Successful Transcatheter Embolization Research Articles

Successful Transcatheter Embolization of Spontaneous Splenic Rupture in a Patient with Chronic Myeloid Leukemia

Successful Transcatheter Embolization of Spontaneous Splenic Rupture in a Patient with Chronic Myeloid Leukemia

A two-staged successful transcatheter embolization for multiple pulmonary arteriovenous fistulas

Pulmonary arteriovenous fistulas (PAVF) are abnormal connections between pulmonary arteries and veins through aneurysmal sac or dilated tortuous channels without capillary bed. The clinical presentation includes exercise intolerance and hypoxemia in childhood. Nowadays, transcatheter closure methods using coils, balloons and several devices have become widely accepted treatment modalities, rather than surgical intervention, in childhood. The Amplatzer ® vascular plug is frequently used in the management of various pathologies of both peripheral and central vascular structures. In this article, we report a three-year-old boy who underwent a successful two-stage closure of multiple PAVF using an Amplatzer vascular plug (I and II) device.

Transcatheter Embolization of Giant Pulmonary Arteriovenous Malformation with an Amplatzer Vascular Plug II

Pulmonary arteriovenous malformation (PAVM) is a rare anomalous direct communication between the pulmonary artery and vein with a considerable risk of serious complications such as cerebral thromboembolism or abscess and pulmonary hemorrhage. Although the past, surgical resection such as lobectomy was mostly used to treat PAVM, the recent development of endovascular treatment has made it a primary consideration to perform transcatheter embolization using coils or detachable balloons. We report a case of successful transcatheter embolization of giant PAVM with the second generation Amplatzer vascular plug II as a new self-expanding device.

Uncommon Cause of Severe Obscure GI Bleeding in the Young Patient with Alcohol-Induced Chronic Pancreatitis

Purpose: Hemosuccus pancreaticus (HP) is an uncommon cause of obscure GI bleeding, commonly found in chronic pancreatitis, resulting from a ruptured splenic artery aneurysm or bleeding from pseudocyst wall. Ruptured splenic artery aneurysm in HP is likely from pseudoaneurysm (which can be found in 10% of chronic pancreatitis) rather than true aneurysm (which is more likely associated with trauma, infection or weakening of the splenic artery wall). The bleeding is usually obscure but could become life-threatening which requires radiologic intervention or surgical management. A 27-year-old alcoholic man presented with fatigue from iron deficiency anemia. Physical examination was unremarkable except pale conjunctiva. On the first admission, upper endoscopy, colonoscopy, and small bowel follow-through were unremarkable. He was readmitted 4 months later with hematochezia and intermittent epigastric pain. CT scan of abdomen with contrast was obtained showing diffused calcified pancreas; therefore, alcohol-induced chronic pancreatitis was diagnosed. Meckel's scan and video-capsule endoscopy were also unremarkable. Repeated upper endoscopy revealed intermittent bleeding from major duodenal papilla and retained blood in second part of duodenum. With history of chronic pancreatitis, HP was suspected so visceral angiography was performed but no significant finding was detected. Three months later, he was readmitted with fatigue and epigastric pain. The third upper endoscopy found no pathology but the concern of HP remained unresolved. CT scan of abdomen with contrast was repeated and demonstrated an interval development of 1.9 × 1.2 cm dense enhancing lesion in the tail of pancreas. Repeated non-provocative visceral angiography showed a saccular pseudoaneurysm in the distal part of pancreas. He underwent a successful transcatheter embolization with coils. The patient recovered well with no recurrent rehospitalization during the next 3 years. In this case, we underscore the diagnostic significance of chronic pancreatitis leading to the development of HP resulting from ruptured splenic artery pseudoaneurysm connected to the pancreatic duct or to a larger side-branch. The distinct feature of HP is an episodic bleeding which delays the definite treatment due to difficulty locating site of bleeding. Surgery might also be an option if the bleeding site cannot be located or the interventional therapy is unsuccessful. Even if the first visceral angiography reveals no aneurysm, repeat visceral angiography might be warranted if HP remains a probable answer to the recurrent obscure GI bleeding. Also, the provocative visceral angiography might be useful in early diagnosis of this case.

