Superselective Arterial Embolization Research Articles

Clinical study of superselective renal arterial embolization in the treatment of iatrogenic renal hemorrhage

Objective To prospectively investigate superselective renal arterial embolization (SRAE) in the treatment of iatrogenic renal hemorrhage MethodsFrom November 2005 to November 2010,19 patients with iatrogenic renal hemorrhage in the Affiliated Hospital of Hangzhou Normal University underwent diagnostic renoarteriography to reveal the site and degree of renal artery rupture,then superselective embolization by coins,or coins combined with spongia gelatinosa were performed for these patients.Results Renal arteriography showed hemorrhage was located at the renal segmental arteries and/ or their branches ( 9 cases at segmental renal artery,6 cases at interlobar artery and 4 cases at arciform artery),two cases were found with simple hemorrhage of segmental renal artery ( SRA ),9 cases with pseudoaneurysm,5 cases with arterio- venous fistula (AVF),3 cases with pseudoaneurysm combined with AVF.Seventeen cases received embolization with coins,while 2 cases with pseudoaneurysmes received embolization with coins and spongia gelatinosa at the same time.Bleeding was successfully ceased immediately and did not recur in all cases.Conclusions Superselective renal arterial embolization could be considered as a safe and effective method to treat hemorrhage of iatrogenic renal vascular injuries.. Key words: Iatrogenic renal hemorrhage ; Renal artery; Angiography; Superselective catheterization; Embolization

Arterio-Venous Malformation in the External Ear in Pregnancy

Arterio-Venous Malformation in the External Ear in Pregnancy

Application of DC Beads in Hepatocellular Carcinoma: Clinical and Radiological Results of a Drug Delivery Device for Transcatheter Superselective Arterial Embolization

Aim: Application of a drug delivery device for transarterial chem-oembolization (TACE) in patients with hepatocellular carcinoma (HCC). Clinical and radiological treatment assessment. Patients and Methods: 24 patients with liver cirrhosis and uni- or multifocal HCC underwent TACE with doxorubicin beads (DC Bead^TM). The underly-ing cause of liver cirrhosis was hepatitis (A: n = 7; B: n = 10) or alco-hol consumption (n = 7). Patients presented with Child Pugh stage A (n = 15) and B (n = 9). The mean intrahepatic tumor size, consid-ering the sum of diameters of all lesions treated, was 3.83 cm (±2.4). Liver function and hematological parameters were docu-mented before and after each TACE. Magnetic resonance imaging (MRI) was performed before and 4 weeks after TACE. The T1-w 3D volume-interpolated breathhold exam (VIBE) sequence was applied for evaluation of the therapy response. Results: 24 patients received a total number of 69 TACE treatments with DC beads (mean dose 160 mg). The elevation of liver function parameters after treat-ment did not affect the patients’ clinical condition. The T1-w VIBE sequence proved very valuable for assessment of the intrahepatic tumor spread. Post-contrast images enabled delineation of the viable HCC lesions, hence facilitating the selective transcatheter ap-proach. The tumor marker a-fetoprotein (AFP), available in 19/24 patients, dropped from 347.5 to 299.5 ng/ml, without being a relia-ble predictor of treatment response. A decrease of tumor size after TACE from 3.83 (±2.40) to 3.01 cm (±2.67; p < 0.0001) was evident on the T1w-VIBE sequences. The mean follow-up period was 30 months. At the time of data analysis, 10 (42%) out of 14 patients were alive. Conclusion: TACE with DC beads in HCC offers a safe and efficient treatment resulting in tumor response within a very short time.

Life-threatening intra-abdominal hemorrhage from left superior colonic artery pseudoaneurysm after percutaneous renal biopsy: successful treatment with superselective arterial embolization

Life-threatening intra-abdominal hemorrhage following ultrasonographically guided percutaneous renal biopsy is extremely rare and, most of the time, is due to renal vascular injury. Injury of other abdominal arteries during percutaneous renal biopsy is exceedingly rare. We report herein a case of left superior colonic artery injury during ultrasonographically guided percutaneous renal biopsy, which was responsible for pseudoaneurysm formation and subsequent intra-abdominal hemorrhage and gastrointestinal bleeding. Arterial pseudoaneurysm was rapidly and successfully treated with minimally invasive endovascular treatment using microcoils. Superselective embolization stopped the bleeding and preserved colonic vascularization, thus preventing ischemia of the involved colonic segment.

