Selective Endovascular Embolization Research Articles

Distal right hepatic artery pseudoaneurysm in a post-cholecystectomy patient presenting with severe gastrointestinal hemorrhage: a rare case report.

Background: Hepatic artery pseudoaneurysm (HAP) is an unusually rare vascular complication following laparoscopic procedures with a few yet gradually increasing incidences. Case Presentation: We report a case of a 63-year-old male with distal right HAP-mediated massive gastrointestinal bleeding after a successful laparoscopic cholecystectomy. He was treated successfully with selective endovascular coil embolization and percutaneous thrombin administration. Conclusion: The risk of rupture and bleeding from HAP can be a potentially life-threatening scenario and needs prompt diagnosis with emergent intervention. The documentation of this case may be useful for practicing surgeons to be cautious about the possibility of pseudoaneurysmal changes during the post-operative period.

Selective arterial embolization of renal angiomyolipomas: A 10-year experience.

ObjectivesTo study safety and efficacy of selective endovascular trans‐arterial embolization (TAE) of renal angiomyolipoma (AML) in a 10‐year period at a regional tertiary referral center in Denmark.Patients and methodsAll 56 patients who underwent TAE of renal AML at Departments of Urology and Radiology, Copenhagen University Hospital – Rigshospitalet, Denmark, from 2009 to 2020 were included. Seven without preoperative and postoperative imaging were excluded, leaving 49 patients for analysis. From national electronic medical records, we retrieved patient characteristics, surgical data, and follow‐up data. Tumor size at the time of embolization and during follow‐up was compared using Student's paired t test. Estimated glomerular filtration rate (eGFR) pre‐ and post‐embolization were compared using Wilcoxon rank sum test.ResultsWe included 49 patients of whom 4 had two tumors treated in the same TAE procedure. Median age was 50 years (interquartile range [IQR]: [29–67 years]), and the median follow‐up time was 4.6 years [IQR: 3.0–6.7 years]. Post‐embolization syndrome (PES) was experienced in 27 patients, and non‐PES in 5 patients. Median length of hospital stay was 0 days [IQR, 0–1]. Postoperative Everolimus immunosuppressive treatment was offered to seven patients. Median tumor size was 6.0 cm [IQR: 4.6–7.9 cm] and was significantly reduced to 3.7 cm [IQR: 2.5–5.2 cm] after treatment (p < 0.001). Kidney function was not affected by TAE. Three deaths, not related to AML, were noted during follow‐up.ConclusionEmbolization of AML was in this cohort effective to significantly reduce tumor size without serious adverse events and loss of renal function. TAE is a safe and efficacious treatment and the preferred minimally invasive treatment option of AML.

Geniculate Artery Embolization in Patients With Recurrent Hemarthrosis After Knee Arthroplasty: A Retrospective Study

BackgroundRecurrent hemarthrosis after knee arthroplasty is an uncommon and disabling complication of this frequently performed procedure. Selective endovascular embolization of the geniculate arteries is one of the therapeutic options to manage this complication. The purpose of this study is to analyze the effectiveness of this treatment in patients suffering from recurrent hemarthrosis after knee arthroplasty. MethodsWe performed a retrospective study of 31 patients (39 embolization procedures) with recurrent hemarthrosis after knee arthroplasty. There were 17 men and 14 women with a median age of 67 years (range 48-90). All patients were referred for geniculate artery embolization between January 2007 and November 2016. ResultsTwenty-seven procedures were executed on the right side and 12 on the left side. Total knee arthroplasty was performed on 29 patients, only 2 patients underwent unicompartmental knee arthroplasty. Embolization of the superior geniculate arteries was achieved in all patients. In 12 of 39 procedures (31%), at least 1 of the inferior geniculate arteries could not be catheterized, therefore embolization was achieved through collaterals. Symptomatic improvement was observed in 26 of 31 patients (84%). Discomfort or mild postprocedural pain was observed in most patients, needing only minor pain medication, mostly resolving within 24 hours. Two patients presented with a severe complication: a 48-year-old male patient developed septic arthritis and an 85-year-old hypertensive female patient treated with anticoagulants showed aseptic necrosis of the femoral condyles. ConclusionEmbolization of geniculate arteries is a safe and effective treatment in recurrent hemarthrosis post knee arthroplasty. Clinical improvement was seen in most patients.

Microguidewire Looping to Traverse Stented Parent Arteries of Intracranial Aneurysms.

