Selective Transcatheter Embolization Research Articles

Uterine artery embolization in obstetrics

Introduction. We did not find any publications or mentions in the Ukrainian medical segment of the Internet and special medical literature about previously performed similar operations (simultaneous caesarean section and embolization of the uterine arteries directly at the moment of birth), which allows us to consider the two operations performed «Prophylactic selective transcatheter embolization of uterine arteries» in pa­­tients with placenta previa percreta the first in Ukraine. Background. The prevalence of placenta previa and placenta percretaincreases from year to year as a result of an increase in the number of cesarean sections. Because of this, the percentage of women at high risk of massive life-threatening bleeding is also increasing. Predictions around the world show that the incidence of cesarean section will increase, which will lead to an increase in the number of placenta previa and placenta increta and thereafter maternal mortality, since the main cause of maternal mortality is bleeding (about 35 % of cases). The aim study was to asses of the effect of preventi­­ve selective embolization of uterine arteries with placenta previa percreta on the volume of blood loss during delivery, and the possibility of preserving the uterus and the reproductive function of women. Material and methods. In 2018—2019, we per­­formed two prophylactic selective transcatheter em­­bolizations of the uterine arteries in patients with placenta previa percreta. The delivery of these patients took place in the form of simultaneous endovascular embolization of the uterine arteries during cesarean section. The delivery algorithm was as follows: the first stage was the contralateral catheterization of the uterine arteries by transfemoral access. Next, corporal cae­sarean section was performed. After extraction of the fetus and clamping of the umbilical cord, uterine arteries were selectively embolized until the blood flow through them was completely stopped. Then, sepa­­ration/dissection of the placenta, metroplasty and suturing of the wound were performed. At the end of the operation, catheters from the uterine arteries were removed. Results and discussion. The entire embolization procedure (in total: from puncture of the femoral arteries to control angiography after embolization) took 27 minutes in the first case and 38 minutes in the second. The longer embolization time in the second case is partially associated with unilateral access and alternate catheterization of the uterine arteries. This was done to minimize post-procedural complications of the site of puncture of the femoral artery. Unfortunately, the technical conditions for these embolizations did not allow transradial access, which is possible from a practical point of view. The postpartum period was without complications. As the experience of these two operations showed, it was not possible to achieve the fullness of the «dry uterus» by embolization of the uterine arteries, but the volume of blood loss taking into account reinfusion in the form of washed red blood cells turned out to be lower than the median values of most cases and published studies described in foreign literature. Conclusions. Preventive selective transcatheter em­­bo­­lization of the uterine arteries before birth/removal of the placenta can be considered as a good preventi­­on of primary postpartum hemorrhage and thus to provide organ rescue. In pregnant women of high-risk groups, it is better to carry out catheterization of the uterine arteries in a planned manner before delivery, simultaneously with cesarean section, which is technically simpler.

Selective Trans-Catheter Coil Embolization of Cystic Duct Stump in Post-Cholecystectomy Bile Leak.

Percutaneous drainage is a first-line treatment for bilomas developed post-cholecystectomy in the setting of bile leak from the cystic duct stump. Percutaneous drainage is usually followed by surgical or endoscopic treatment to address the leak. This study aimed to evaluate outcome of selective coil embolization of the cystic duct stump via the percutaneously placed drainage catheters in patients with post-cholecystectomy bile leak. Seven patients with persistent bile leak after laparoscopic cholecystectomy who underwent percutaneous catheter placement for biloma/abscess formation in the region of the gallbladder fossa were followed. These patients underwent selective trans-catheter cystic duct stump coil embolization from Feb 2013 to Feb 2019. Procedural management, complications, and success rates were analyzed. All patients underwent placement of a percutaneous catheter for drainage of biloma formation in the gallbladder fossa post-cholecystectomy. Selective coil embolization of the cystic duct was performed through the existing percutaneous tract on average 3.5weeks after percutaneous catheter placement, resulting in resolution of the biloma. All bile leaks were immediately closed. None of the patients showed recurrent bile leak or further clinical symptoms. Coil migration to the common bile duct was diagnosed in a single case, after 2.5years, with no bile leak reported. Selective trans-catheter coil embolization of the cystic stump is a feasible and safe procedure, which successfully seals leaking cystic duct stumps and can circumvent the need for repeat surgical or endoscopic intervention in selected patient populations.

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.