Bleeding in acute pancreatitis treated by transcatheter arterial embolization with ethylene-vinyl alcohol copolymer (Onyx)

Hemorrhagic complications are usually manifestations of the progress of severe pancreatitis. In major arterial hemorrhage resulting from pancreatic inflammatory disease, visceral angiography is valuable in localizing the site of bleeding, and hemostasis can be achieved by transcatheter arterial embolization. Successful transcatheter embolization of bleeding in the anterior superior pancreaticoduodenal artery using ethylene-vinyl alcohol copolymer (Onyx) was performed in a 38-year-old woman with acute biliary necrotic-hemorrhagic pancreatitis.

Radiological treatment of a spontaneously ruptured inferior adrenal artery aneurysm

A 70-year-old man with a history of hypertension presented with severe epigastric discomfort that radiated to his back. CT revealed cystic kidney disease and a large retroperitoneal hemorrhage, and CT angiography identified an active bleeding point in the region of the left adrenal gland. Selective left renal angiography identified a small inferior adrenal artery aneurysm with active hemorrhage. The patient underwent successful transcatheter embolization with microcoils and polyvinyl alcohol microparticles to control the bleeding. Blood tests, urinalysis, electrocardiography, triphasic CT with CT angiography. Ruptured left inferior adrenal artery aneurysm. Access to the inferior adrenal artery was achieved with a microcatheter, followed by transcatheter embolization using a combination of polyvinyl alcohol microparticles distally and microcoils proximally to the aneurysm.

Spontaneous recurrent idiopathic knee haemarthrosis in a paediatric patient: successful transcatheter embolization

Spontaneous recurrent idiopathic knee haemarthrosis in a paediatric patient: successful transcatheter embolization

Massive Retroperitoneal Adrenal Hemorrhage Secondary to Lung Cancer Metastasis Treated by Adrenal Artery Embolization

The development of adrenal hemorrhage from lung cancer metastasis is extremely rare. A 54-year-old woman with stage IV Non–Small-cell lung cancer and known bilateral adrenal metastasis developed severe right-sided abdominal pain while undergoing chemotherapy treatment. A computerized tomography scan of the abdomen with intravenous contrast demonstrated massive right-sided retroperitoneal hemorrhage. The bleeding vessel was identified as the right middle adrenal artery. The patient underwent successful transcatheter embolization (TCE) and occlusion of the right middle adrenal artery using metallic coils, with resolution of the abdominal pain and stabilization of her hemoglobin. TCE can be used to control hemorrhage arising from metastatic involvement of the adrenal gland.

Deep Circumflex Iliac Artery-Related Hemoperitoneum Formation After Surgical Drain Placement: Successful Transcatheter Embolization

A 53-year-old woman with liver cirrhosis and hepatocellular carcinoma underwent living donor liver transplantation. After transplantation, her hemoglobin and hematocrit levels decreased to 6.3 g/dl and 18.5%, respectively, during the course of 3 days. A contrast-enhanced abdominal computed axial tomography (CAT) scan showed a hemoperitoneum in the right perihepatic space with no evidence of abdominal wall hematoma or pseudoaneurysm formation. An angiogram of the deep circumflex iliac artery (DCIA) showed extravasation of contrast media along the surgical drain, which had been inserted during the transplantation procedure. Transcatheter embolization of the branches of the DCIA was successfully performed using N-butyl cyanoacrylate.

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.

Successful Embolization of a Renal Artery Pseudoaneurysm with Arteriovenous Fistula and Extravasations Using Onyx After Partial Nephrectomy for Renal Cell Carcinoma

Partial nephrectomy can be associated with vascular complications. Computed tomography (CT) with CT angiography is ideal for noninvasive imaging of this process. The treatment of choice is selective embolization. Successful transcatheter embolization of right renal subsegmental artery pseudoaneurysm with arteriovenous fistula and extravasations using Onyx was performed in a 66-year-old woman with macrohematuria 12 days after partial nephrectomy for renal cell carcinoma.

