Selective Transcatheter Arterial Embolization Research Articles

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.

Delayed Post-Traumatic Hemobilia in a Patient With Blunt Abdominal Trauma: A Case Report and Review of the Literature.

Hemobilia is a rare condition defined as bleeding in the biliary tract. The clinical presentation is variable. The typical manifestation consists of jaundice, upper gastrointestinal bleeding, and right upper quadrant abdominal pain. This set of symptoms is known as "Quincke's triad." It is present in only 22%-35% of cases. Post-traumatic hemobilia is an extraordinarily rare condition occurring in only 6% of the patients with hemobilia. In general, it occurs in less than 0.2% of patients with liver trauma. A delay in the development of bleeding after liver trauma is frequent. Early diagnosis is essential because massive bleeding into the biliary tract is a potentially life-threatening condition. We present a case of a patient with massive hemobilia developed 12 days after blunt abdominal trauma. Computed tomography angiography showed two pseudoaneurysms in hepatic segments V and VIII with contrast medium extravasation. We successfully performed digital subtraction angiography with selective transcatheter arterial embolization of the leaking segment VIII pseudoaneurysm. Embolization of the pseudoaneurysm in segment V was technically impracticable. Our article provides a review of the published literature focussing on the prevalence, diagnostics, and treatment of post-traumatic hemobilia.

A rare case of insulinoma presenting with deep vein thrombosis, successfully treated with minimally invasive procedures including microwave ablation.

SummaryTreatment of insulinoma can be challenging, while surgical resection is considered the first line. When surgery is contraindicated or is refused, minimally invasive procedures such as selective arterial embolization, local ablative techniques including alcohol ablation, radiofrequency ablation and microwave ablation are being used of late. The world’s first microwave ablation of insulinoma was performed in 2015, after which there have been only a handful of reported cases. A 78-year-old female presented with painful swelling of the left lower limb. She was drowsy and was previously misdiagnosed as epilepsy when she had similar episodes since 2 years ago. She had hypoglycaemia with high serum insulin and C-peptide, and mildly high adjusted calcium, serum prolactin. MRI did not show pituitary adenoma. Lower limb venous duplex scan showed left lower limb deep vein thrombosis for which she was treated with anticoagulation. CT of the abdomen showed a tumour measuring 1.8 cm, located in the antero-superior aspect of the body of the pancreas, with the superior surface being abutted by the splenic artery and the inferior surface being 3 mm above the pancreatic duct, suggestive of an insulinoma. Selective transcatheter arterial embolization of the pancreatic tumour was attempted but was abandoned due to multiple small feeding arteries. Microwave ablation of the tumour was performed successfully. Since there was a possibility of the ablation being compromised due to the heat sink at the splenic artery, 2 mL of 99% alcohol was injected into the rim of the tumour near the artery. She was subsequently normoglycaemic. She defaulted follow up for repeat imaging of pancreas and screening for MEN1 syndrome due to the impact of the COVID-19 pandemic. Minimally invasive procedures are preferred over surgery in selected patients with insulinoma, out of which microwave ablation could be preferentially recommended due to its efficacy and minimal complications. We report the first case of MWA performed in combination with AA in successfully treating insulinoma to our knowledge. This is also the first reported case of DVT associated with isolated insulinoma prior to intervention, though it is rarely reported in MEN1 syndrome.Learning pointsNovel therapeutic minimally invasive procedures are successful in treating selected cases of insulinoma.Microwave ablation could be recommended preferentially over selective trans-arterial embolization, and radiofrequency ablation in treating insulinoma due to its efficacy and minimal complications.We report the first case of microwave ablation performed in combination with alcohol ablation in successfully treating insulinoma to our knowledge.

Traumatic Hemothorax Caused by Thoracic Wall and Intrathoracic Injuries: Clinical Outcomes of Transcatheter Systemic Artery Embolization.

PurposeWe aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma.Materials and MethodsBetween 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications.ResultsBleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia.ConclusionTAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency surgery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.