Preoperative Superselective Transarterial Embolization in Laparoscopic Partial Nephrectomy: Technique, Oncologic, and Functional Outcomes

We report the mid-term oncologic and functional results of a series of 110 patients treated with transperitoneal laparoscopic partial nephrectomy (LPN) after superselective arterial embolization (SEA). Between August 2003 and August 2007, 110 patients underwent LPN after SEA for T1 renal tumors. All data were collected in a prospectively maintained database. Mean age of patients was 61 (range 37-80), and mean tumor size was 4.4 cm (range 2.5-6.5). Angiographic procedure was performed by a single experienced radiologist, and surgical procedure was performed by a single experienced surgeon. Perioperative data were collected and analyzed. Renal function was evaluated by preoperative and 3- and 12-month postoperative (99m)Tc diethylenetetramine pentacetic acid renal scans. Mean operative time was 58 minutes (range 35-220), and mean blood loss was 106 mL (range 20-800). No conversion to open surgery occurred; in one patient radical nephrectomy was necessary because of the total intraparenchymal growth of the tumor. Mean hospital stay was 3.2 days (range 2-12). Pathologic analyses found 33 benign tumors in 31 patients and renal cell carcinoma in 79 cases (26 pT1a, 45 pT1b, 6 pT2, and 2 pT3a). At a median follow-up of 41 months, computed tomography scan revealed two local recurrences, one of which not confirmed by pathologic evaluation after radical nephrectomy. One patient died of disease 1 year after surgery. When matching preoperative and 1-year postoperative renal scan, median decrease of glomerular filtration rate was 5% (range 0%-9%). Preoperative SEA allows us to perform LPN without clamping hilum vessels and so without time threshold related to ischemic damage. Oncological outcome is comparable to that of open surgery, and functional results are encouraging, thanks to the optimal preservation of renal function.

W1062 Therapeutic Efficacy of Superselective Arterial Embolization in Patients with Gastrointestinal Hemorrhage

W1062 Therapeutic Efficacy of Superselective Arterial Embolization in Patients with Gastrointestinal Hemorrhage

Value of superselective intraarterial infusion chemotherapy and embolization in advanced cervical carcinoma patients before surgery

Objective To investigate the clinical effect of superselective arterial infusion chemotherapy(SACT) and embolization in advanced cervical carcinoma patients before surgery. Methods 26 previously untreated patients with stage ⅡA-Ⅳ cervical carcinoma admitted from January 2004 to March 2008 were enrolled into the study, patients underwent SACT of the internal iliac artery(dose of the drug: CBP 80 rag, VCR 2 rag, MMC 16 mg) by Seldinger technique in the surveillance of DSA, the obvious branches of the tumor blood supply were embolized by gelfoam particles. Size of tumor before and after chemotherapy was measured by gynecological examination combined with B ultrasonic examination and CT, then calculated the percentage of tumor regression. Radical hysterectomy was administered one month after chemotherapy. Results 24 patients were evaluated as PR, the reaction rate of chemotherapy was 92.3 %. Conclusion SACT before surgery can effectively reduce tumor volume, decrease lymphatic metastasis and subclinical dissemination and enhance the opportunity of radical hysterectomy, and to improve the quality of life and OS of the advanced cervical carcinoma patients. Key words: Uterine cervical neoplasms; Chemotherapy, cancer, regional peffusion

Emergency intervention therapy for renal vascular injury

To evaluate the efficacy and safety of the interventional techniques in the treatment of renal vascular injury. A total of 16 patients with renal vascular injuries were treated by superselective arterial embolization. The renal injuries resulted from renal biopsy in 7 patients, endovascular intervention in 2, percutaneous puncture and pyelostomy in 2, local resection of renal tumor in 1 and trauma in 4. With regards to clinical manifestations, there was hemorrhagic shock in 8 patients, severe flank pain in 14, and hematuria in 14. CT and ultrasonography confirmed that 15 patients had perirenal hematoma. The embolization was performed with microcoils in 13 and standard stainless steel coils in 3 patients, associated with polyvinyl alcohol particles (PVA) in 9, and gelfoam particles in 6 cases. Renal angiogram revealed arteriovenous fistula in renal parenchyma in 9 cases, pseudoaneurysm in 3 and extravasation of contrast media in 4. The arterial embolization was successful in all 16 cases in a single session. The angiography at the end of therapy showed that abnormal vessels had disappeared without other major intrarenal arterial branch occlusion. In 13 patients with hemodynamical compromise, blood loss-related symptoms were immediately relieved after blood transfusion. In 14 patients with severe flank pain, the pain was progressively relieved. Hematuria ceased in 14 patients 2-14 days after the embolization procedures. The renal function was impaired after the procedure in 6 cases, in which preoperative renal insufficiency was exacerbated in 3 and developed new renal dysfunction in 3, 2 of whom received hemodialysis. The ultrasonography showed that perirenal hematoma was gradually absorbed within 2-6 months after the procedure. All patients were followed up in 6-78 months (mean, 48 months). Six patients died of primary diseases (5 cases of renal failure and multiple organ failure and 1 case of malignant tumor). Ten patients survived without bleeding and further intervention. The deterioration of renal function did not occur and the serum creatinine and blood urea were in normal range. Transcatheter selective renal arterial embolization is a safe and effective method in the treatment of renal vascular injuries.

