Selective Embolization Research Articles

FRI668 Insulinoma As A Cause Of New Onset Hypoglycemic Episodes

Abstract Disclosure: S. Zahra: None. M.A. Abbas: None. R. Subramani: None. F. Manas: None. S. Yavuz: None. 37 years old female with a past medical history of hypothyroidism presented with complaints of shakiness, lightheadedness, and palpitations, relieved by eating. The physical examination was unremarkable. Fasting blood work showed low glucose of 41 mg/dl (70-99 mg/dl), normal insulin levels of 8.4 UIU/ ml (normal:1.9-23 UIU/ml), elevated proinsulin 21.1 pmol/ L (normal:<8.0 pmol/L), normal C Peptide 2.5 ng/ ml (normal:1.1-4.4 ng/ml), and negative for insulin antibody. Serum ACTH and cortisol levels were normal. Blood testing for hypoglycemia-inducing medications was negative. CT and MRI abdomen pelvis contrast was normal. She was prescribed to wear Dexcom to monitor her blood glucose round the clock. She continued to have low blood glucose, sometimes without symptoms and was rescued by the alarm. She underwent endoscopic ultrasound and was found to have a 10mm x 9mm ill-defined rounded pancreatic head mass with diffuse echogenicity of the pancreas. Biopsy of the mass revealed clusters of epithelial cells with neuroendocrine differentiation, compatible with insulinoma. She underwent surgical resection of the mass. She was also referred to genetic testing due to the association of pancreatic tumors with MEN syndrome. The diagnosis of Insulinomas is clinical as well as biochemical with presenting symptoms of Whipple’s Triad along with the presence of the following lab findings: hypoglycemia with plasma glucose of less than 50mg /dl, insulin greater than 5 UIU/L, C-Peptide greater than 0.2 nmol/L (0.6 ng/mL), Insulin/C-Peptide ratio of greater than 1.0, Proinsulin greater than 20pmol/L, and the absence of sulfonylurea metabolites in plasma or urine. Insulinoma is the most common pancreatic neuroendocrine and functional endocrine tumor of the beta cells of the pancreas with a prevalence of 1-4 people per million with equal gender distribution. They are mainly seen in the fifth decade of life but can occur at any age. They can occur sporadically or can be associated with MEN 1. Insulinomas are mostly benign, about 5-10% can be malignant. When to do medical vs surgical management? For benign insulinomas, surgical resection is preferred. For locally invasive and malignant tumors, aggressive surgical resection is performed, unless surgery is contraindicated for any other reason or patient refuses it. Medical treatment is reserved for the patients with diffuse Beta cell disease, multiple insulinoma and unresected malignant insulinoma. In the presence of unresectable metastatic disease; radiofrequency ablation, selective embolization, intraarterial chemotherapy, alone or in combination has been shown to be effective in controlling hypoglycemic episodes and improving quality of life. Octreotide, via inhibiting insulin secretion, normalizes the blood glucose levels. For better detection of hypoglycemia and adequate response to medical therapy, continuous glucose monitoring is helpful. Presentation: Friday, June 16, 2023

Selective Transarterial Embolization for Intractable Hematuria Due to Bladder Carcinomas: A Single-Center Experience.

Malignant bladder neoplasms can cause life-threatening persistent hematuria. Selective transarterial embolization is an effective way to achieve hemostasis in such patients. The purpose of our study is to share our experience in these patients and to evaluate the short- and long-term effectiveness of this procedure. Twelve male patients with intractable hematuria due to bladder carcinoma were included in the study. A total of 17 selective transarterial embolization procedures (bilateral in 5 patients) were performed in 12 patients with microspherical particles and microcoils. Complete control of bleeding was achieved in 9 patients after the procedures whereas the need for transfusion continued in 3 patients. Approximately 75% bleeding control was achieved during our average 6-month (4- to 12-month) follow-up period. After the procedure, the patients had mild complaints that lasted for a few days, such as pain (66%), fever (42%), and nausea (50%). No major complications occurred. Selective transarterial internal iliac artery embolization is a reliable method that can be used for the palliative treatment of intractable hematuria due to bladder carcinomas.