Μassive secondary postpartum hemorrhage caused by pseudoaneurysm of uterine artery, treated with uterine artery embolization – An uncommon case report

Introduction: Uterine artery pseudoaneurysm is an uncommon cause of secondary postpartum hemorrhage that can be fatal. Material & Methods: We present a case of a 42-year-old woman who developed massive secondary postpartum hemorrhage 17 days after c-section and was diagnosed to have pseudoaneurysm from the left uterine artery on computed tomography scan. After blood transfusion she got hemodynamically stable and selective transcatheter arterial embolization was performed. Results: The pseudoaneurysm was successfully obliterated. Conclusions: Angiographic embolization is a safe and competent method for managing postpartum hemorrhage caused by pseudoaneurysm in hemodynamically stable patients. However, uterine artery ligation may be the preferred method for hemodynamically unstable patients when fertility preservation is strongly desired. In a woman with unexplained vaginal bleeding after c-section , pseudoaneurysm should be considered in the differential diagnosis of secondary postpartum hemorrhage. Angiographic embolization should be examined as a treatment method before turning to surgery, in suitable selected cases.

3:54 PM Abstract No. 370 Selective transcatheter arterial embolization for acute gastrointestinal bleeding: single-center comparison of 30-day outcomes of N-butyl-2-cyanoacrylate glue versus coil embolization

3:54 PM Abstract No. 370 Selective transcatheter arterial embolization for acute gastrointestinal bleeding: single-center comparison of 30-day outcomes of N-butyl-2-cyanoacrylate glue versus coil embolization

A Case of Intra–abdominal Hemorrhage Resulting from a Rectal Foreign Body in Which Hemostasis Was Achieved Through Selective Transcatheter Arterial Embolization

A Case of Intra–abdominal Hemorrhage Resulting from a Rectal Foreign Body in Which Hemostasis Was Achieved Through Selective Transcatheter Arterial Embolization

Provocative angiography for lower gastrointestinal bleeding.

This study evaluated the results of provocative angiography performed to identify the site of hemorrhage in lower gastrointestinal bleeding to enable transcatheter arterial embolization. The subjects of this study were 11 patients with acute lower gastrointestinal bleeding who underwent provocative angiography, after contrast agent extravasation could not be identified during conventional angiography. One patient underwent provocative angiography twice, making 12 cases of provocative angiography that were analyzed in this study. Urokinase was used in all cases. Heparin was administered in 2 cases, nicardipine in 3 cases, and alprostadil and isosorbide in 1 case each. Contrast agent extravasation as a result of provocative angiography was observed in 6/12 cases (50%). Selective transcatheter arterial embolization was performed in all 6 cases in which extravasation was apparent, and it was technically successful in all six. Clinical success was achieved in 5 (83.3%) of the 6 cases in which technical success was achieved after provocative angiography. Provocative angiography enabled the site of lower gastrointestinal bleeding to be identified in 6 of 12 cases (50.0%) when it could not be identified by conventional angiography, and in all 6 cases hemostasis was effectively achieved by embolization.

Effectiveness of Selective Transcatheter Arterial Embolization in Delayed Postpartum Hemorrhage

Background: Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality worldwide. Delayed PPH has received less attention compared to early PPH because the incidence rate of delayed PPH is relatively lower than that of early PPH. Objectives: The aim of this study was to evaluate the clinical manifestations, angiographic findings, and effectiveness of selective transcatheter arterial embolization (TAE) for delayed PPH. Patients and Methods: Selective TAE was performed on 37 women (mean age: 32.1 years, range: 24 - 40) with delayed PPH between March 2006 and October 2016. Delayed PPH was defined as continuous hemorrhage from the female genital tract 24 hours to 6 weeks after delivery. Medical records were retrospectively reviewed for patient characteristics, the time interval between delivery and TAE, angiographic findings, embolized artery, embolic materials, technical and clinical success rate, and complications. Results: Delayed bleeding developed at a median 11.6 days (range: 2 - 34 days) after cesarean section (n = 19) and vaginal delivery (n = 18). On angiography, diffuse hypervascularity was detected in 24 patients, pseudoaneurysm in 11, active extravasation in 1, and arteriovenous malformation in 1. Arteries subjected to TAE included bilateral uterine arteries (UAs) (n = 29), bilateral UAs and unilateral ovarian artery (OA) (n = 4), bilateral UAs and bilateral OAs (n = 1), bilateral UAs and cervicovaginal branch (n = 1), unilateral OA (n = 1), and internal pudendal artery (n = 1). Embolic materials were Gelfoam (n = 30), Gelfoam and coil (n = 3), polyvinyl alcohol (PVA) (n = 2), and PVA and coil (n = 2). There were no procedure-related major complications. Technical success was obtained in all patients (100%), and clinical success was obtained in 34 patients (91.9%) Conclusion: Selective TAE in patients with delayed PPH is a useful treatment with high technical and clinical success.