NOT ALL MASSES ARE AS THEY SEEM: A CASE OF SPONTANEOUS BRONCHIAL ARTERY RUPTURE

SESSION TITLE: Disorders of the Mediastinum 1 SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/08/2018 03:15 pm - 04:15 pm INTRODUCTION: Spontaneous bronchial artery rupture is an uncommon cause of hemomediastinum. Observed in less than 1% of all selective bronchial arteriography cases, this condition is often associated with an underlying secondary process. Here we review a case of sporadic bronchial artery rupture presenting as a mediastinal mass. CASE PRESENTATION: A 64-year-old man with a history of smoking and poorly controlled hypertension presented to our institution after awakening with sharp chest pain, diaphoresis, and pre-syncope. He was hemodynamically stable aside from mild tachycardia. A contrast-enhanced chest CT revealed a 7 cm posterior mediastinal mass extending to the level of the sub-carina (figure 1) with compression upon the left atrium, and an associated left pleural effusion. Concern for a neoplastic process led to bronchoscopy. The mucosa of his central airways were pale with violaceous, linear striations along the posterior membrane. Fine needle aspiration (FNA) of the mass with endobronchial ultrasound (EBUS) was non-diagnostic. Following the procedure, we re-evaluated his imaging with thoracic radiology who identified a bronchial artery pseudoaneurysm (PSA) with extravasation into the lesion. Angiography confirmed the presence of an aberrant bronchial artery, and selective transcatheter embolization with coils and Gelfoam pledgets (figure 2) achieved stasis without further visualization of the defect. Repeat imaging 12 weeks later demonstrated new segmental pulmonary emboli, but otherwise no discernable change in size of the mediastinal collection. Subsequent bronchoscopy with EBUS guided sampling again yielded non-diagnostic results. DISCUSSION: Atraumatic, spontaneous hemomediastinum due to rupture of a bronchial artery PSA is an uncommon and portentous clinical event. We found less than 100 cases of this disorder upon review of the available literature. Symptoms can vary greatly, and range from atypical chest pain to frank hemoptysis and cardiovascular collapse. A low threshold of suspicion is necessary, and CT angiography is the diagnostic study of choice. Early selective embolization is the preferred management, with operative intervention reserved for select cases. CONCLUSIONS: We present a rare case of spontaneous bronchial artery rupture with resultant hemomediastinum. Despite initial diagnostic uncertainty, contrast enhanced imaging and multidisciplinary evaluation facilitated proper recognition and management. Our case highlights not only an uncommon diagnosis, but also the multifaceted evaluation often required to identify and treat potentially overlooked entities such as this. Reference #1: Sheffield, E. A., et al. “Massive haemoptysis caused by spontaneous rupture of a bronchial artery.” Thorax 43.1 (1988): 71. Reference #2: Kalangos, Afksendiyos, et al. “Ruptured mediastinal bronchial artery aneurysm: a dilemma of diagnosis and therapeutic approach.” The Journal of thoracic and cardiovascular surgery 114.5 (1997): 853-856. Reference #3: Seo, Yeon-Ho, and Jin Young Kwak. “Spontaneous hemomediastinum and hemothorax caused by a ruptured bronchial artery aneurysm.” The Korean journal of thoracic and cardiovascular surgery 44.4 (2011): 314. DISCLOSURES: No relevant relationships by Elliot Backer, source=Web Response No relevant relationships by Allison Backer, source=Web Response no disclosure on file for Farhad Mazdisnian; No relevant relationships by Joseph Phillips, source=Web Response

Case Report: Successful treatment of refractory high-flow priapism in a patient with sickle cell disease by selective trans-catheter embolization using an autologous blood clot: A case report

Priapism is an abnormal prolonged and persistent penile erection lasting more than 4 h, unrelated to sexual desire, stimulation or activity. The three types of priapism are low-flow, high-flow and stuttering. Patients with sickle cell disease (SCD) have increased risk of low-flow and stuttering priapism, but high-flow priapism is relatively uncommon in SCD. We report a case of non-traumatic refractory high-flow priapism evolving from a stuttering low-flow priapism in a patient with SCD. The patient was successfully treated by super-selective transcatheter embolization of the penile arteries with an autologous blood clot. It is proposed that the super-selective transcatheter embolization of unilateral or bilateral penile arteries with autologous blood clot is a relatively safe and effective non-surgical treatment option for high-flow priapism, even in patients with SCD, and has a low probability of developing erectile dysfunction.

Renal Pseudoaneurysms and Arteriovenous Fistulas as a Complication of Nephron-Sparing Partial Nephrectomy: Technical and Functional Outcomes of Patients Treated With Selective Microcoil Embolization During a Ten-Year Period.