Emergency Endovascular Management of Gluteal Artery Pseudoaneurysm

Abstract Introduction: Gluteal artery pseudoaneurysms are rare, yet the most common in cases involving the superior gluteal artery. Pseudoaneurysms of the inferior gluteal artery are uncommon and are often related to blunt or penetrating trauma, infections and fractures of the pelvis. Presentation of Case: The authors describe a case of pseudoaneurysm which was presented to the emergency department. A thorough workup revealed a history of pelvic fracture that could constitute a probable cause of the pseudoaneurysm, which was treated with selective embolization of the artery during angiography. Discussion: The most common manifestation pseudoaneurysm of inferior gluteal artery is the presence of a painful mass in the buttock. However, both diagnosis and therapy are facilitated by catheter angiography. Conclusion: Although pseudoaneurysms are rare, pseudoaneurysms of the inferior gluteal artery require a high index of suspicion and careful physical examination by the physician in order to avoid misdiagnosis. In addition, the treatment performed using the endovascular technique is less invasive than the conventional technique, giving the patient better recovery.

EMBOLIZATION FOR THE TREATMENT OF DELAYED HEMATURIA RENAL ARTERY PSEUDOANEURYSM FOLLOWING BLUNT TRAUMA

Background: The occurrence of a renal artery pseudoaneurysm after blunt renal trauma is an infrequent complication. The occurrence of delayed bleeding is typically observed within a period of 2 to 3 weeks following an injury and is commonly attributed to the presence of an arteriovenous malformation (AVM) or pseudoaneurysm. They are frequently observed in cases of injuries of greater severity or trauma that penetrates the body. The application of angiographic catheterization is efficacious in the detection of pseudoaneurysms in the renal artery. The management of renal pseudoaneurysms necessitates the consideration of distinct clinical associations, including the location and size of the lesion as well as the presence of symptoms.
 Objective: The objective of this study is to provide a detailed account of the use of an angiographic catheter and embolization in the treatment of a patient afflicted with a post-traumatic renal artery pseudoaneurysm.
 Materials and Methods: Conducting a literature review and medical records.
 Results: A case of renal artery pseudoaneurysm is presented. A male individual aged 33 sought medical attention at the emergency department following a motorcycle collision and exhibited symptoms of pain in the right flank region. The individual underwent a medical intervention involving the placement of a double J stent. After a period of nearly fourteen days, the individual reported experiencing hematuria. The abdominal CT scan revealed a renal injury on the right side with an AAST grade of 4, while the renal CTA demonstrated the presence of a pseudoaneurysm. A pseudoaneurysm was observed at the renal poles on the right side through the use of an angiographic catheter. The procedure of selective embolization utilising coils was executed on the renal arteries located at the lower and middle poles of the right kidney.
 Conclusion: The occurrence of renal artery pseudoaneurysms is infrequent; however, it is a grave complication that may arise from renal trauma. The accurate diagnosis and effective management of pseudoaneurysms are of paramount importance due to their potential to cause severe and potentially fatal complications if left untreated. The diagnostic process for pseudoaneurysms heavily relies on the involvement of the general radiologist. Interventional radiology provides alternative minimally invasive procedures that are linked to reduced morbidity and mortality rates and have replaced surgical interventions in the management of certain conditions.
 Keywords: pseudoaneurysm, angiographic catheter, embolization

Commentary: Quantitative Blood Flow Reduction in Selective Embolization of Intranidal Fistula of Cerebral Arteriovenous Malformations: Case Series.

Commentary: Quantitative Blood Flow Reduction in Selective Embolization of Intranidal Fistula of Cerebral Arteriovenous Malformations: Case Series.

Quantitative Blood Flow Reduction in Selective Embolization of Intranidal Fistula of Cerebral Arteriovenous Malformations: Case Series.