Application of a Stent-Graft After Initial Occlusion with Interlocking Detachable Coils for Treatment of Penetrating Atherosclerotic Ulcer of the Aorta

We read with interest the Case Report published September 2000 in CardioVascular & Interventional Radiology describing successful transcatheter embolization of a penetrating aortic ulcer using interlocking detachable coils [1]. However, follow-up CT and angiography performed in our department 24 months after the procedure confirmed recanalization of thrombosed false lumen and, again, demonstrated a pseudoaneurysm of the descending aorta (Fig. 1). To prevent rupture of the aorta, implantation of an aortic stent-graft was planned. Under general anesthesia, the right femoral artery was exposed and punctured. A 20Fr Keller-Timmerman sheath was introduced, and a noncommercial Dacron-covered spiral Z stent constructed at Nara Medical University [2], 20 mm wide and 60 mm long, was placed in the aneurysmal portion of the descending aorta. No procedure-related complications were encountered, and the patient was discharged 1 week later. Followup angiography 8 months after the procedure showed faint

Transcatheter Embolization of a Renal Artery Aneurysm Using Ethylene Vinyl Alcohol Copolymer

Our aim was to treat a clinically silent renal artery aneurysm. The patient was a 76-year-old man with elevated prostate-specific antigen and prostate biopsies with a grade II-III adenocarcinoma who was incidentally found to have an aneurysm in his right renal artery. We performed a successful transcatheter embolization of the aneurysm using ethylene vinyl alcohol copolymer (Onyx). To avoid migration of the liquid material into the parent artery, a balloon was inflated in the orifice of the neck of the aneurysm while the liquid was injected. Five-month follow-up computed tomography (CT) imaging confirmed total occlusion of the aneurysm.

Failed Endoscopic Therapy and the Interventional Radiologist: Non-Variceal Upper Gastrointestinal Bleeding

The exact site of nonvariceal upper gastrointestinal bleeding is not always visualized by endoscopy. In these instances, other modalities must be utilized to isolate and treat the bleeding site. Angiography and transcatheter embolization provide a nonoperative option for patients whose bleeding has either not been controlled or not identified under endoscopy. Technically successful transcatheter embolization has been shown to significantly reduce mortality in patients with UGI hemorrhage. Temporary embolization agents like Gelfoam and permanent agents like polyvinyl alcohol, cyanoacrylic glues, and coils are used to embolize bleeding lesions. In patients with UGI hemorrhage that do not demonstrate bleeding on angiography, some authors have advocated prophylactic embolization of the left gastric artery. Major complications are unusual. While embolotherapy may not always be a permanent cure, it may stabilize the patient until definitive therapy/surgery is performed.

Transcatheter Occlusion of a Large Pulmonary Arteriovenous Malformation with Use of a Cardioseal Device

Large pulmonary arteriovenous malformations (PAVMs) carry a significant risk of neurologic complications and present technical difficulties in transcatheter treatment with use of coils or detachable balloons. A 26-year-old man with a giant PAVM, who had undergone unsuccessful attempted closure with use of a Gianturco-Grifka occlusion device in the past, underwent successful transcatheter embolization with two Cardioseal double umbrella devices designed for occlusion of intracardiac communications. The procedure was technically easy, had no complications, and provided sustained improvement in arterial saturation and exercise tolerance during follow-up. Transcatheter double umbrella device occlusion of large arteriovenous malformations is feasible and should be considered, especially for very large fistulas.