ObjectiveStents are widely used in coil embolization of intracranial aneurysms, but on occasion, a microcatheter must traverse a stented segment of artery (so-called trans-cell technique) to select an aneurysm, or double stenting may necessary. In such situations, microguidewire passage and microcatheter delivery through a tortuous stented parent artery may pose a technical challenge. Described herein is a microguidewire looping technique to facilitate endovascular navigation in these circumstances.MethodsTo apply this technique, the microguidewire tip is looped before entering the stented parent artery and then advanced distally past the stented segment, with the loop intact. Rounding of the tip prevents interference from stent struts during passage. A microcatheter is subsequently passed into the stented artery for positioning near the neck of aneurysm, with microguidewire assistance. The aneurysm is then selected, steering the microcatheter tip (via inner microguidewire) into the dome.ResultsThis technique proved successful during coil embolization of nine saccular intracranial aneurysms (internal carotid artery [ICA], 6; middle cerebral artery, 2; basilar tip, 1), performing eight trans-cell deliveries and one additional stenting. Selective endovascular embolization was enabled in all patients, resulting in excellent clinical and radiologic outcomes, with no morbidity or mortality directly attributable to microguidewire looping.ConclusionMicroguidewire looping is a reasonable alternative if passage through a stented artery is not feasible by traditional means, especially at paraclinoid ICA sites.

Досвід лікування хворих із посттравматичними артеріовенозними сполуками склепіння черепа

Objective – to improve results of treatment of patients with scalp arteriovenous malformations. Materials and methods. Results of treatment of three patients (two male 27 and 36 years old and one famale of 32 years old) with posttraumatic scalp arteriovenous malformations were analysed. The main method for verifying the diagnosis was selective cerebral angiography, Endovascular embolization and surgical resection was used in two cases, and in one case endovascular embolization was used alone. Results. In all cases the appearance of clinical manifestations was preceded by a local injury of scalp. In all patients posttraumatic malformations were localized along the midline in the projection of the intersection of sagittal and coronary sutures. The period between the onset of clinical symptoms and surgery in two cases was 3 years, in one case – 30 years. In all patients the predominant source of malformations filling was unilateral superficial temporal artery, which formed anastomosis with a contralateral superficial temporal artery, middle meningeal artery and meningeal branches of the ophtalmic artery. In two cases, malformations was an abnormally enlarged angiomatous net of small arteries without visible direct arteriovenous drainage, in one case it was direct arteriovenous shunt. In all cases the endovascular embolization of the malformations was utilized, in two cases – the surgical removal of the malformations was performed. We didn't seen any complications during the intervention. The complete occlusion of malformations with a satisfied cosmetic effect was achieved. Conclusions. Posttraumatic scalp arteriovenous malformations have heterogeneous structure. The choice of optimal management depends on the type of the malformations. In cases of direct arteriovenous shunt the method of choice should be endovascular occlusion, and in cases of angiomatous net the embolization should be supplemented by the surgical resection of the malformations.

Complications of transjugular biopsies.

Transvenous biopsy was first performed in 1964 by Charles Dotter. Now routinely performed in the liver and kidney by interventional radiologists, the transjugular approach to biopsy has assumed a central role in coagulopathic patients. Major arterial complications from transjugular liver and renal biopsy are rare. In this article, the authors describe such complications in both organs that necessitated selective endovascular coil embolization.

2:34 PM Abstract No. 158 - Emergency endovascular superselective embolization of traumatic and iatrogenic renal artery pseudoaneurysms with fuaile medical adhesive (α-cyanoacrylate)

Purpose The aim of this study is to report the effectiveness of selective endovascular embolization with FuAiLe(FAL) medical adhesive (α-cyanoacrylate) in the treatment of traumatic and iatrogenic renal arterial pseudoaneurysms. Materials and Methods Retrospective study of patients with pseudoaneurysms treated with FAL over a 3-year period was conducted. 12 consecutive patients were evaluated, including 4 women and 8 men ranging in age from 16 to 62 years (mean, 45.2y). Causes included renal biopsy (n = 4), percutaneous renal lithotripsy (n = 3), renal trauma (n = 4), and guidewire stabbed renal artery branch in cardioangiography procedural (n = 1). FAL was the only embolic agent used in all patients. FAL was mixed with iodized oil in a 1:1 ratio to control its polymerization time and to make it radiopaque. Diagnostic angiography and superselective embolization were performed at the same session. Results All the pseudoaneurysms were successfully embolized and excluded from the circulation without any other major intrarenal arterial branch occlusion. There were no major or minor complications related to the embolization procedures. Haematuria ceased in 1-3 days after the embolization, and during the follow-up period both re-bleeding and deterioration of renal function did not occur. Conclusion The endovascular management of renal artery branch pseudoaneurysms by superselective embolization with FuAiLe medical adhesive (α-cyanoacrylate) is a reasonable and an effective therapeutic technique.