Arteriovenous malformations (AVMs) are often associated with high-flow intranidal fistulas (INFs). Although INF embolization has been suggested to provide higher reduction of total AVM flow compared with regular pedicle embolization, this effect has not previously been quantified. The aim of this study was to characterize the effect of AVM INF embolization on total AVM flow. This study is an Institutional Review Board-approved, retrospective case series of patients from 2010 to 2022 with AVMs, both with and without INFs, who underwent quantitative magnetic resonance angiography and endovascular embolization. Twenty patients accounted for 35 separate embolization sessions: 13 patients with INFs underwent a total 21 embolizations and 12 patients without INFs had 14 embolizations. No significant differences were found between groups on age, sex, laterality, drainage pattern, and Spetzler-Martin grade. However, AVMs with INFs were larger than the control group (12.7 vs 8.37 cm 3 , P = .049). Baseline pre-embolization AVM flow significantly differed between AVM with INF vs control groups (522 vs 320 cc/min, P = .005). Similarly, postembolization AVM flow also differed between AVM with INF and control groups (392 vs 224 cc/min, P = .008), with a larger decrease in flow per vessel per embolization session within the AVM INF group compared with controls (101.5 vs 33.2 cc/min, P < .001). Repeated measure analysis of variance showed significant differences pre-embolization and postembolization AVM flow between those with INFs vs controls ( P < .001). This study represents the first to examine the effect of INF embolization on total AVM flow. AVMs with INFs showed higher baseline flow, and targeted embolization toward INFs significantly lowered AVM flow in comparison with controls without INFs. The results of this study emphasize the importance of recognizing the presence of INFs within AVMs and their embolization to reduce AVM flow as part of a multistep management paradigm.

Results of transjugular intrahepatic portosystemic shunt combined with selective gastric vein embolization

Aim. To improve the outcomes of surgical treatment of patients with cirrhosis complicated by clinically significant portal hypertension by performing TIPS with selective embolization of gastric veins.Materials and methods. The authors explored the immediate and long-term outcomes of treatment of 62 patients with liver cirrhosis: group I included 27 patients who underwent TIPS with selective embolization of one left gastric vein; group II included 35 patients who underwent TIPS with selective embolization of ≥2 gastric veins. The authors tested a non-invasive method for predicting the risk of bleeding from gastric and oesophageal varices after TIPS with selective embolization of gastric veins and compared MRI and EGD results before and after the surgery (n = 14).Results. The maximum follow-up duration comprised 72 months. Bleeding from the oesophageal veins was not reported in the early period after TIPS with embolization of the left gastric vein, however, the long-term bleeding developed in 2 patients (7.4%). In 6–72 months following TIPS with embolization of the left gastric vein and posterior gastric vein, as well as short gastric veins (when indicated), no recurrences of variceal bleeding appeared. The method of predicting the risk of bleeding after TIPS proved to be effective in all 14 patients in the follow-up period of 6 months (invention application No. 2022129022).Conclusion. The obtained results confirmed the efficacy of TIPS combined with gastric vein embolization. The unique patent solution determined the technique, indications and peculiarities of the intervention.

Amplatzer Vascular Plug in Renal Artery Embolization: Case Serial and Review of the Literature

Abstract: Embolization constitutes a safe and effective therapeutic possibility in the treatment of numerous renal pathologies whether election or urgency. The use of Amplatzer vascular plug (AVP) constitutes a more recent and less widespread therapeutic choice, and its use in the renal district is not yet widespread although potentially very valid. Perioperative renal artery embolization has been introduced to reduce the risk of oncological spread and intraoperative bleeding, in order to facilitate surgery, thus decreasing perioperative morbidity. Nevertheless, in recent literature the real usefulness of perioperative renal artery embolization is still debated. Some authors agree that the advantages of perioperative renal artery embolization are to decrease intraoperative bleeding with a lower transfusion rate and to reduce operative time. Therefore, we presented five cases of renal arterial embolizations (RAEs) performed with AVP from July to August 2022 at Prof. Dr. R. D. Kandou Hospital, Manado. In all cases, a single plug was used which perfectly adapted to the target artery resulting in complete occlusion of the vessel within a short period of time. Renal artery embolization was generally performed the day before surgery under local anesthesia. After confirmation of the tumor vascularization with a contrast study, the selective renal artery embolization was performed. In our experience, the use of AVP for the treatment of renal arteriovenous fistula and neoplastic masses had given excellent results without any complications during and after the treatment. In conclusion, RAE performed with AVP has growing potential and numerous advantages in terms of the time of the procedure, speed of embolization, and precision of occlusion, but with a relative increase in costs. Keywords: amplatzer vascular plugs; vascular surgery; endovascular surgery; renal artery embolization

