Role Of Transarterial Embolization Research Articles

Role of Transarterial Embolization in the Treatment of Life-Threatening Hemorrhage in Patients With Maxillofacial Injury.

Life-threatening hemorrhage following maxillofacial injury (MFI) is rare but can be fatal. Conventional measures for hemostasis including nasal packing, balloon tamponade, and surgical ligation of bleeding points may not be effective or efficient in patients at risk of hypovolemic shock. Advantages of transarterial embolization (TAE) include rapid identification of the bleeding focus and its access, direct obstruction of the culprit vessels, ability to control multiple bleeding sites, and no requirement of general anesthesia. The internal maxillary artery is the most frequently targeted vessel for embolization. Several studies have demonstrated that TAE was technically successful at rates between 79.4% and 100% and was associated with good clinical outcomes. However, major complications such as tongue necrosis or facial nerve palsy have rarely been reported (0%-7%), probably because of rich collaterals in the maxillofacial region, and failure to diagnose complications in patients who are severely disabled or died. Traditionally, Gelfoam and coils have been widely used as embolic materials. Polyvinyl alcohol particles and n-butyl-cyanoacrylate are also favored, and newer embolic materials, such as Onyx or precipitating hydrophobic injectable liquid, are available for use. Operators should be familiar with the distinctive characteristics of each embolic material. Early treatment with TAE for intractable hemorrhage may improve outcomes in patients with MFI, and further studies are necessary to develop a treatment algorithm to define when to initiate TAE in cases of severe oronasal hemorrhage following MFI.

The role of percutaneous transarterial embolization in the management of spinal bone tumors: a literature review.

Spinal bone tumors include a heterogeneous broad of primary or metastatic lesions that may present as incidental findings or manifest with painful symptoms and pathological fractures. Optimal management of spine bone lesions is often difficult and treatment algorithms are usually solidly based on surgery. We aimed to evaluate the contribution of trans-arterial embolization in this field, with particular attention to the procedure efficacy, technical difficulties and complications. We present a literature review on the role of trans-arterial embolization in the management of spinal bone tumors, both primary and metastatic, evaluating its contribution as preoperative treatment, palliative procedure and standalone curative strategy. Trans-arterial embolization provides an important contribution to reducing surgery hemorrhagic risks, offering a better visualization of the operating field, and possibly increasing tumor susceptibility to chemotherapy or radiation therapy. Nonetheless, it plays an important part in pain palliation, with the unquestionable advantage of being easily repeatable in case of necessity. Its curative role as a standalone therapy is still subject of debate, and at the present time, satisfactory results have been recorded only in the treatment of aneurysmal bone cysts. Percutaneous trans-arterial embolization has established as a highly useful minimally invasive procedure in the management of spinal bone lesions, particularly as adjuvant preoperative therapy and palliative treatment.

Role of Trans-Arterial Embolization in Management of Bone Tumors

Abstract Background: Trans-arterial embolization (TAE) is a prom-ising less aggressive modality in either primary treatment or adjuvant to surgical management of bone tumors. The main aim is to induce necrosis and decrease bleeding and therefore facilitate resection. Palliation of compression manifestation of inoperable bone neoplasm is another indication of TAE. Frequent tumors selected to this modality include vascular tumors (particularly metastases), aneurysmal bone cysts (ABC), giant cell tumor (GCT), and osteosarcoma. Aim of Study: Our aim is to assess the role of embolization in management of bone tumors. Patients and Methods: The current study prospectively evaluated 33 patients (23 males and 10 females). Their age ranged from 9 to 69 years (mean age of 43.246±19.65). Extremities, hip, vertebrae, and skull were involved by variety of bony tumors. Sixteen patients were affected by primary osseous tumors, while 17 patients had metastases. A transar-terial embolization was done in all patients as a preoperative procedure in 15 patients, definite treatmentof primary benign inaccessible tumors in 6 patients, prebiopsy embolization in 6 patients, and as a palliative treatment in 6 patients. Results: Technical success was obtained in 30 out of 33 cases with percentage of 90.9%. All benign and primary malignant bony tumors showed technical success while, 82.4% of metastatic lesions did. Clinical success was achieved in 73.3% cases of first group, 83.3% of second group, 100% of third group and 66.7% of fourth group. Four patients (12.1%) showed no clinical improvement with 9% lost follow-up. Five out of 6 benign tumors showed clinical success (83.3%) as the sixth case lost follow-up (16.7%). Embolization of 9 of primary malignant lesions was clinically successful (90%), whereas 12 out of 17 metastatic lesions were improved clinically (70.6 %), 3 cases showed no clinical success (17.6%), and 2 cases were lost at follow-up (11.8%).Conclusion: A high consideration should be given totran-sarterialembolization in the algorithmic treatment strategy of bone tumors as it is much safer and effective tool when diminution of bleeding and compression manifestations is to be specifically aimed.

