to the operating room for exploratory laparotomy and evacuation of the hematoma. Despite these interventions, the patient developed cardiac arrest in the operating room and expired. Methods: A systematic root-cause analysis (RCA) was performed. Data was gathered and evidence collected from multiple hospital stakeholders (staff, nurses, advance practice providers, physicians, bed management, and hospital administrators). Causal factors, current practice paradigms, and root causes were investigated. Potential corrective actions were explored. Results: Detailed discussions were held with emergency, IR, hepatology, hematology, and medical and surgical ICU staffing. Cause and effect diagram was constructed - Figure. RCA revealed potential areas for institutional improvement including post-procedural follow-up (phone contact and lab monitoring), physician consultation methods (automatic consultations for high-risk patients), massive transfusion protocols (thromboelastrography correction of coagulopathy), and triage of patients to medical versus surgical intensive care units (ICU).Figure: Cause and Effect Fishbone Diagram.Discussion: This case highlights a fatal complication from liver biopsy and microwave ablation. Through this RCA, an institution-wide protocol through discussions with all stakeholders is needed to reduce future adverse events. Furthermore, this case emphasizes the need for early involvement of the hepatobiliary surgical service and appropriate triage of massive transfusion protocol patients to a surgical ICU.

Technically Successful Geniculate Artery Embolization Does Not Equate Clinical Success for Treatment of Recurrent Knee Hemarthrosis after Knee Surgery

PurposeTo evaluate technical details, clinical outcomes, and complications in patients undergoing geniculate artery embolization for treatment of spontaneous hemarthrosis after knee surgery. Materials and MethodsDuring 2009–2014, 10 consecutive patients (seven women; mean age, 57.4 y) underwent geniculate artery embolization at a single tertiary care center. All patients except one had hemarthrosis after total knee replacement (TKR). One patient presented with hemarthrosis after cartilage surgery. Two patients in the TKR group had a history of TKR revisions before the embolization. Embolization was performed with polyvinyl alcohol particles (range, 300–700 µm). In one patient requiring repeat embolization, N-butyl cyanoacrylate/ethiodized oil was used. The endpoint for embolization was stasis in the target artery and elimination of the hyperemic blush. ResultsIn 10 patients, 14 embolizations were performed with 100% technical success. Hemarthrosis resolved in six patients. Four patients required repeat embolization for recurrent hemarthrosis, which subsequently resolved in two of four patients. Three of the four patients who required repeat embolization had serious comorbidities, either blood dyscrasias or therapeutic anticoagulation. There were two minor skin complications that resolved with conservative management. The average length of follow-up after embolization was 545 days (range, 50–1,655 d). One patient was lost to follow-up. ConclusionsGeniculate artery embolization is a safe, minimally invasive treatment option for spontaneous and refractory knee hemarthrosis after knee surgery with 100% technical success. However, limited clinical success and higher repeat embolization rates were noted in patients with serious comorbidities.

VESS4. The Implications of False Lumen Embolization During TEVAR and EVAR on Thrombosis, Pressurization, Remodeling, and Mortality

To evaluate the implications of thoracic and abdominal aortic false lumen embolization (FLE) during thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR) for complicated aortic dissections. Ninety-six consecutive patients who presented with complicated acute and chronic type B thoracic aortic dissections (TAD) who underwent TEVAR with FLE (n = 32 [33.3%]) and without FLE (n = 52 [54.2%]), as well as abdominal aortic dissections (AAD) who underwent EVAR with FLE (n = 4 [4.2%]) and without FLE (n = 8 [8.3%]). In a subset of 26 patients, before FLE, a wireless cardioMEMS Endosure pressure sensor was placed in the false lumen and used to quantify the false lumen to systemic systolic, diastolic, mean, pulse pressure indices. All data were prospectively collected and outcomes analyzed. The 30-day mortality in patients with FLE (n = 1 [2.3%]) was significantly lower than patients without FLE (n = 5 [9.6%]), and none of the patients with FLE developed spinal cord ischemia. After TEVAR and FLE, nine patients (29.0%) had persistent retrograde false lumen endoleaks that required repeat embolization procedures. FLE and complete thrombosis was achieved in 100% of EVAR patients. At a mean 18-month follow-up, 88% (23 of 26 patients) had a significant decrease in all false lumen-to-systemic pressure indices, and 65% (17 of 26 patients) had a false lumen remodeling with >5 mm maximum diameter reduction. At midterm follow-up, there are no thoracic or abdominal related ruptures, conversions, or deaths. FLE during TEVAR for complicated acute and chronic TAD and AAD is associated with a lower mortality and is effective in reducing false lumen pressures and maximum diameter. This adjunctive technique should be considered when managing complicated aortic dissections.