A case of duodenal perforation and pancreatic bleeding after flexible ureteroscopy for right renal pelvis UTUC

Upper tract urothelial carcinoma (UTUC) can be managed by flexible ureteroscopy (f-URS) and tumor laser ablation if kidney-sparing surgery is possible. This procedure can be affected by minor to serious complications, including life-threatening sepsis, ureteral strictures, and ureteral and renal pelvis injuries. The case of a 53-year-old man with history of high grade right renal pelvis and bladder tumor who undergone multiple endoscopic treatments and has already refused radical surgery is reported. F-URS and laser ablation with Thulium: YAG laser for UTUC recurrence of the right renal pelvis was performed, but the procedure was stopped due to significant bleeding which impaired vision. Postoperatively, the patient developed hematemesis and hemodynamic instability due to duodenal lesion and active bleeding documented at CT scan. An emergency exploratory laparotomy was performed to drain hemoperitoneum, repair duodenal lesion and concurrent radical right nephroureterectomy was carried out. A second surgery was necessary for repairing duodenal fistula. After 1 week the patient presented again with recurrent hematemesis and hemorrhagic shock. He underwent angiography and selective embolization of the duodenal branch of superior mesenteric artery and as well as branches of gastroduodenal artery successfully and the patient recovered with no other complications. This is the first case of duodenal perforation and pancreatic bleeding due to flexible ureteroscopy and laser ablation of right renal pelvis urothelial carcinoma.

Aneurysmal bone cyst: Is selective arterial embolization effective as curettage and bone grafting?

Aneurysmal bone cyst (ABC) is a lytic benign bone lesion representing about 1% of all primary bone tumors. Method to treat ABC's have developed over time. The standard of care cure for ABC has been curettage with or without bone grafting of the defect but is burdened by recurrence rates of approximately 25%-31%. Based on the assumption that ABCs usually supplied by one or more pathological feeding arteries, selective arterial embolization has been described as an adjuvant preoperative procedure to reduce intra-operative hemorrhage, and as primary treatment for lesions in difficult surgical access. In the current study, we therefore asked whether (1) a single or a repeat selective arterial embolization (SAE) for treating ABCs would produce comparable healing rates compared with curettage and bone grafting; (2) evaluated the relationship of recurrence in relation to the site of the cyst, the age, and gender of the patients; and (3) the two techniques differ in term of long-term complication. We retrospectively reviewed 265 patients who underwent curettage and bone grafting or SAE performed at our institute from 1994 to 2018. The diagnosis of ABC was always established with percutaneous CT-guided biopsy or open biopsy. Patients were followed clinically with plain radiographs or CT scan at 3, 6, 9, and 12 months then annually in the absence of symptoms. Treatment success was determined evaluating pre- and postprocedural imaging according to Chang classification. Two hundred and nineteen were treated with curettage and bone grafting (curettage group), and 46 with SAE Group. Of the 219 patients treated with Curettage and bone grafting (curettage group), 165 out of 219 (75.3%) experienced bone healing, while local recurrence was observed in 54 cases (24.7%) after 12 months on average (range: 3-120 months) from surgery. After the first SAE, bone ossification was seen in 27 (58.7%), without needing any further treatment. Eleven recurred patients were treated with SAE (four patients need two while seven need three SAE to heal), and eight patients with curettage and bone grafting. Thirty-eight out of 46 (82%) patients experienced bone ossification regardless the number of SAE. The overall rate of local recurrence for all patients was 26.7%. SAE group presented a lower complication rate (6%) where two patients experienced skin necrosis, and one limb-length discrepancies (2% of all cohort). The use of SAE is an attractive option to treat ABC as it combines on one hand a lower complication rate than curettage and bone grafting, on the other it can be carried out in case of nonresectable ABCs, significantly reducing the size of viable ABC lesions, fostering bone remodeling and mineralization, and most importantly, significantly improving the patient's quality of life.

Renal angiomyolipoma: Beyond size criteria for predicting rupture.