Tuberculous esophagomediastinal fistula with concomitant mediastinal bronchial artery aneurysm-acute upper gastrointestinal bleeding: A case report

BACKGROUNDEsophagomediastinal fistula is a very rare complication of tuberculosis in otherwise healthy adults, and mediastinal bronchial artery aneurysm is even rarer. In this case report, we describe a rare case of tuberculosis complication that presented with acute upper gastrointestinal (GI) bleeding. It also highlights the benefits of chest computed tomography (CT) as an excellent adjunct diagnostic tool to endoscopy and bronchoscopy and the role of trans-arterial embolization as a minimal invasive therapy alternative to surgery.CASE SUMMARYA 19-year-old medically free male patient presented with acute multiple episodes of hematemesis for 1 d. Upper GI endoscopy, bronchoscopy, and chest CT with IV contrast confirmed esophagomediastinal fistula with mediastinal bronchial artery aneurysm. After resuscitating patient with IV fluid and blood product transfusion, trans catheter embolization was performed for mediastinal bronchial artery aneurysm.CONCLUSIONWe successfully treated a patient with acute upper GI bleeding due to tuberculous esophagomediastinal fistula and mediastinal bronchial artery aneurysm using transcatheter coil embolization.

Role of Transarterial Embolization in the Management of Urologic Diseases

Role of Transarterial Embolization in the Management of Urologic Diseases

WITHDRAWN: Transarterial embolization for hepatocellular adenomas: a literature review

// Bao-Hong Yuan 1 , Ru-Hong Li 1 , Bhavesh-K. Ahir 2 , Wei-Ping Yuan 3 , Jian-Hong Gu 4,5 , Tian Yang 6 and Liang Ma 3 1 Department of General Surgery, Yan’An Hospital Affiliated to Kunming Medical University, Kunming, China 2 Department of Medicine, Section of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, USA 3 Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China 4 College of Veterinary Medicine, Yangzhou University, Yangzhou, China 5 Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China 6 Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China * These authors have contributed equally to this work Correspondence to: Tian Yang, email: // Liang Ma, email: // Keywords : avoidance of resection, hepatocellular adenomas, systematic review, transarterial embolization, tumor reduction Received : January 04, 2017 Accepted : February 08, 2017 Published : March 11, 2017 Abstract Since the utilization of transarterial embolization (TAE) for hepatocellular carcinoma, TAE is used to treat bleeding hepatocellular adenomas (HCAs) and occasionally, in symptomatic HCAs with large tumors. However, the role of TAE in an elective setting is uncertain. The present review aims to evaluate the benefits and harms of TAE in bleeding and non-bleeding HCAs, especially in an elective setting. A systematic review of studies published from January 2000 to December 2016 in the EMBASE, PubMed and Scopus databases was performed. Avoidance of resection and tumor reduction after TAE were the primary outcomes measure in both bleeding and non-bleeding HCAs. Twenty-one case series involving 1481 patients with HCAs were included in the analysis. Most of them were underwent hepatic resection. Only 148 (10%) patients (involving 189 lesions) received TAE, including 93 (62.8%) patients with bleeding HCAs and 55 (37.2%) patients with non-bleeding HCAs. Based on data of 107 tumors, the rates of Complete Response and Partial Response were 10.3% and 73.8%, respectively. Hepatic resection was avoided in 72 of 148 (48.6%) TAE treated patients. Intended elective TAE was performed in 45/148 (30.4%) patients; 95.6% of them did not require further hepatic resection. No mortality or adverse side effects were reported during the hospitalization period. Therefore, Either in an elective setting or in the setting of bleeding, TAE can be considered safe in the management of HCAs. In the elective setting, TAE can be regarded as a reasonable alternative management to hepatic resection. High-quality prospective study with long-term follow-up is warranted.