Cases report: severe colonic bleeding in ulcerative colitis is refractory to selective transcatheter arterial embolization

BackgroundSevere haemorrhage is an uncommon but life-threatening complication of ulcerative colitis (UC). Superselective transcatheter embolization has shown to be an effective and safe therapeutic modality in patients with lower gastrointestinal bleeding of various aetiologies; nevertheless, its role in UC-related acute bleeding is unknown.Cases presentationEfficacy and safety of selective transcatheter arterial embolization in three consecutive UC patients diagnosed with massive haemorrhage admitted in a tertiary institution are reported. In all patients computed tomography scan showed active arterial haemorrhage from ascendant or sigmoid colon; subsequent arteriography demonstrated active arterial bleeding from colic branches of the superior or inferior mesenteric arteries, and selective transcatheter embolization was performed with immediate technical success in all three cases. Nevertheless, rebleeding requiring subtotal colectomy occurred between 5 h and 6 days after the procedure.ConclusionsTranscatheter arterial embolization is not an effective therapeutic approach in UC patients with severe, acute colonic haemorrhage. Colectomy should not be delayed in this setting.

Abstract No. 667 Transcatheter arterial embolization for traumatic thoracic bleeding: 4-year experiences in a single trauma center

We aimed to assess the safety and efficacy of transcatheter arterial embolization (TAE) for thoracic arterial hemorrhage following chest trauma. From November 2013 to May 2017, 35 patients were referred to our interventional unit for thoracic arterial bleeding following chest trauma, based on clinical decisions and computed tomography (CT) images. A total of 35 patients (male:female ratio, 26:9; mean age, 52.9 years) who underwent selective TAE of thoracic hemorrhage-culprit arteries were included in this study. Technical and clinical success, complications, and 30-day mortality rate were analyzed. In 35 patients who underwent TAE, the main bleeding arteries were intercostal artery (n=23), internal mammary artery (n=11) superior and/or lateral thoracic artery (n=3), and bronchial artery (n=3). N-butyl-2-cyanoacrylate (NBCA) (n=21), gelatin sponge particles (n=7), microcoils (n=2), and combinations of NBCA, microcoils, or gelatin sponge particles (n=10) were used as embolic agents. Initial technical success was achieved in all 27 patients, with immediate cessation of bleeding. Eight patients showed rebleeding 1-2 days later and underwent repeated TAE with successful result. Clinical success rate was 85.7% (30/35), and five patients underwent thoracotomy for controlling residual bleed. There were no TAE-related major complications such as infarction or quadriplegia. The 30-day mortality rate was 5.7% (2/35). Our clinical experience suggests that TAE used to control thoracic arterial bleeding following chest trauma is safe and effective as a minimally invasive treatment alternative to surgery.

Analysis of the time course of changes in imaging findings of small arteries embolized with the N-Butyl cyanoacrylate-lipiodol mixture.

Background:There are no reports analyzing imaging findings of arteries embolized with N-butyl cyanoacrylate (NBCA)-Lipiodol. To evaluate the time course of changes in the imaging findings of small arteries embolized with NBCA-Lipiodol.Materials and Methods:Selective transcatheter arterial embolization procedures via the inferior phrenic artery (right IPA, n = 25; left IPA, n = 5) were performed in 30 patients (25 males, 5 females; mean age 63 years, range: 45–78) at our institution. The NBCA-Lipiodol mixture was used as an embolic agent. The ratio of NBCA to Lipiodol was 1:4 (Group-A, n = 16) or 1:8 (Group-B, n = 14).We retrospectively reviewed the computed tomography (CT) findings and outcomes of small arteries embolized with the NBCA-Lipiodol mixture. The residual lipiodol was compared between Group-A and Group-B. The Student's t-test and Chi-square test were used for statistical analyses. In addition, the residual lipiodol rate was calculated using the Kaplan–Meier method and compared using the log-rank test.Results:The mean observation period was 264 ± 84 days (range: 104–425). Lipiodol completely disappeared in 20 arteries (66%) during follow-up. Recanalization of arterial flow was not seen in CT images, even when Lipiodol disappeared. Group-B showed a shorter period of progression to disappearance of Lipiodol than Group-A (P < 0.05). On follow up, the rate of residual Lipiodol in Group-A was higher than that in Group-B (P < 0.05).Conclusion:Residual Lipiodol was expected to gradually disappear. Lipiodol disappeared early when the density of NBCA was low in the NBCA-Lipiodol mixture. Further evaluations of various arteries and ratios of NBCA to Lipiodol are needed.

Endovascular management of arterial injuries after blunt or iatrogenic renal trauma.