Renal angiomyolipomas (AMLs) are vascular tumours that while histologically benign, carry a risk of rupture and potentially life-threatening haemorrhage. Selective arterial embolisation (SAE) has been demonstrated as effective treatment; however, given most tumours are asymptomatic, the challenge facing the radiologist is selection of which AML should undergo treatment. This study considers presence and size of intratumoural aneurysm, to advance the readers treatment decision-making beyond historical size criteria. Retrospective cohort analysis of all SAE-treated AML at a quaternary-level institution in the last 10 years was completed independently by two radiologists. Computerised tomography (CT) and angiographic imaging were reviewed to evaluate tumour size, presence of intratumoural aneurysm and aneurysm size. Univariant and multivariant statistical analyses were used to identify predictors of spontaneous rupture and haemorrhage. Twenty-seven renal AML underwent SAE. Five tumours had presented with haemorrhage. Twenty-two were asymptomatic or without CT/angiographic detectable haemorrhage. There was no statistically significant size difference between ruptured (mean 7.8 cm, range 6.1-12.0 cm) and unruptured AML (7.5 cm, 3.3-21.7 cm) in the study population. Eighty percent of ruptured AML and 27% of unruptured AML contained at least one intratumoural aneurysm (P-value < 0.05). Mean aneurysm size in ruptured AMLs was 5.4 mm, versus 4.6 mm among unruptured AML (P-value > 0.05). The presence of intratumoural aneurysm is a useful predictor for AMLs that are at risk of spontaneous rupture and haemorrhage. Intratumoural aneurysm should therefore be considered when selecting patients to undergo SAE.

Placental Polyp with Suspected AVM Treated with Methotrexate Followed by Selective Embolization and Removal - A Case Report

Placental Polyp with Suspected AVM Treated with Methotrexate Followed by Selective Embolization and Removal - A Case Report

Comparisons of the Safety and Effectiveness of Robot-Assisted vs Laparoscopic Partial Nephrectomy for Central Renal Angiomyolipomas: A Propensity Score-Matched Analysis Study.

Objective: To compare the safety and effectiveness of robot-assisted partial nephrectomy (RAPN) vs laparoscopic partial nephrectomy (LPN) in the treatment of central renal angiomyolipomas (AMLs). Methods: We retrospectively analyzed the clinical data of 103 patients who were treated with either RAPN or LPN for central AMLs between January 2017 and June 2022. Propensity scores were matched according to sex, age, laterality, body mass index, symptoms, diameter of tumor, location of tumor distribution, R.E.N.A.L score, preoperative hemoglobin, preoperative serum creatinine, preoperative estimated glomerular filtration rate, chronic disease, previous abdominal surgery, preoperative selective arterial embolization, American Society of Anesthesiologists scale, and duration of follow-up, and after matching, perioperative and prognostic data of the two groups were compared. Results: A total of 57 patients underwent RAPN, and 46 patients underwent LPN. Before matching, there were more complex AMLs in the RAPN group, and R.E.N.A.L scores differed between the two groups (10 vs 9, p < 0.001). After matching, the median warm ischemic time in the RAPN group was significantly shorter than that in the LPN group (21.5 minutes vs 28 minutes, p = 0.034), as well as the median time of postoperative mobilization (1 day vs 2 days, p < 0.001). The other indicators were not significantly different between the groups. Conclusions: For central AMLs, both RAPN and LPN were safe and feasible surgical treatments, but RAPN might be associated with shorter warm ischemia time and earlier postoperative mobilization.

Nonvariceal Upper Gastrointestinal Hemorrhage: The Interventional Radiologist's Perspective

AbstractNonvariceal upper gastrointestinal (GI) bleeding is one of the most common diseases of the GI tract and represents a high percentage of emergency room admissions. Eighty percent to 90% of upper GI bleeds are nonvariceal, with a mortality of 1 to 10% of patients. Selective embolization of the arterial source can be achieved with many therapeutic alternatives available in the interventional radiologist's arsenal, such as particles, coils, liquid emboli, selectively infused vasoconstrictor agents, or a combination of these techniques. Up to 95% of patients can obtain initial hemostasis without angiographic intervention. However, rebleeding is common, occurring in up to 50% of patients and persistent hemorrhage has been described in 7 to 30% of patients with mortality rates up to 14%.