Spontaneous Rupture of Hepatocellular Carcinoma

A contrast enhanced computer tomography (CECT) abdomen of the patient showed hepatomegaly with nodular irregular liver margins. A 15.5 × 10.5 cm large exophytic heterogeneously attenuating mass seen arising from segment VI/VII with extension into the subphrenic space. Multiple right hepatic artery branches were supplying it. There was a breech in the lateral margin of the superior part of this mass lesion suggestive of rupture (Figures 1B and 2B). Figure 1B Axial contrast enhanced CT section showing a large heterogeneously enhancing mass lesion in right subphrenic space with capsular breech (thick arrow) along its lateral aspect with associated free fluid in the subphrenic space. Figure 2B Sagittal reconstruction contrast enhanced CT image showing large tumor mass (thick arrows) extending into right subphrenic space. Tortuous feeding vessels (thin arrow) are also demonstrated. The rupture of richly supplied hepatocellular carcinoma resulted hemorrhagic ascites in this case. Hence, bland embolization of the feeding vessels was planned to reduce the tumor bulk. Patient was taken up for transarterial embolization of the feeding vessels. A catheter was introduced into the celiac trunk via right transfemoral approach and selective celiac angiogram was performed which revealed multiple feeder vessels arising from the right hepatic artery (Figure 3). Following this, a microcatheter was co-axially introduced into right hepatic artery and selective runs were taken which confirmed arterial supply to the tumor through branches of the right hepatic artery (Figure 4). These feeding vessels were embolized using gelfoam. Post-embolization celiac angiogram showed complete nonopacification of the feeding vessels (Figure 5). Patient remained stable after the procedure. Patient was also started on tablet sorafenib three days post-embolization. His ascites gradually decreased. Figure 3 Selective celiac axis run showing tortuous, feeding vessels (thick arrow) arising from branches of right hepatic artery (thin arrow). Figure 4 Selective microcatheter (thin arrow) run showing multiple feeding vessels to the tumor (thick arrows). Figure 5 Celiac axis post-embolization check run showing complete nonopacification of branches of right hepatic artery supplying the tumor. Hepatocellular carcinoma is the commonest primary malignant tumor of the liver. Also, spontaneous rupture of a tumor is not very uncommon as initial presentation. In the Far East, the rupture rate is as high as 10%.1 Without any treatment, the outcome is poor. Traditional surgical treatment consists of packing, hepatic artery ligation and hepatectomy. However, surgery is often associated with a high mortality rate, which has been reported to be as high as 70%.1,2 The major drawbacks of emergency hepatectomy are liver failure and tumor involvement of the resection margins due to inadequate preoperative work-up. Even less invasive procedures like packing, argon beam coagulation or hepatic artery ligation, are not different in terms of the operative morbidity and mortality. Hence transarterial embolization (TAE) is gaining popularity as a less invasive measure in this field. Role of TAE in the management of ruptured HCC, especially for the initial period, has been well established. The mean survival rate of those who received TAE has been reported to be from one to twenty weeks.1,2 In one study, the mean survival rate of those having TAE performed was 126 days.3 TAE application should be selective when taking cost factor and complications into account. The level of size of tumor, bilirubin level and patency of portal vein may affect the outcome.4 The adverse effects of portal vein thrombosis and selective arterial embolization on patient's survival have been demonstrated in some studies.5 Embolization of the hepatic artery may cause further damage to the liver cell and lead to subsequent liver failure. However, the findings are not consistent in all these studies. In one of the studies, the survival following embolization of the hepatic artery proper or selective embolization of branches of the hepatic artery are comparable.3 The difference may result from the choice of embolic material. In our patient who also had portal vein thrombosis, we used gelfoam which is dissolvable and, therefore, the artery may recannulate after a period of time.