The therapic effect of the combination of endovascular embolization and hormone in Kasabach-Merritt phenomenon

Objective To explore the therapic effect of the combination of endovascular embolization and clinical hormone in treatment of Kasabach-Merritt phenomenon (KMP),and analyze the advantages. Methods Six cases with KMP from May 2010 to June 2012 were retrospectively analyzed.All the patients underwent large dose hormone shock therapy after admission for 7—10 d.Subsequently,selective endovascular embolization was performed using Seldinger technique under general anesthesia.Then,the hormone therapy was continued for 2 weeks after embolization.The platelet count and the effect were recorded.If the area of the tumor reduction is less than 50%,3—4 courses of local hardening treatment was conducted for the residual tumor.The local treatment used multipoint puncturing of the tumor and injection drugs under X-ray fluoroscopic monitoring until the tension of local vascular increased. Results On DSA,the lesions of all the 6 cases showed rich blood supply with a large number of hybrid distribution of tumor blood vessels.The lesions disappeared in 4 cases after 1—2 weeks combination therapy and no recurrence for 0.5—1.0 year follow-up.Two cases whose tumor reduced less than 50% after combination therapy received local hardening treatment,and faded after 3—4 courses.The number of platelet for all patients kept normal and the spirit of the patients showed great improvement,the bleeding tendency and local soft tissue swelling was in remission.Subcutaneous blood stasis and petechiae disappeared.There were no serious adverse reaction and complications. Conclusion Combination therapy with endovascular embolization and clinical hormone for Kasabach-Merritt phenomenon has a good curative effect. Key words: Hemangioendothelioma; Embolization,therapeutic; Hormones

Pseudoaneurysm and hemobilia in a neonate

Hemobilia, arterial-biliary fistula, and pseudoaneurysm are rare complications of percutaneous liver biopsy in a neonate. We present the management of persistent hemobilia in a previously premature 2877 g neonate. Despite the ongoing correction of coagulation parameters and multiple large volume transfusions our patient's hemobilia persisted. We eventually controlled the arterial-biliary fistula using a selective endovascular embolization technique not commonly used in patients of this size. The pseudoaneurysm was no longer visible on outpatient follow up ultrasound 21 days after embolization. Pseudoaneurysm should be considered in the neonate with persistent hemobilia after percutaneous liver biopsy. Angiography can be both diagnostic and therapeutic in the management of hepatic pseudoaneurysm and arterial-biliary fistula after percutaneous liver biopsy.

Selective endovascular embolization for refractory idiopathic epistaxis is a safe and effective therapeutic option: Technique, complications, and outcomes

Epistaxis generally responds to conservative management, but a more invasive approach, such as superselective embolization, is sometimes justified. We report our experience with endovascular procedures in 19 patients from 2002 to 2011 for the treatment of refractory idiopatic posterior epistaxis. The sphenopalatine artery and distal internal maxillary arteries were embolized in all patients. Unilateral embolization was performed in 12 patients (63%), bilateral embolization in seven (37%). Additional embolization of the descending palatine artery was performed in eight patients (42%) and embolization of the facial artery and palatine arteries in four (21%). In one patient the distal ophthalmic artery was embolized with n-butyl cyanoacrylate. No minor or major complications occurred in relation to the embolization procedures. The average hospital stay was 11.1±8.6days, including an average 5.2±3.4days after embolization. Average follow-up after discharge was 21.3±25.7months. Superselective endovascular embolization proved safe and effective in controlling idiopathic epistaxis, refractory to other maneuvers.

Fatal mediastinal biopsy: How interventional radiology saves the day

This was a case of a 35-year-old man with mediastinal mass requiring computed tomography (CT)-guided biopsy for tissue diagnosis. A posterior approach with an 18-gauge biopsy needle was used to obtain tissue sample. Post biopsy, patient condition deteriorated and multiphase CT study detected active bleeding in arterial phase at the biopsy site with massive hemothorax. Subsequent angiography showed arterial bleeder arising from the apical branch of the right pulmonary artery. Selective endovascular embolization with NBCA (n-Butyl cyanoacrylate) was successful. Patient survived the complication. The case highlighted a rare complication in a common radiology procedure and the value of the interventional radiology unit in avoiding a fatal outcome.