Percutaneous Transcatheter Embolization of Coronary Arteriovenous Fistulas

Coronary artery fistulas are infrequently encountered vascular communications that are either congenital or due to cardiac trauma. Most patients with these anomalies are asymptomatic, but late complications can occur and include congestive heart failure, myocardial ischemia, arrhythmias, and endocarditis. Therefore, many investigators have recommended surgical repair, even for asymptomatic patients. Although coronary arteriovenous fistulas pose many challenges to interventional cardiologists, early experiences suggest that these abnormal vessels can be successfully obliterated percutaneously; thus, the patient is spared the risks and morbidity associated with cardiac surgical intervention. Herein we present two cases that illustrate many of the technical issues involved in successful transcatheter embolization of coronary artery fistulas.

Percutaneous transcatheter embolization in multiply injured patients with pelvic ring disruption associated with severe haemorrhage and coagulopathy

Six multiply injured patients with pelvic fractures were treated by percutaneous transcatheter embolization during a 10 month period. Diagnosis and therapy were carried out early in two cases (first day of admission into the trauma unit). Three patients were treated on the second day after admission. The last patient was embolized on the third day. Two patients underwent one and two remote embolizations. Embolization was indicated due to uncontrolled haemorrhaging, requiring large volumes of packed erythrocytes (median: 11.3) and fresh frozen plasma units (median: 6.8). Three patients had severe coagulopathy (disseminated intravascular coagulation). From two to 12 arteries were embolized per patient (median: 5). After successful transcatheter embolization, the circulation and coagulation stabilized rapidly without recurrence of haemorrhage or coagulopathy.

Effectiveness of Transcatheter Embolization in the Control of Hepatic Vascular Injuries

The authors describe their 11-year experience with transcatheter embolization (TCE) in the treatment of patients with hemorrhagic hepatic injuries. Twenty-eight TCE procedures were performed in 24 patients between 1980 and 1991. Injuries in 21 patients were due to vehicular or criminal trauma; in three patients, injuries were iatrogenic. There were 21 male and three female patients (age range, 6-64 years). All patients underwent angiography and had evidence of active hemorrhage, pseudoaneurysm, or arteriovenous fistula (AVF). All embolizations were performed with use of Gianturco coils, microcoils, or gelatin sponge. TCE was technically successful in occluding hepatic vascular lesions in 21 of 24 patients (88%). Technical failures were due to the inability to select the appropriate vessel for embolization in two cases and due to a persistent AVF that did not occlude despite further attempts at embolization. Lesions recurred in two patients who underwent initially successful TCE. Both patients were treated effectively with repeated TCE. Only two catheter-related complications were encountered, both after successful TCE. Twenty-one patients survived to be discharged from the hospital. Two patients among the group treated successfully and one from the group in whom treatment failed died. This experience demonstrates that TCE is effective in the management of hepatic vascular injuries due to trauma.

Transcatheter Embolization of a Superior Mesenteric Artery Pseudoaneurysm and Arteriovenous Fistula

' SCVIR, 1993 S u p m l o n mesenteric artery (SMA) aneurysms and pseudoaneurysms complicated by arteriovenous fistulas (AVFs) are rare but clinically important lesions. To our knowledge, only 35 cases of superior mesenteric AVF have been reported to date. The cause of these lesions includes penetrating or blunt abdominal trauma, surgery, or aneurysm rupture (1). Recently published reports discuss embolization of splanchnic artery aneurysms and pseudoaneurysms (2,3); however, we are aware of only three previous reports of successful transcatheter embolization of SMA pseudoaneurysms complicated by an AVF (46). We present a case of successful transcatheter embolization of a traumatic SMA pseudoaneurysm associated with an AVF and briefly discuss the clinical implications of these lesions.

Spontaneous Hepatic Hemorrhage in Preeclampsia: Treatment with Hepatic Arterial Embolization

Four patients with spontaneous rupture of the liver due to preeclampsia of pregnancy underwent diagnostic angiography followed by successful transcatheter embolization of the hepatic artery with gelatin particles. All patients stopped bleeding and were discharged in good condition. Transcatheter embolization of the hepatic artery may be an attractive alternative to surgery for control of spontaneous rupture of the liver in preeclampsia.