Nonoperative Management of Grade 5 Renal Injury in Children: Does It Have a Place?

BackgroundNonoperative treatment of blunt renal trauma in children is progressively gaining acceptance; grade 5 renal trauma is associated with a significant rate of complications. ObjectiveTo assess the feasibility and outcome of initial nonoperative management of grade 5 blunt renal trauma in children. Design, setting, and participantsThis retrospective study included 18 children (12 boys and 6 girls; mean age: 8.4±3.4 yr) who presented to the authors’ institutes with grade 5 blunt renal trauma between 1990 and 2007. MeasurementsAn intravenous contrast-enhanced computed tomography (CT) scan demonstrated grade 5 renal trauma in all patients. Associated major vascular injuries were suspected in four patients. All were initially managed conservatively. Indications for intervention included hemodynamic instability, progressive urinoma, or persistent bleeding. Dimercaptosuccinic acid (DMSA) scans were performed at a mean time of 3.1 yr (range: 1–17) following the injury in nine patients. Results and limitationsFour patients (22%) with suspected major vascular injuries required nephrectomy 1–21 d following the trauma. Two patients with continuing hemorrhage required selective lower-pole arterial embolization (11%). Three patients (17%) had their progressive urinoma drained percutaneously, and two of them required delayed reparative surgery for ureteropelvic junction (UPJ) avulsion. Nine patients (50%) were successfully managed nonoperatively. Kidneys were salvaged in 78% of patients. DMSA scanning showed a split function >40% in 44% of evaluated kidneys. Two patients (22%) had split function <30%. At last follow-up, none of the children were hypertensive or had any abnormality on urine analysis. ConclusionsNonoperative management of grade 5 renal trauma is feasible. Prompt surgical intervention is required for those with major vascular injuries. Superselective arterial embolization can be an excellent option in patients with continuing hemorrhage and who have pseudoaneurysms. Patients with UPJ disruption can be salvaged by initial drainage of the urinoma followed by deferred correction.

Repeat Transcatheter Arterial Embolization for the Management of Pelvic Arterial Hemorrhage

Most arterial hemorrhage associated with pelvic fracture can be adequately controlled by a single transcatheter arterial embolization (TAE). However, there is a small group of patients who remain hemodynamically unstable after TAE, have no other identifiable source of bleeding, and who benefit from repeat TAE of the pelvis. We conducted a retrospective study of patients with hemorrhage from pelvic fractures between January 2001 and June 2006. Clinical parameters and results were compared between patients requiring more than one pelvic TAE and those undergoing a single TAE. Risk factors for repeat TAE were identified by univariate and stepwise logistic regression analyses. During the study period, 174 of 964 patients with pelvic fracture received pelvic angiography for suspected arterial hemorrhage. One hundred forty TAEs were performed. Thirty-four (24.3%) patients underwent more than one angiography for suspected recurrent arterial hemorrhage, and 26 (18.6%) underwent repeat TAE. Repeat angiography was performed 3 to 58 hours (mean, 21 hours) after initial TAE. Patients with repeat TAE had significantly more blood transfusions, higher mortality rate, and longer intensive care unit stay. Independent predictors for repeat TAE included initial hemoglobin level lower than 7.5 g/dL (OR, 6.22), superselective arterial embolization in initial TAE (OR, 3.22), and more than 6 units of blood transfusion after initial TAE (OR, 3.22). Careful monitoring and prompt recognition of patients requiring repeat TAE is paramount. The arterial access sheath should remain in place for up to 72 hours after angiography. Initial hemoglobin level lower than 7.5 g/dL and more than 6 units of blood transfusion after initial angiography are predictors for repeat TAE. Superselective TAE is associated with a significantly higher risk of recurrent hemorrhage, and its use should be limited.