Cauda Equina Syndrome Caused by Spinal Dural Arteriovenous Fistula

Spinal dural arteriovenous fistula (SDAVF) is rare but still the most commonly encountered vascular malformation of the spinal cord. A 31-year-old male developed gait disturbance due to weakness of his lower extremities, voiding difficulty and sexual dysfunction with a progressive course since 3 months. He showed areflexia in both knees and ankles. Electromyographic findings were suggestive of multiple root lesions involving bilateral L2 to S4 roots of moderate degree. Magnetic resonance images showed high signal intensity with an ill-defined margin in T2-weighted images and intensely enhanced by a contrast agent through the lumbosacral spinal cord. Selective spinal angiography confirmed a dural arteriovenous fistula with a nidus at the L2 vertebral level. After selective endovascular embolization, his symptoms drastically improved except sexual dysfunction. We report a rare case of cauda equina syndrome due to spinal arteriovenous fistula with drastic improvement after endovascular embolization.

Onyx (Ethylen-Vinyl-Alkohol-Kopolymer) – Ein neuer Anwendungsbereich in der endovaskulären Behandlung akuter peripherer Blutungen

The purpose of our retrospective study was to determine the feasibility and efficacy of the endovascular embolization of peripheral acute arterial hemorrhage using Onyx. Between October 2003 and February 2007, 14 patients with acute arterial bleeding underwent percutaneous arterial embolization using Onyx. Bleeding was caused by iatrogenic vessel injury (6 patients), malignancy/inflammation (5 patients) and trauma (3 patients). Hematomas were located in the pelvis (5 patients), followed by liver (3 patients), retroperitoneal space (2 patients), thorax (2 patients), pancreas (1 patient), and thigh (1 patient). The number of embolized arteries, the volume and viscosity of embolic agent (Onyx), the number of additionally used coils, the embolization time, and the technical and clinical outcome were documented. Procedure-related complications, recurrent bleeding during hospital stay and outcome were recorded. In 14 patients selective endovascular embolization of 15 arteries was performed. The average volume of injected Onyx was 1.3 +/- 0.8 ml. In 6 cases (42.9%) Onyx was used in conjunction with coils. The average time between the correct placement of microcatheter and complete embolization was 24.9 +/- 12.6 minutes. In 13 of 14 patients (92.8%), embolization was technically successful. In one case, procedure-related complications occurred and embolization was performed in a second session a day later. After technically successful embolization, no recurrent bleeding occurred during hospitalization. Out of 14 patients, six (42.9%) died 1 - 38 days after technically successful embolization due to multiple organ failure (2 patients), hypoxic brain injury (2 patients), septic shock (1 patient) or malignancy-associated death (1 patient). We conclude that transcatheter embolization with the new liquid embolic agent Onyx is technically feasible and effective in patients with acute arterial hemorrhage.

Hémorragie massive au cours d’un traumatisme craniofacial traitée par ligature de la carotide externe

Life-threatening bleeding following craniofacial injury is rare. The rich collateral circulation between external and internal carotid arteries complicates the problem of controlling haemorrhage. We report the case of a 63-year-old man who presented a life-threatening haemorrhage following maxillofacial trauma and a severe head injury with subdural haematoma requiring neurosurgical evacuation. Although we had an interventional radiology unit, facial haemostasis was achieved by an unilateral ligation of the external carotid artery. There were three reasons behind our decision: multiple bleeding excluding selective endovascular embolization, efficiency and speed of the ligation of the external carotid, only one place for this cephalic surgery in two phases (neurosurgery and neck surgery). The role of ligation of the external carotid artery for life-threatening bleeding following facial injury is discussed.

Selective endovascular treatment of a traumatic basilar aneurysm after endoscopic third ventriculostomy

A 4-year-old girl suffered intraventricular and subarachnoid hemorrhage during endoscopic third ventriculostomy. Cerebral angiography revealed a traumatic basilar aneurysm secondary to basilar artery injury. The aneurysm was treated with selective endovascular embolization using Guglielmi detachable coils. We review some therapeutic features of traumatic basilar aneurysms after endoscopic third ventriculostomy and describe the feasibility of endovascular selective therapy to manage these lesions successfully.