The role of transarterial embolization and chemoembolization (TACE) for palliative treatment of recurrent and metastatic abdominal mesenchymal tumors (RMAMT): The Brazilian Tertiary A.C. Camargo Cancer Center (ACCCC) experience.

e21520 Background: TACE local palliative therapy has been increasingly employed in clinical practice for managing patients (pts) harboring chemotherapy (CT) refractory RMAMT. Relief of symptoms, e....

The Role of Transarterial Embolization in the Management of Hematuria Secondary to Congenital Renal Arteriovenous Malformations

Objective: To evaluate the efficacy and safety of transarterial embolization (TAE) in the management of hematuria secondary to congenital renal arteriovenous malformations (AVM). Patients and Methods: Between May 2007 and February 2012, 6 patients with congenital AVM treated with TAE were analyzed retrospectively, followed by a brief review of TAE in the treatment of congenital AVM. Clinical records with respect to general conditions, location, embolic materials, complications and overall outcome were collected from the original hospital charts and outpatient medical records. Results: Three patients with AVM were confirmed by contrast-enhanced CT scans, and the other 3 patients were detected by renal angiography. TAE was performed with steel coils in 2 patients and n-butyl-2-cyanoacrylate (NBCA) in 4 patients. After a mean follow-up of 22 months, no serious adverse effects were observed in all patients. There were no complaints of hematuria at the end of the follow-up period. Conclusion: For unexplained massive hematuria, congenital renal AVM needs to be considered as a differential diagnosis. Selective renal angiography and embolization should be recommended as the first choice to treat massive hematuria secondary to congenital renal AVM.

Gastrointestinal bleeding caused by angiodysplasia; one stop angiographic diagnosis and endovascular treatment by super selective embolization with polyvinyl alcohol particles

Background and aimsAngiodysplasia is the most common vascular abnormality of the gastrointestinal tract GIT. Angiography, like colonoscopy, serves as both a diagnostic and a therapeutic modality for gastrointestinal bleeding. Since the development of microcatheters and new embolic materials, the role of embolization has grown as primary therapy for gastrointestinal bleeding with fewer complications reported. Microcatheters allow more selective catheterization, often enabling embolization of the offending artery at the bowel wall.The current study aims to assess the role of trans arterial embolization in treatment of GIT bleeding secondary to angiodysplasia of the gastrointestinal tract using super selective embolization with polyvinyl alcohol particles. MethodsThis study was carried out at the Radiology Department, Assiut University Hospitals, in the period from July 2007 to November 2009. The study included 12 consecutive patients (1 patient with upper and 11 patients with lower GI bleeding); referred from Surgical Department Assiut University and Tropical Medicine Department, Minia University, in whom active hemorrhage caused by angiodysplasia of gastrointestinal tract as shown on arteriograms underwent superselective transcatheter arterial embolization by polyvinyl alcohol particles 250–350μm in diameter. ResultsThe study included 12 consecutive patients (3 females and 9 males); (1 patient with upper and 11 patients with lower GI bleeding); in whom active hemorrhage due to angiodysplasia of gastrointestinal tract as shown on arteriograms underwent superselective transcatheter arterial embolization by polyvinyl alcohol particles 250–350μm particles to stop the hemorrhage. Bleeding was found in the distribution of the right gastroepiploic artery in one patient, in the distribution of the superior mesenteric artery, jejunal branch in three patients, in the distribution of the inferior mesenteric artery in eight patients, sigmoidal branch (n=2), ileocolic/anterior cecal branch (n=3), and superior rectal branch (n=3). One patient had a lesion in the greater curvature of the stomach. Three patients have lesions in the small intestine; all at the jejunum, eight patients had large-bowel lesions in the following distribution: cecum and proximal part of ascending colon (n=3), sigmoid colon (n=2), and rectum (n=3). The cause for bleeding was angiodysplasia in all cases. Three patients had recurrent lower GI bleeding 1–24days (mean 9days) after initial embolization. Two of these patients had surgery, while one had a successful second embolization. ConclusionSuperselective embolization using 250–350μm polyvinyl alcohol particles is effectively used as the transcatheter therapy for treatment of both upper and lower gastrointestinal tract bleeding.