Application of multislice spiral CT and 3D reconstruction in diagnosis and treatment of vascular malformations in head and neck

To explore the application of MS-CT and 3D reconstruction in diagnosis and treatment of vascular malformations in head and neck. 20 cases with vascular malformations in head and neck underwent MS-CT and 3-D reconstruction. Then the treatment was determined based on the results of MSCT scanning. The postoperative results were evaluated. The images of MS-CT showed the edge of vascular malformations partially or completely in 16 cases of venous malformations. The lesion's anatomic site and 3-D position was obtained. The 3-D images also showed the overexpanded supply arteries in 4 case of arteriovenous malformations. 2 case of venous malformations in lip underwent resection and healed completely. 12 cases of venous malformations in buccal and floor of mouth were treated with compartmentalized sclerotherapy with partial lesion involution. 2 case of venous malformations in mouth floor were treated with operation followed by sclerotherpy with partial lesion involution. 4 cases of arteriovenous malformations were treated with Superselective Artery Embolization with partial lesion involution. MS-CT and 3D reconstruction can play an important role in diagnosis and treatment of vascular malformations in head and neck.

Kidney Hemorrhage After Renal Biopsy Treated by Percutaneous Superselective Segmental Renal Artery Embolization

Kidney Hemorrhage After Renal Biopsy Treated by Percutaneous Superselective Segmental Renal Artery Embolization

Colonic diverticular bleeding: precise localization and successful management by a combination of CT angiography and interventional radiology

We report a case of 50-year-old man with relapsing severe colonic diverticular bleeding. The patient required total blood transfusion of 14 units, despite fasting for bowel rest. Repeated CT, colonoscopy, and angiography could not determine the accurate bleeding site. Superselective arterial embolization could be finally achieved by precise localization on CT immediately after superior mesenteric arteriography.

Superselective uterine arterial infusion and embolization in the treatment of ectopic pregnancies of 56 cases

Objective To probe a simple, safe, and minimally invnsive method to treat ectopic pregnancy with preservation of the organs. Methods Superselective catheterization of uterine artery through cannulation of right femoral artery was achieved in 56 patients with ectopic pregnancy. Location of the lesions involved, feeding arteries, and active bleeding were observed on angiography. 150 mg of methylamine neopterin diluted in 100 ml of saline water was infused slowly into the target artery. Small gelatin spongy particles with size of 0.5 mm in diameter were used to embelize the uterine artery until its branches were totally obliterated. Follow-up was undertaken to observe the results of the treatment. Results Suporselective uterine arterial infusion and embolization were successfully performed in all 56 patients without any related complications. Active bleeding in the peritoneum in 33 cases ceased soon after embolization. The embryos in 13 patients were confirmed to have died by ultrasound two days after the procedure. Beta-HCG value dropped to below 5 U/L within two to twelve days. Hemorrhage in the peritoneum dissolved after seven days in all cases. Mixed mass disappeared after one month. Histerosalpingography was performed three months after the procedure in 19 patients and patent fallopians were demonstrated in 11 patients. Conclusions Superselective uterine arterial infusion and embolization is a minimally invasive procedure, which can be used to effectively treat ectopic pregnancy by disabling the ectopic embryo and embelizing leaking arteries with the advantages of preserving the fallopian tubes. Key words: Pregnancy,ectopic; Hemorrhage; Radiology,interventional

Super-Selective Arterial Embolization for Uncontrolled Bleeding in Abdominal Pregnancy

Abdominal pregnancy with massive bleeding is life-threatening. Thus, multimodal treatment approaches are necessary. A 36-year-old woman with abdominal pregnancy at 14 weeks of gestation presented with abdominal pain due to intraabdominal bleeding. Laparotomy demonstrated massive bleeding from the placenta implanted in the right lower quadrant involving the posterior uterine wall, right adnexa, and small intestine. Because attempted removal of the placenta aggravated the bleeding, only the fetus was removed. To stop abdominal bleeding, embolization of the placental vasculature was successfully performed with a 2.0-F microcatheter after identification of the bleeding point with computed tomography arteriography. The patient was the treated with methotrexate. Super-selective arterial embolization with a microcatheter is a useful treatment of abdominal bleeding due to abdominal pregnancy.