The kidney is the third most common abdominal organ to be injured in trauma, following the spleen and liver, respectively. The most commonly used classification scheme is the American Association for the Surgery of Trauma (AAST) classification of blunt renal injuries, which grades renal injury according to the size of laceration and its proximity to the renal hilum. Arteriovenous fistula and pseudoaneurysm are the most common iatrogenic biopsy-related or surgery-related vascular injuries in native kidneys. The approach to renal artery injuries has changed over time from more aggressive intervention to more conservative observational or endovascular management, including selective transcatheter arterial embolization (TAE) and the placement of stents/stent grafts. In this article, we describe the role and technical aspects of endovascular interventions in the management of arterial injuries after blunt or iatrogenic renal trauma.

Transcatheter arterial embolization in normal canine liver.

To determine the effects of selective transcatheter arterial embolization (TAE) in the normal canine liver. Experimental study. Adult Beagle dogs (n = 5). Gelatin sponge particles (GSPs) were injected through a microcatheter for selective embolization of the left hepatic artery in normal dogs. Computed tomography (CT) and histology were performed during an 8-week observation period; biochemical analysis data were obtained during a 12-week observation period after TAE. Embolization was successful in all dogs and did not induce any change in the clinical appearance of dogs. Postoperative CT was consistent with recanalization of the artery within 2 weeks of embolization in all dogs. Hepatic enzyme levels increased temporarily after embolization but gradually returned to normal ranges. Histological examinations did not differ between treated and untreated liver tissues. TAE appears safe in normal dogs observed for 12 weeks. Arterial recanalization seems to occur within 2 weeks after injection of GSPs in the left hepatic artery. Selective TAE of the hepatic artery was well tolerated in normal dogs. Selective TAE may be applicable to canine hepatocellular carcinoma.

Transcatheter arterial embolization for traumatic mesenteric bleeding: a 15-year, single-center experience.

We aimed to assess the safety and effectiveness of transcatheter arterial embolization (TAE) for mesenteric bleeding following trauma. From 2001 to 2015, 12 patients were referred to our interventional unit for mesenteric bleeding following trauma, based on clinical decisions and computed tomography (CT) images. After excluding one patient with no bleeding focus and one patient who underwent emergency surgery, a total of 10 patients (male:female ratio, 9:1; mean age, 52.1 years) who underwent super selective TAE of visceral arteries were included in this study. Technical and clinical success, complications, and 30-day mortality rate were analyzed. In 10 patients who underwent TAE, the types of trauma were motor vehicle collision (n=6), fall (n=2), assault (n=1), and penetrating injury (n=1), and the bleeding arteries were in the pancreaticoduodenal arterial arcade (n=4), jejunal artery (n=3), colic artery (n=2), and sigmoid artery (n=1). N-butyl-2-cyanoacrylate (NBCA) (n=2), microcoils (n=2), and combinations of NBCA, microcoils, or gelatin sponge particles (n=6) were used as embolic agents. Technical success was achieved in all 10 patients, with immediate cessation of bleeding. Clinical success rate was 90% (9/10), and all patients were discharged with no further treatment required for mesenteric bleeding. However, one patient showed rebleeding 10 days later and underwent repeated TAE with successful result. There were no TAE-related ischemic complications such as bowel infarction. The 30-day mortality rate was 0%. Our clinical experience suggests that TAE used to control mesenteric bleeding following trauma is safe and effective as a minimally invasive alternative to surgery.

Minimal invasive treatment of life-threatening bleeding caused by cardiopulmonary resuscitation-associated liver injury: a case report