Coil Embolization of the Splenic Artery: Impact on Splenic Volume

PurposeTo determine the impact of coil embolization of the splenic artery on splenic volume based on computed tomography (CT) imaging. Materials and MethodsSplenic artery embolization (SAE) was performed in 148 consecutive patients over an 8-year period in an institutional review board–approved retrospective study. Of these, 60 patients (36 men; mean age, 49 y) had undergone contrast-enhanced CT before and after SAE with a mean time interval of 355 days. Pre- and postembolization splenic volumes were calculated with volume-rendering software. Presence of Howell–Jolly bodies was ascertained on laboratory tests. A trauma control group consisted of 39 patients with splenic laceration and follow-up CT but no splenic intervention. ResultsSAE in trauma patients resulted in an insignificant decrease in mean spleen size from 224 cm3 to 190 cm3 (P = .222). However, postembolization splenic volume was significantly smaller than follow-up volume in the trauma control group (353 cm3; P < .001). In nontrauma patients, the mean splenic volume decreased from 474 cm3 to 399 cm3 after SAE (P = .068). Multivariable analysis revealed that coil pack location was the only factor significantly affecting resultant splenic volume (P = .016). For trauma and nontrauma patients, distal embolization resulted in significant splenic volume loss (P = .034 and P = .013), whereas proximal embolization did not. No patients had persistent circulating Howell–Jolly bodies after SAE. No patients required repeat embolization or splenectomy. ConclusionsCoil embolization of the splenic artery resulted in a modest but significant decrease in splenic volume when performed distally; proximal embolization resulted in an insignificant volume change.

Abstract No. 311 - Coil embolization of the splenic artery: long-term impact on splenic volume

Purpose Maintenance of splenic function is often a concern when choosing the appropriate treatment for splenic and splenic arterial pathology. Splenic artery embolization is less morbid than splenectomy, but devascularization of the spleen has the potential to have a similar end-result. The purpose of this study is to determine whether coil embolization of the splenic artery results in a significant degree of splenic volume loss based on long-term CT follow-up data. Materials and Methods Between 1/2004 and 1/2012, a total of 148 patients underwent splenic artery embolization at our institution. Of these, 24 patients (13 males, 11 females, mean age 52) had follow-up contrast-enhanced CT imaging greater than 6 months post-procedure. Embolization was performed using coils anywhere from the splenic artery origin to the splenic hilum. The mean time between embolization and last follow up CT was 27.1 months. Pre- and postembolization splenic volumes were calculated with the use of volume rendering software and compared using the paired t-test. Inter-group comparisons were performed using the unpaired t-test. The presence of Howell-Jolly bodies were ascertained on lab tests. Results Splenic artery embolization resulted in a mean splenic volume loss of 15% (p=0.09). Two patients had a splenic volume loss of greater than 50%: one with 67% loss and one with 88% volume loss. The 9 patients with a grade 3-4 splenic laceration demonstrated a 22% mean volume loss compared to 8% in the 15 patients without trauma (p=NS). Patients that underwent distal splenic artery embolization (n=13) demonstrated a 21% volume reduction while patients with proximal embolization (n=11) demonstrated a 4% reduction (p=NS). No patients had Howell-Jolly bodies on most recent lab tests. No splenic abscesses requiring drainage occurred. No patients required repeat embolization or splenectomy. Conclusion Based on CT volumetric analysis, coil embolization of the main splenic artery resulted in only a mild degree of splenic volume loss over the long term, with a mean of 15% decrease in volume.

Usefulness of Pelvic Artery Embolization in Cesarean Section Compared with Vaginal Delivery in 176 Patients

PurposeTo evaluate the efficacy and safety of transcatheter arterial embolization of the pelvic arteries for the treatment of postpartum hemorrhage (PPH) associated with cesarean section compared with vaginal delivery. Materials and MethodsA retrospective analysis of 176 patients undergoing transcatheter arterial embolization of the pelvic arteries for PPH from January 2006 through August 2011 was conducted at two institutions. The mean patient age was 33.9 years (range, 24–46 years). Data including delivery details, hematology and coagulation results, embolization details, and clinical outcomes were collected. Technical success was defined as cessation of bleeding on angiography or angiographically successful embolization of the bleeding artery. Clinical success was defined as the obviation of repeated embolization or surgical intervention. ResultsThe technical success rate was 98.8% (n = 174), and the clinical success rate was 89.7% (n = 158). Among 176 patients, 71 had cesarean sections, and 105 underwent normal vaginal deliveries. Of the 105 patients who underwent normal vaginal deliveries, 11 (10.5%) required repeat embolization or surgical intervention. Of the 71 patients who had cesarean sections, 7 (9.8%) required repeat embolization or surgical intervention. The clinical success rate and complication rate were not related to the mode of delivery. All women resumed menses after transcatheter arterial embolization, and most (n = 125) described their menses as unchanged. Subsequent spontaneous pregnancies occurred in 13 women. ConclusionsThe cesarean mode of delivery is not a predictor of poorer outcomes of transcatheter arterial embolization; however, further study is needed to clarify this relationship.