Virtual injection software for endovascular management of spinal dural arteriovenous fistula.

Endovascular management of spinal dural arteriovenous fistula (DAVF) is arduous because of complex angioarchitecture and motion artifacts and is limited by the two-dimensional (2D) view. However, cone beam computed tomography (CBCT) acquisitions with selective injections allow 3D multiplanar reconstructions contributing to high diagnostic, anatomical and safety value. In this study, we described the use of virtual injection software (VIS) computed from CBCT acquisition and already used for prostatic and cerebral embolization, for the endovascular management of spinal DAVFs (EmboAssist, GE HealthCare, Chicago, USA). The VIS has been designed to facilitate the analysis of the patient's vasculature during the planning of embolization procedures to define the afferent pedicles to the shunt and the incidence of oblique projection, allowing for a better anatomical understanding and helping for the selection of 2D incidence. Combined with 3D roadmapping, VIS allows vessel tracking for selective catheterism and embolization. The VIS is a useful tool for planification and navigation during endovascular treatment of spinal DAVF with a safety value.

Intraoperative Multivessel Embolization Reduces Blood Loss and Transfusion Requirements Compared to Internal Iliac Artery Balloon Placement during Cesarean Hysterectomy for Placenta Accreta Spectrum

PurposeTo evaluate the effectiveness and safety of prophylactic multivessel selective embolization (MVSE) compared to those of internal iliac artery occlusion balloon (IIABO) placement in patients undergoing cesarean hysterectomy for placenta accreta spectrum (PAS). Materials and MethodsAn institutional review board-approved retrospective series was conducted with consecutive patients with PAS at a single institution between 2010 and 2021. MVSE was performed in a hybrid operating room after cesarean section prior to hysterectomy. IIABO was performed with balloons placed into the bilateral internal iliac arteries, which were inflated during hysterectomy. Median blood loss, transfusion requirements, percentage of cases requiring transfusion, and adverse events were recorded. ResultsA total of 20 patients treated with embolization and 34 patients with balloon placement were included. Placenta percreta and previa were seen in 60% and 90% of patients, respectively. Median blood loss in the MVSE group was 713 mL (interquartile range [IQR], 475–1,000 mL) compared to 2,000 mL (IQR, 1,500–2,425 mL) in the IIABO group (P < .0001). The median total number of units of packed red blood cell transfusions (0 vs 2.5) and percentage of cases requiring a transfusion (20% vs 65%) were less in the MVSE group (P < .01). A median of 4 vessels (IQR, 3–9) were embolized during MVSE. No major adverse events or nontarget embolization consequences were observed. ConclusionsProphylactic MVSE is a safe procedure that reduces operative blood loss and transfusion requirements compared to those of IIABO in patients undergoing cesarean hysterectomy for presumed higher-degree PAS.

Treatment with selective transcatheter arterial embolization of a ruptured profunda artery perforator after internal thigh liposuction: a case report

BackgroundHemorrhage is an uncommon complication of liposuction that may be trauma-induced by the cannula on the subcutaneous perforators. It usually resolves spontaneously with external compression and results in mild to moderate ecchymosis on the liposuction site. However, in sporadic cases, active bleeding may persist and require urgent intervention for hemostasis.Case presentationWe report the case of a 60-year-old White female who developed a massive hematoma in the hour following liposuction of the right internal thigh, with active bleeding in the subcutaneous plane reported on contrast-enhanced computed tomography. The initial angiogram was conducted in the right common femoral artery and showed active bleeding from a profunda artery perforator. After careful selective catheterization of the feeding artery using a 2.0-French microcatheter, 0.3 mL of Onyx 34 was injected. Control angiography showed no immediate complication and confirmed the exclusion of the pseudoaneurysm. No postoperative event occurred. Blood pressure and hemoglobin levels remained stable throughout the episode.ConclusionsAlthough liposuction is a very common procedure in plastic surgery, hemorrhagic complications may occur and require urgent hemostasis. This case suggests a vital place for interventional radiology in the management of hemorrhagic complications after liposuction.

Selective transarterial embolization for arterial hemorrhage after upper third molar extraction: illustrative cases.