BackgroundLife-threatening bleeding caused by liver injury due to chest compressions is a rare complication in otherwise successful cardiopulmonary resuscitation. Surgical intervention has been suggested to achieve bleeding control; however, reported mortality is high. In this report, we present a brief literature review and a case report in which use of a less invasive strategy was followed by an uneventful recovery.Case presentationA 37-year-old white woman was admitted after out-of-hospital cardiac arrest. Bystander cardiopulmonary resuscitation was immediately performed, followed by advanced cardiopulmonary resuscitation that included tracheal intubation, mechanical chest compressions, and external defibrillation with return of spontaneous circulation. Upon hospital admission, the patient’s blood pressure was 94/45 mmHg and her heart rate was 110 beats per minute. Her electrocardiogram showed no signs of ST-segment elevations or Q-wave development. Coronary angiography revealed a proximal thrombotic occlusion of the left anterior descending coronary artery. Successful recanalization, after thrombus aspiration and balloon dilation followed by stent implant, was verified with normalized anterograde flow. Immediately after the patient’s arrival in the intensive cardiac care unit, a drop in her blood pressure to 60/30 mmHg and a hemoglobin concentration of 4.5 g/dl were noticed. Transfusion was started, and bedside abdominal ultrasound examination revealed free intraperitoneal fluid. Computed tomography of the abdomen revealed liver injury with active extravasation from the cranial surface of the right lobe and a massive hemoperitoneum. The patient was coagulopathic and acidotic with a body temperature of 33.5 °C. A minimally invasive treatment strategy, including angiography and selective trans-catheter arterial embolization, were performed in combination with percutaneous evacuation of 4.5 L of intraperitoneal blood. After completion of these procedures, the patient was hemodynamically stable. She was weaned off mechanical ventilation 2 days later and made an uneventful recovery. She was discharged to a local hospital on day 13 without neurological disability.ConclusionsAlthough rare, bleeding caused by liver injury due to chest compressions can be life-threatening after successful cardiopulmonary resuscitation. Reported mortality is high after surgical intervention, and patients may benefit from less invasive treatment strategies such as those presented in this case report.

Successful Management of a Rare Complication After Percutaneous Native Renal Biopsy

Percutaneous renal biopsy is presumed to be a relatively safe procedure that is routinely performed to help in the diagnosis, prognosis and treatment of various renal parenchymal diseases. It is widely performed by interventional nephrologists and radiologists for certain indications. Here, we report a young man who developed a significant retroperitoneal hematoma and active bleeding due to left 12th intercostal artery injury after a native renal biopsy, with a concomitant renal segmental artery pseudoaneurysm. The bleeding was successfully treated by selective transcatheter arterial embolization with coils. J Med Cases. 2015;6(9):399-402 doi: http://dx.doi.org/10.14740/jmc1963w

Hepatic Artery Mycotic Aneurysm and Microabscesses: A Rare Complication of Infective Endocarditis with Classical Quincke’s Symptom

Hepatic artery branch mycotic aneurysm causing intrahepatic biliary dilatation and associated with hepatic micro abscesses is a rare complication of infective endocarditis and patient presenting with classical Quincke’s symptoms has not been reported in literature so far. We report a case of 38 years old woman who presented with epigastric pain and obstructive jaundice. She has recently been diagnosed to have infective endocarditis. Hepatic artery pseudoaneurysm causing moderate intrahepatic biliary dilatation and micro abscesses was reported on contrast enhanced computed tomography (CT) scan and immediately conveyed to primary physician which led to successful selective transcatheter arterial embolization of the aneurysm, leading to early stabilization and recovery of the patient. Case Study Haroon et al.; IJMPCR, 3(3): 80-83, 2015; Article no.IJMPCR.2015.040 81

Massive hemobilia in a cirrhosis patient after percutaneous liver biopsy

Hemobilia is commonly seen in clinic after liver injury or other diseases, but it is uncommonly secondary to percutaneous liver biopsy, especially leading to significant hemorrhage. We reported a case that a patient with post hepatitis C cirrhosis has received percutaneous liver biopsy at our hospital. After that, the patient suffered from discontinuous abdominal pain and jaundice which were caused by the obstruction of blood clots due to hemobilia, but there was no performance of upper gastrointestinal bleeding. Not until the symptoms of hemorrhagic shock emerged did the diagnosis of hemobilia was confirmed. Urgently surgical exploration eliminated blood clots in biliary tract relieving biliary obstruction. And then the hemorrhage was restrained by selective transcatheter arterial embolization. Pseudoaneurysm and arterioportal fistula were also found by hepatic arteriography. We learn from this case that rational choice of treatments is of importance, whether surgery, arterial embolization, conservative therapy or the combination of them, which mainly rests on the situation.

Successful Management of a Rare Complication After Percutaneous Native Renal Biopsy

Percutaneous renal biopsy is presumed to be a relatively safe procedure that is routinely performed to help in the diagnosis, prognosis and treatment of various renal parenchymal diseases. It is widely performed by interventional nephrologists and radiologists for certain indications. Here, we report a young man who developed a significant retroperitoneal hematoma and active bleeding due to left 12th intercostal artery injury after a native renal biopsy, with a concomitant renal segmental artery pseudoaneurysm. The bleeding was successfully treated by selective transcatheter arterial embolization with coils. J Med Cases. 2015;6(9):399-402 doi: http://dx.doi.org/10.14740/jmc1963w