The aim of this study was to evaluate the clinical and functional outcomes in patients who underwent selective interventional embolization of renal pseudoaneurysms or arteriovenous fistulas at our center. Our retrospective analysis included all consecutive patients who received selective transcatheter embolization of renal pseudoaneurysms or arteriovenous fistulas after partial nephrectomy in our department from January, 2003 to September, 2013. The technical and clinical success rate and functional outcome of every procedure was collected and analyzed. Furthermore, the change in renal parenchymal volume before and after embolization was determined in a subgroup. A total of 1425 patients underwent partial nephrectomy at our hospital. Of these, 39 (2.7 %) were identified with a pseudoaneurysm or an arteriovenous fistula after partial nephrectomy. The diagnosis of the vascular lesions was made by means of biphasic CT or CEUS. Technical success by means of selective microcoil embolization was achieved in all 39 patients (100 %). Clinical success, defined as no need for further operation or nephrectomy during follow-up, was achieved in 35 of 39 patients (85.7 %). Renal function, as measured by eGFR before and after the intervention, did not change significantly. However, a mean loss of parenchymal volume of 25.2 % was observed in a subgroup. No major or minor complications were attributable to the embolization procedure. Transcatheter embolization is a promising method for treating vascular complications which may occur after partial nephrectomy. We confirm the high success rate of this technique while discussing renal functional outcomes and potential safety aspects. Arterial pseudoaneurysms and arteriovenous fistulas are rare but severe complications after partial nephrectomy. Selective microcoil embolization is a safe and effective kidney-preserving procedure for treating these complications. Embolization leads to a significant loss of renal parenchymal volume but not to a loss of renal function.

Selective Arterial Embolization of Arteriovenous Malformation Causing Gross Hematuria in Horseshoe Kidney

Introduction: Renal arteriovenous malformations (AVMs) are aberrant connections between the renal artery and vein. They present most commonly with gross hematuria. Treatment options are catheter embolization, balloon catheter occlusion, vascular ligation, partial nephrectomy or nephrectomy. Selective embolization is currently the first line treatment for arteriovenous fistulas. Setting: KFMC, Riyadh, Saudi Arabia Case: A 28 year female presented with gross intractable hematuria. C.T revealed horseshoe kidney. Selective left renal angiography revealed a cork-screw like small renal vessels at inter polar region. Selective embolization of AV malformation was done. Hematuria was resolved. DMSA after one year revealed 33% function in that kidney. Conclusion: Super selective transcatheter embolization should be the initial treatment modality for congenital AVM even in anomalous kidneys with the aim to control bleeding and occlude those malformations supplied by the terminal portion of inters lobar arteries. Renal scintigraphy is a useful follow up tool for evaluating renal function in these patients after embolization.

1:38 PM Abstract No. 151 - Angiographic appearance and treatment of arterial injuries secondary to partial nephrectomy. A single center retrospective review

Purpose The authors wish to report their experience with the angiographic appearance and management (selective transcatheter embolization) of arterial lesions following partial nephrectomy. Materials and Methods Between February 2007 and January of 2011, 947 patients underwent a partial nephrectomy at our institution. Of these, 22 patients ages 28-83 (19 men, 3 women), were referred for selective angiography to treat hemorrhage or a suspected arterial lesion. Retrospective chart review was performed for the 22 patients. Angiographic technique and therapy for each patient was at the discretion of the individual operator. Follow-up consisted of clinical evaluation for the cessation of hematuria and cross-sectional imaging as part of the patient’s routine oncologic management. Results 20/22 patients presented with symptomatic postprocedure bleeding occurring within 10 +/- 4 days of partial nephrectomy. Two incidentally-noted and asymptomatic pseudoaneurysms were found in 2 patients on routine follow-up CT exams 120 +/- 2 days postprocedure. The most common bleeding complication for all patients was a solitary pseudoaneurysm formation, documented in 12 of the 22 patients (69%). The second most common complication was AV fistula in addition to pseudoaneurysm formation, documented in 6 of the 22 patients (27%). Solitary AV fistula was documented in only 2 of the 22 patients (9%). 19/22 patients were treated with coil embolization only. 4 of 22 patients were treated with a combination of coil and either alcohol, Gelfoam, PVA-particles or Ivalon-assisted embolization. All patients experienced short-term technical success except for one patient who presented with recurrent bleeding secondary to extravasation from an untreated vessel, which was observed to be partially thrombosed on initial angiographic evaluation. Conclusion Arterial injury secondary to partial nephrectomy presents with variable and recognizable angiographic appearances and often affects more than one segmental or interlobar artery. Angiographic coil embolization with or without particle assistance is an effective treatment strategy allowing for selective branch occlusion.