The present report describes 2 cases of arterial bleeding after removal of the upper third molar that were successfully treated with selective transarterial embolization. The first patient underwent removal of the left upper third molar. A few hours later, facial swelling and massive bleeding appeared near the extraction socket involving the posterolateral wall of the maxillary sinus. Angiography showed a pseudoaneurysm involving the posterior superior dental artery, and the lesion was selectively embolized with an N-butyl cyanoacrylate (NBCA)-lipidiol mixture. The second patient underwent removal of the left upper third molar, and massive bleeding occurred from the extraction socket involving the greater palatine foramen. Angiography revealed the pseudoaneurysm of the greater palatine artery, and the lesion was selectively embolized with an NBCA-lipiodol mixture. Both patients were discharged uneventfully, and no recurrent bleeding was observed during the 82- and 5-month follow-up periods. Massive arterial bleeding after a third molar extraction occurs from either the posterior superior dental artery or the greater palatine artery, which is associated with the location of the extraction socket. Selective transarterial glue embolization is a useful option for the treatment of arterial bleeding after the removal of the upper third molars.

Predictive factors of selective transarterial embolization failure in acute renal bleeding: a single-center experience.

Transarterial embolization of renal artery branches (RTE) is a minimally invasive procedure commonly performed in life-threatening renal bleeding of different etiologies. Despite the widespread use of RTE, no consensus guidelines are currently available. Our aim was to investigate clinical and technical efficacy and to identify potential predictors for clinical failure of this procedure. All the RTE procedures performed in our Interventional Radiology unit in last 10years were retrospectively collected and analyzed. All selected patients underwent both pre-procedural computed tomography angiography (CTA) and post-procedural CTA within 30days. Clinical success was considered as primary endpoint. Demographic, laboratory, and diagnostic findings predictive of clinical failure of RTE were identified. Over a total of 51 patients enrolled, 27 (53%) were females and 33 (64.7%) had a renal bleeding of iatrogenic origin. Technical and clinical success was 100% and 80.4%, respectively. Hematoma volumes > 258.5 cm3 measured at CTA, higher pre- and post-procedural serum creatinine (Scr) levels, an increase in Scr value > 0.135mg/dl after the procedure, a worse post-procedural estimated glomerular filtration rate (eGFR), a post-procedural reduction of eGFR < 3.350ml/min, and a post-procedural reduction of platelet count (PLT) > 46.50 × 103/mmc showed a significantly higher rate of clinical failure. RTE is a safe and effective procedure in the management of acute renal bleeding of various origins. Hematoma volume, Scr, PLT, and eGFR values were found to be predictive factors of poor clinical outcome and should be closely monitored.

Selective Arterial Embolization of Pseudoaneurysms and Arteriovenous Fistulas after Partial Nephrectomy: Safety, Efficacy, and Mid-Term Outcomes.

The primary objective was to evaluate the clinical success rate after endovascular embolization of iatrogenic vascular lesions caused during partial nephrectomy. The secondary objective was to evaluate the technical success and to assess potential effects on renal function. We retrospectively included consecutive patients from our center who underwent selective embolization to treat iatrogenic renal arterial lesions induced during partial nephrectomy between June 2010 and June 2020. The technical and clinical success rates and renal outcomes were collected. We identified 25 patients with 47 pseudoaneurysms and nine arteriovenous fistulas. Among them, eight were treated by coils only, eight by liquid embolization agents only, and nine by both. The technical success rate was 96% after the first attempt and 100% after the second attempt. The median follow-up was 27.1 ± 24.3 months. Clinical success, defined as no need for further hemostatic surgery during follow-up, was also obtained in 96% and 100% of patients with one and two attempts, respectively. Renal function estimated by the modification of diet in renal disease equation did not change significantly despite a mean 13.8% ± 15.1% decrease in kidney functional volume estimated by angiography. No complications were attributable to the endovascular treatment. No significant difference was found across embolization agents; however, the subgroup sizes were small. Endovascular embolization is safe and effective for treating iatrogenic arterial lesions after partial nephrectomy: success rates are high, complications are infrequent, and renal function is maintained. Recommendations by interventional radiology societies are needed to standardize this treatment.