Hemorrhagic Complications of Minimally Invasive Urological Surgeries, Treated with Selective Endovascular Embolization

Hemorrhagic Complications of Minimally Invasive Urological Surgeries, Treated with Selective Endovascular Embolization

Hemorrhagic Complications of Minimally Invasive Urological Surgeries, Treated with Selective Endovascular Embolization

Minimally invasive urological procedures have gained in popularity and replaced open surgery in various urological procedures. Although considered minimally invasive, these procedures are not free from complications, and life-threatening hemorrhage may occur. Herein we describe 3 case series of patients who underwent minimally invasive urological surgeries that were complicated with bleeding. In all 3 patients we used super selective angiographic embolization to stop hemorrhage. Minimally invasive urological surgeries carry the risk of hemorrhage, and patients should be informed about this possibility. In hemodynnmic stable patients endovascular embolization allowed bleeding cessation with maximal preservation of the bleeding kidney tissue.

Different modalities of treatment of intracranial mycotic aneurysms: report of 4 cases

Background Intracranial mycotic aneurysms, although rare neurovascular pathology, represented a neurosurgical challenge that required careful stepwise decision making. Different approaches for their management were used. We present our experience with 4 patients treated in terms of indications and efficacy of different treatment modalities. Methods Four patients with infective endocarditis and 5 intracranial mycotic aneurysms were treated during the last 5 years. All of the patients were men; their ages ranged between 29 and 62 years (mean, 47.3 years). Distal MCA was the commonest site (3 patients) of aneurysm, 1 was located at the distal PCA, whereas the remaining aneurysm was at the distal ACA. Angiographic studies were done in 2 patients because of neurologic signs and for screening in 2 patients with documented endocarditis. Results One patient was treated conservatively because of his moribund general condition; 1 patient was treated with direct surgical clipping; 1 patient was treated with surgical trapping and resection of the aneurysm without revascularization; and the remaining patient, harboring 2 distal mycotic aneurysms, was treated with selective embolization for his PCA aneurysm and endovascular trapping for the distal ACA aneurysm. Follow-up angiographic results showed stable occlusion of the aneurysms. No periprocedural technical complications were reported, and none of the patients, including the patient with medical treatment only, has ever experienced new neurologic events after definitive treatment. Conclusions Prolonged courses of antibiotics are recommended for all patients with mycotic aneurysms. Selective endovascular embolization or trapping with soft and ultrasoft electrolytically detachable coils seems to be an effective technique that should be considered for treatment of dynamic unruptured mycotic aneurysms, with conventional surgical repair restricted for ruptured aneurysms with associated hematoma and high intracranial pressure.

Traumatic pseudoaneurysm of the pharyngeal artery: an unusual cause of hematemesis and hematochezia after craniofacial trauma

Background Traumatic aneurysms of the internal maxillary artery are extremely rare. We report a case of traumatic pseudoaneurysm of the pharyngeal artery, a branch of the internal maxillary artery, presenting with hematemesis and hematochezia. Case Description An 18-year-old man presented with deep drowsy consciousness after a motor vehicle accident, in which he had a severe craniofacial injury. Three days later, he had hematemesis and hematochezia with a marked decrease in circulating hemoglobin level. External carotid arteriography performed to rule out vascular injury revealed active leakage from a false aneurysm of the pharyngeal artery. The lesion was successfully obliterated by superselective endovascular embolization. Conclusions In patients with craniofacial injury associated with multiple traumas, traumatic pseudoaneurysm of the pharyngeal artery should be suspected as one of the possible causes of hematemesis and hematochezia. Selective endovascular embolization with cerebral angiography is an effective modality for the treatment and diagnosis of this leison.

Embolization of an Extracranial Internal Carotid Artery Pseudoaneurysm

Deep neck space infections are rarely complicated by pseudoaneurysms of the extracranial internal carotid artery. This condition has a high mortality rate with conservative management and significant morbidity with open surgical techniques. Recent advances in endovascular therapy have allowed embolization of the diseased vessel to be performed with a more acceptable safety profile. We report a case of an extracranial internal carotid artery pseudoaneurysm complicating a deep neck space infection in an adolescent that was treated with selective endovascular embolization. We present the findings of computed tomography, magnetic resonance angiography, and conventional angiography.