Cystic artery bleeding due to blunt gallbladder injury: computed tomography findings and treatment with transcatheter arterial embolization

Blunt gallbladder injury is rare, and bleeding from the cystic artery due to blunt trauma is even rarer. We report herein a case of extraluminal bleeding of the gallbladder in a patient following blunt abdominal trauma. Contrast-enhanced computed tomography revealed pericholecystic fluid and extravasation of contrast material in the subcapsular liver space adjacent to the gallbladder. Abdominal digital subtraction angiography revealed pseudoaneurysm originating from a branch of the cystic artery. Successful treatment was achieved using selective transcatheter embolization, and cholecystectomy was not required.

Rupture of a Deep Circumflex Iliac Artery After Abdominal Liposuction: Treatment with Selective Arterial Transcatheter Embolization

We report an uncommon case of a life-threatening abdominal wall hematoma after liposuction. One day after liposuction surgery, the patient experienced syncope and low blood pressure. Enhanced computed tomography (CT) demonstrated an extravasation in an abdominal wall hematoma. Transcatheter embolization was done successfully, without complication. Life-threatening complications caused by abdominal wall hematomas after liposuction are very rare. There have been few reports in the literature of life-threatening hemorrhagic complications after liposuction that were treated by transcatheter embolization.

Pseudoaneurysm of the Uterine Artery After Cesarean Delivery

Uterine artery pseudoaneurysm is a rare but serious complication of pelvic surgery. Cesarean delivery is the most common cause. We report a case of postpartum pelvic hemorrhage after cesarean delivery. A false aneurysm of the uterine artery was found by color Doppler ultrasonography and multislice spiral computed tomography. Arteriography confirmed the diagnosis. Superselective coil embolization of the aneurysm sac was achieved using the packing technique. The main uterine artery was preserved and the postprocedural course was uneventful. Color Doppler ultrasonography and computed tomography were useful for the early diagnosis of uterine artery pseudoaneurysm. Primary transcatheter arterial embolization controlled bleeding without compromising reproductive potential.

A Case of Massive Hemorrhage from a Far-advanced Rectal Carcinoma Successfully Treated by Selective Transcatheter Embolization

症例は40歳男性．1年前より高度進行直腸癌に対して化学療法を施行するも増悪し，S状結腸にストマを造設した．疼痛緩和目的で放射線療法施行中であったが，ストマおよび肛門より多量の出血を認めたため救急外来受診し，緊急入院となった．入院後止血剤，輸血にて対応するも出血が続くため，血管造影検査を行った．下腸間膜動脈造影にて上直腸動脈より腸管内への造影剤の漏出を認めたため，n-butyl-2-cyanoacrylateにて選択的動脈塞栓術を施行した．その後永眠されるまでの4カ月間に明らかな出血は認めなかった．消化管原発悪性腫瘍からの消化管出血においては，手術不能な場合消極的な対応をとることが多いが，本例のように動脈塞栓術が有用となる場合があり，選択肢の一つとして念頭におく必要があると考えられた．

Massive hematuria due to a congenital renal arteriovenous malformation mimicking a renal pelvis tumor: a case report

IntroductionCongenital renal arteriovenous malformations (AVMs) are very rare benign lesions. They are more common in women and rarely manifest in elderly people. In some cases they present with massive hematuria. Contemporary treatment consists of transcatheter selective arterial embolization which leads to resolution of the hematuria whilst preserving renal parenchyma.Case presentationA 72-year-old man, who was heavy smoker, presented with massive hematuria and flank pain. CT scan revealed a filling defect caused by a soft tissue mass in the renal pelvis, which initially led to the suspicion of a transitional cell carcinoma (TCC) of the upper tract, in view of the patient's age and smoking habits. However a subsequent retrograde study could not depict any filling defect in the renal pelvis. Selective right renal arteriography confirmed the presence of a renal AVM by demonstrating abnormal arterial communication with a vein with early visualization of the venous system. At the same time successful selective transcatheter embolization of the lesion was performed.ConclusionThis case highlights the importance of careful diagnostic work-up in the evaluation of upper tract hematuria. In the case presented, a congenital renal AVM proved to be the cause of massive upper tract hematuria and flank pain in spite of the initial evidence indicating the likely diagnosis of a renal pelvis tumor.