The role of transarterial embolization in the treatment of renal cell carcinoma

OBJECTIVE To review the role of transarterial renal embolization in our unit, assessing the indications, tolerability and efficacy of this technique for treating renal cell carcinoma (RCC). PATIENTS AND METHODS Thirty patients undergoing transarterial embolization between 1991 and 1999 were identified and 25 case notes analysed retrospectively. RESULTS Most patients (14 of 25) presented with less advanced (stage I–III) RCC who were unable or unwilling to undergo radical surgery; the remainder (11) presented with advanced (stage IV) disease. The embolizing agent was ethanol, usually combined with stainless steel coils (85% of cases). Procedural pain and fever was controlled successfully. The median hospital stay associated with the procedure was 4 days. At the time of analysis six of 11 stage IV and 11 of 14 stage I–III patients were alive (median follow-up 27 and 39 months, respectively). Symptoms from the primary tumour were well controlled. Overall, 17 of 25 (68%) of patients reported no problems while three (12%) required brief hospital admission for treatment of persistent haematuria. Fourteen patients were subsequently re-staged; the primary tumour in two had increased, in seven remained unchanged and in five it decreased. No patients without metastases developed them and metastases in two patients regressed. CONCLUSION Transarterial embolization is associated with minimal morbidity and complications, and subsequent symptom control is good. The effect of palliative embolization on RCC progression is unknown and requires prospective investigation. Presently, there is no role for cytoreductive embolization; it should be included as a treatment option in clinical trials evaluating such options in patients with metastatic RCC.

The role of transarterial embolization in the treatment of renal cell carcinoma.

To review the role of transarterial renal embolization in our unit, assessing the indications, tolerability and efficacy of this technique for treating renal cell carcinoma (RCC). Thirty patients undergoing transarterial embolization between 1991 and 1999 were identified and 25 case notes analysed retrospectively. Most patients (14 of 25) presented with less advanced (stage I-III) RCC who were unable or unwilling to undergo radical surgery; the remainder (11) presented with advanced (stage IV) disease. The embolizing agent was ethanol, usually combined with stainless steel coils (85% of cases). Procedural pain and fever was controlled successfully. The median hospital stay associated with the procedure was 4 days. At the time of analysis six of 11 stage IV and 11 of 14 stage I-III patients were alive (median follow-up 27 and 39 months, respectively). Symptoms from the primary tumour were well controlled. Overall, 17 of 25 (68%) of patients reported no problems while three (12%) required brief hospital admission for treatment of persistent haematuria. Fourteen patients were subsequently re-staged; the primary tumour in two had increased, in seven remained unchanged and in five it decreased. No patients without metastases developed them and metastases in two patients regressed. Transarterial embolization is associated with minimal morbidity and complications, and subsequent symptom control is good. The effect of palliative embolization on RCC progression is unknown and requires prospective investigation. Presently, there is no role for cytoreductive embolization; it should be included as a treatment option in clinical trials evaluating such options in patients with metastatic RCC.