Massive gastrointestinal bleeding due to the rupture of arterial aneurysm in Behçet’s disease: case report and literature review

Massive gastrointestinal bleeding is a very rare manifestation of gastrointestinal Behçet's disease, mainly from the gastrointestinal mucosal lesions. We report herein the case of a 50-year-old man with intestinal Behçet's disease who suffered massive hemorrhage from ruptured arterial aneurysm. Colonoscopy demonstrated large amount of fresh blood in the entire colon, but we were not able to localize bleeding focus anywhere in the colon. Angiography was performed and it revealed that a small aneurysm on the right ileocolic artery with apparent extravasation of contrast material. A guiding catheter was inserted to a right ileocolic artery and superselective arterial embolization using microcoils was successful. Following this procedure, the gastrointestinal bleeding gradually subsided and completely stopped within a few days. He is now treating with prednisolone and sulfasalazine without recurrent bleeding until now.

Superselective Coil Embolization of Arterial Esophageal Hemorrhage

The authors report a case of arterial esophageal bleeding resistant to endoscopic hemostasis in a patient in critical condition after complicated gastrointestinal and pulmonary surgery. Unfit for surgery, the patient's massive hemorrhage was successfully treated with superselective coil embolization of the afferent esophageal branch of the thoracic aorta. In patients with severe arterial bleeding of the esophagus, percutaneous superselective arterial coil embolization may be feasible for control of hemorrhage.

Superselective arterial embolization for patients with high-flow priapism: results of follow-up for five or more years

To retrospectively evaluate the long-term results of transcatheter arterial embolization for high-flow priapism. The study comprised six patients with high-flow priapism treated by superselective embolization of the internal pudendal arteries at our institution. The cause of priapism was traumatic in five patients and idiopathic in one. Follow-up was > or = 5 years in all cases. A total of nine embolizations were performed in the six patients. Embolization was performed once in three patients, while repeated embolizations were performed in the remaining three. Eleven arteries were altogether treated. Embolic materials used were gelatin sponge in nine arteries, gelatin sponge and microcoils in one, and microcoils alone in one. Embolization of the internal pudendal arteries on both sides in one single session was performed in one patient. In one patient, complete occlusion of the pseudoaneurysm was not achieved. However, restoration of erectile function and detumescence were noted during follow-up. Complications during the procedure were not registered. At follow-up > or = 5 years after successful embolization, all six patients experienced detumescence as well as normal erectile function. Superselective embolization of the internal pudendal artery is the procedure of choice for treatment of high-flow priapism.

Embolization for massive urethral hemorrhage

Priapism is the term given to a prolonged, painful penile erection, unaccompanied by sexual desire. Most cases of priapism occur as a result of engorgement of the cavernous body of the penis due to intrinsic or extrinsic venous outflow obstruction, which is termed veno-occlusive priapism. However, in a small number of patients, the cause is related to uncontrolled arterial inflow due to trauma and resultant laceration of cavernosal arteries. This form of disease has been termed high-flow priapism and usually occurs in association with genitoperineal trauma. Most incidents of high-flow arteriogenic priapism result from genitoperineal trauma, such as that caused by sliding on a wooden bar or falling astride a ladder. We experienced a patient with a high-flow priapism due to urethral trauma caused by a misplaced Foley catheter. The treatment consisted of superselective arterial embolization of the bilateral internal pudendal arteries using metallic microcoils, which resulted in the subsequent detumescence of the penis with no complications. This case showed that bilateral arteriocavernosal fistulae can be successfully treated by superselective arterial embolization.

Successful superselective arterial embolization for post‐traumatic high‐flow priapism

We report a case of high-flow priapism treated successfully with superselective embolization of the cavernous artery. An 18-year-old man presented to our hospital 12 days after having been struck in the perineum by the corner of a skateboard. Immediately after the injury, he suffered painless sustained incomplete erection. High-flow priapism was diagnosed on the basis of cavernosal blood gas analysis and color Doppler ultrasonography findings. Right internal pudendal arteriography showed blood pooling in the cavernosum as a result of a broken artery. We identified the precise position of the arterial-venous fistula and embolized it superselectively with gelatin sponge particles. The fistula disappeared completely. One year later, the patient's erectile function was completely restored, and there had been no recurrence of the priapism. According to the American Urological Association guidelines, conservative treatment should be attempted first for high-flow priapism. In our review of the literature, superselective arterial embolization could be an alternative treatment after more than 3 weeks of conservative treatment.