Abdominal Wall Hematoma After Laparoscopic Surgery: Early Treatment with Selective Arterial Transcatheter Embolization

Bleeding from the site of a trocar insertion is a relatively frequent complication after laparoscopic surgery, despite precautionary techniques aimed at reducing such events. It may result in a hemoperitoneum, requiring emergency reintervention or large hematomas of the abdominal wall. In the latter case, although conservative treatment is possible, hospital stay is prolonged and large amounts of blood-bank resources are consumed. Early diagnosis and selective embolization of the bleeding vessel may reduce the severity and consequences of this complication.

Superselective Embolization in Posttraumatic Priapism with Glubran 2 Acrylic Glue

Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, resulting in temporary penile detumescence and an apparent resolution of the artero-venous fistula. In both cases, priapism recurred 24 hours after the procedure and was successfully treated through selective transcatheter embolization of the nidus using acrylic glue (Glubran 2). The patients showed complete recovery of sexual activity within 30 days from the procedure and persistent exclusion of the artero-venous fistula after a 12-month follow-up.

High-flow priapism due to cavernosal artery fistula with pseudoaneurysm treated by N-butyl-cyanoacrylate embolization

Objective: Our purpose is to determine the diagnosis of high-flow priapism due to cavernosal artery fistula with pseudoaneurysm and treatment with N-butyl-cyanoacrylate (NBCA) embolization in a case. Methods and material: A 32-year-old man presented with a 2-month history of painless priapism after perineal blunt trauma. On colour Doppler sonography and clinical examination high-flow priapism due to the left cavernosal artery fistula with pseudoaneurysm was diagnosed in the patient. Right cavernosal artery was normal. The diagnosis was confirmed with angiography. It was treated by transcatheter embolization using NBCA. Results: After treatment, immediate complete detumescence and normal potency was achieved after 2 days follow-up. Conclusion: Perineal colour Doppler ultrasonography is a reliable and noninvasive examination to demonstrate cavernosal artery fistula and pseudoaneurysm. Super selective transcatheter embolization with NBCA is a method of choice in the treatment of the cavernosal artery fistula and pseudoaneurysm.

Successful treatment of arterial priapism with radiologic selective transcatheter embolization of the internal pudendal artery

We report our successful treatment of arterial priapism by means of radiologic selective transcatheter embolization of the internal pudendal artery using an absorbable gelatin sponge (Spongel).

Spontaneous Extraperitoneal Hemorrhage with Hemodynamic Collapse in Patients Undergoing Anticoagulation: Management with Selective Arterial Embolization

The authors report their experience with management of unstable spontaneous extraperitoneal hemorrhage (SEH) with selective transcatheter embolization. Five consecutive patients underwent angiographic evaluation for SEH complicated by hemodynamic collapse while undergoing anticoagulation therapy. Bleeding occurred via one or two lumbar arteries in psoas hematomas. Two abdominal wall hematomas were supplied by the inferior epigastric artery, with additional supply via the deep circumflex iliac artery in one. Microcoil embolization successfully controlled extravasation in all patients, with stabilization of hemodynamic parameters. Four of the five patients survived the immediate postprocedural interval. Selective transcatheter embolization may be a viable life-saving option in SEH-associated hemodynamic collapse.

Transcatheter embolization of renal artery aneurysm in Behçet’s disease

A 20-year-old man with Behçet's disease presented with a ruptured renal artery aneurysm. This patient had previously had aneurysms of the coronary arteries and coronary vein thrombosis that were treated with immunosuppression. A selective transcatheter embolization of the renal artery branch was done successfully and treatment with corticosteroids and methotrexate was added. Presented here is a rare complication of Behçet's disease, with discussion on the pathophysiology, differential diagnosis, and the advantages and disadvantages of the angiographic treatment. This paper is supplemented with a comprehensive review of the literature.

Selective arterial embolization in the management of symptomatic renal angiomyolipomas

Current management of renal angiomyolipomas (AMLs) include observation, transcatheter embolization and partial or total nephrectomy. Patients symptoms and size of the lesion are the determinants for the choice of the treatment. In general symptomatic or greater than 8 cm masses require intervention. A retrospective study of five patients presented with symptomatic lesions and treated with selective transcatheter embolization, over a 3 year period was performed in our hospital. A total of eight embolizations were performed, all on an emergency basis due to retroperitoneal bleeding or significant hematuria. Surgical intervention was necessary in one case, due to massive rebleeding on the fourth post-procedural day. Two patients rebled within 6 months and 2 years respectively, and were managed successfully with additional embolization. The remaining two patients are still asymptomatic 26 and 18 months after the successful initial result. Experience with this procedure is reported on with emphasis to the clinical outcome. It is believed that selective arterial embolization should be the standard initial therapy for symptomatic renal AMLs.