Superselective Embolization for the Management of Postpancreatectomy Hemorrhage: A Single-Center Experience in 25 Patients

PurposeTo evaluate the efficacy of superselective embolization in patients with late postpancreatectomy hemorrhage (PPH). Materials and MethodsBetween January 2002 and July 2010, 25 patients (19 men) with suspected late PPH (> 24 hours after the operation) were evaluated. The primary study endpoint was technical success, defined as complete angiographic occlusion of the site of hemorrhage. Secondary study endpoints were multidetector computed tomography (CT) and angiographic findings regarding accurate detection of the site of hemorrhage, persistence of hemorrhage, or occurrence of rebleeding during clinical follow-up. ResultsMultidetector CT was performed before the intervention in 17 (68%) patients with detection of hemorrhage in 15 (88%) patients. The site of hemorrhage was detected in 23 (92%) of 25 patients by angiography. Four (17%) patients required a superselective catheter position. Embolization was attempted in all 23 patients with angiographically visible hemorrhage. In three (13%) patients, embolization could not be performed because a superselective catheter position was not achievable. Technical success was 83% (19 patients). In one patient, hemostasis was not achieved by embolization. Minor complications occurred in three (13%) patients. No major complications occurred. Three patients with technically successful embolization (16%) had a second episode of bleeding during follow-up and required repeat embolization 5–23 days after the procedure. The 30-day mortality rate was 20%. ConclusionsSuperselective embolization is a technically and clinically effective procedure in patients with late PPH. Diagnostic angiography should be performed with a superselective microcatheter position to detect the bleeding site effectively.

Selective Arterial Embolization for Pseudoaneurysms and Arteriovenous Fistula of Renal Artery Branches Following Partial Nephrectomy

We describe the presentation, endovascular management and functional outcomes of 15 patients with renal arterial pseudoaneurysm following open and laparoscopic partial nephrectomy. An institutional review board approved, Health Insurance Portability and Accountability Act compliant retrospective review of a prospectively maintained database revealed that 7 of 1,160 patients who underwent open partial nephrectomy and 8 of 301 treated with laparoscopic partial nephrectomy were diagnosed with a pseudoaneurysm of a renal artery branch between 2003 and 2010. Some cases were associated with arteriovenous fistula. Diagnosis of pseudoaneurysm was made a median of 14 days after surgery. Gross hematuria was the most frequent symptom. Median estimated glomerular filtration rate measurements at the preoperative evaluation, postoperatively, on the day the vascular lesion was diagnosed, after embolization and at the last followup were 62, 55, 55, 56 and 58 ml/minute/1.73 m(2), respectively. Median followup was 7.8 months. All patients underwent angiography and superselective coil embolization of 1 or more pseudoaneurysms with or without arteriovenous fistula. Eleven patients had immediate cessation of symptoms while 4 had persistent gross hematuria after the procedure. Of these 4 patients 2 were treated with bedside care, 1 required repeat embolization with thrombin, which was successful, and the remaining patient had coagulopathy and underwent radical nephrectomy for persistent bleeding. Pseudoaneurysms and arteriovenous fistulas of the renal artery are rare complications of partial nephrectomy. Presentation is often delayed. Superselective coil embolization is a safe, minimally invasive treatment option that usually solves the clinical problem and preserves renal function.

The Fatal Risk in Hepatic Artery Embolization for Hemostasis after Pancreatic and Hepatic Surgery: Importance of Collateral Arterial Pathways

Purpose To assess retrospectively the cause of hepatic failure related to hepatic arterial embolization (HAE) for hemostasis after pancreaticoduodenectomy or hepatic lobectomy. Materials and Methods Between June 1993 and March 2006, Twenty HAEs in 17 patients (15 men, two women; mean age, 64 years) were performed. Angiographic findings, including portal vein stenosis, collateral arterial pathways after HAE, and the difference of embolic materials, were recorded. The morbidity (hepatic failure and abscess) and mortality were detailed according to collateral arterial pathways, portal vein stenosis, and embolic material used. Results Bleeding was controlled in all patients, although two patients required repeat embolization. Hepatic failure ( n = 8) and abscess ( n = 2) arose in nine of 20 HAEs. Death occurred after six of eight HAEs complicated by hepatic failure. The morbidity and mortality rates of HAE were 45% and 30%, respectively. Hepatic complication was eight times more likely to occur ( P = .005) in cases with no hepatic collaterals involving hepatic, replaced, or accessory hepatic arteries. Death was observed only in the cases without hepatic collaterals ( P = .011). The correlation between the embolization outcome and the presence of portal vein stenosis or the difference of embolic materials was not significant ( P > .61). Conclusions HAE can be used to successfully control bleeding secondary to hepatic arterial rupture. In the absence of hepatic collaterals, collateral circulation distal to the occlusion from nonhepatic sources may be inadequate and lead to hepatic failure after HAE.