Superselective Transcatheter Embolization Research Articles

Management of Mid-Facial Fracture Complicated by Pseudoaneurysm of Posterior Superior Alveolar Artery.

Facial fractures, particularly mid-facial fractures, can result in various complications, such as functional and esthetic problems. Prompt reconstruction of the fractured bones is crucial for restoring normal anatomy and function and preventing complications. However, such procedures can be complex and carry the risk of potential complications. The authors report the case of a 27-year-old man who underwent open reduction and internal fixation of the left zygomatic complex fracture and reconstruction of the left inferior orbital wall. During the surgery, heavy bleeding from the posterior superior alveolar artery due to a broken bone near the pterygomaxillary region caused a prolonged surgery time and the development of a pseudoaneurysm. The pseudoaneurysm was eventually treated with superselective transcatheter embolization using 25% N-Butyl cyanoacrylate glue. This case highlights the challenges in the management of mid-facial fractures and the potential complications that can arise during surgery, particularly when dealing with the pterygomaxillary region.

Long-term results of super-selective trans-catheter embolization of the vesical arteries for the treatment of intractable bladder haematuria

PurposeTo evaluate the feasibility, safety and long-term efficacy of super-selective trans-catheter arterial embolization for the management of intractable bladder bleeding.Materials and methodsThe records of 20 patients with intractable haematuria referred urgently for selective arterial embolization after failed conventional therapy, between 2013 and 2018, were retrospectively analyzed. Primary outcomes were technical (cessation of extravasation and/or stasis of flow within the target vessel) and clinical (bleeding control) success. Secondary outcomes included complication and re-intervention rates.ResultsTechnical success was 90% (18/20 cases), as in 2 cases, embolization was not feasible. Super-selective embolization of the vesical arteries was feasible in 15/18 cases (83.3%). Selective proximal occlusion of the anterior division of the internal iliac artery was performed in two cases (11%) and embolization of the anterior division after coil blockage of the posterior division was performed in one case (5%). Bilateral and unilateral embolization was performed in 10 and 8 cases, respectively. Peri-procedural mortality rate was 5% (1/18 patients). One possible procedure-related death occurred due to myocardial infarction ten days following non-target embolization of the buttocks and the anterior abdominal wall. Mean time follow up was 35 ± 15 months. Bleeding reoccurred in three patients (16.6%), all successfully managed (one conservatively and two with further embolization). Clinical success was 85% (17/20 cases). During follow up 11 more patients died, due to underlying conditions not related to bleeding or the procedure.ConclusionsSuper-selective angiographic embolization is feasible, safe and effective to control refractory, life threatening bladder bleeding and should be considered as a first line treatment, as to obviate the need for emergency surgery.

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.

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.

Efficacy and Safety of Treatment of High-flow Priapism with Superselective Transcatheter Embolization

This study is aimed to evaluate the effectiveness and safety of the treatment of highflow priapism with superselective transcatheter embolization. From Sep. 1999 to Jan. 2013, six patients with high-flow priapism underwent superselective transcatheter embolization of the cavernous artery. Recurrence of priapism, and change in erectile function detected by nocturnal penile tumescence and rigidity (NPTR) test and the International Index of Erectile Function 5-item questionnaire (IIEF-5) were evaluated during a mean follow-up of 12 months. A single superselective transcatheter embolization was sufficient for complete resolution of priapism in the six patients. None of the patients had a relapse of priapism after embolization, and all the patients who had premorbid normal erectile function showed maintained potency with normal results of NPTR and a mean postoperative IIEF-5 score of 23.5 (range 23 to 24) during the follow-up period. In conclusion, superselective transcatheter embolization is an effective and safe treatment method for high-flow priapism, and it can ensure a high level of preservation of premorbid erectile function.

346 Treatment of High-Flow Priapism With Superselective Transcatheter Embolization in 6 Patients

346 Treatment of High-Flow Priapism With Superselective Transcatheter Embolization in 6 Patients

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.

Management of Postbiopsy Arteriovenous Fistulas in Transplanted Kidneys and Effectiveness of Endovascular Treatment: A Single-center Experience

We sought to evaluate the best therapeutic management of postbiopsy arteriovenous fistulas (AVFs) in transplanted kidneys. Between January 2005 and December 2011, we observed 17 cases of postbiopsy AVF in transplanted kidneys (9 asymptomatic; 8 symptomatic). Asymptomatic cases were managed conservatively, while patients with symptomatic AVF underwent endovascular treatment. We used a technique that consisted in a superselective transcatheter embolization of the afferent branch. We evaluated the technical success (postoperative closure of AVF), the immediate clinical efficacy (cessation of symptoms), and clinical efficacy at follow-up (measurement of serum creatinine at 7 days and 6 and 12 months compared with preoperative levels using t-tests). Asymptomatic AVFs resolved spontaneously, while the endovascular treatment in symptomatic AVFs showed a complete technical and clinical success with prompt remission of the presented symptoms. We observed a statistically significant reduction in serum creatinine at 7 days and 6 and 12 months postoperatively (mean creatinine--preoperative: 3.23 ± 1.4 mg/dL; 7 days: 2.25 ± 0.8 mg/dL; 6 months: 1.65 ± 0.28 mg/dL; 12 months: 1.4 ± 0.26 mg/dL; in all cases P < 0.05). In our experience, asymptomatic AVFs could be managed conservatively with close follow-up while the endovascular treatment for symptomatic AVFs is both safe and effective in the short- and long-term.

Successful arterial embolization of a giant pseudoaneurysm of the gastroduodenal artery secondary to chronic pancreatitis with literature review

We report a case of an uncommon giant pseudoaneurysm of the gastroduodenal artery secondary to chronic pancreatitis. It presented with a perfused volume of 17.3 cm(3) close to the branch-off of the right hepatic artery. Superselective transcatheter embolization including interlocking detachable coils and a mixture of Ethibloc and Lipiodol was our technique of choice. Following the procedure, the patient was in hemodynamically stable condition. At that time, he was free of any clinical symptoms and showed no further signs of bleeding or ischaemia. Additionally, we present an overview of the relevant literature.

Quinckeʼs Triad: A Rare Complication of a Common Outpatient Procedure

Purpose: We describe the case of a 64 year old male who presented to our hospital with RUQ pain five days after ultrasound-guided liver biopsy at an outside hospital. The pain was intermittent, sharp and worsened by deep breathing and movement. It was associated with black stool, pruritus and dark urine. He was found to have icteric sclera and mild pallor. His abdomen was soft, non-distended and mildly tender in the RUQ. Rectal exam was positive for melenic stool. Lab results revealed an elevated total bilirubin of 8 mg/dl along with elevated amylase and lipase of 4022 and 3957 U/L respectively. AST, ALT and ALP were elevated at 264, 118 and 269 U/L respectively. Hemoglobin was marginally decreased at 10.4 g/dL. Stool was heme positive and urine positive for urobilinogen and bilirubin. Abdominal ultrasound showed echogenic matter in the gallbladder suspicious for blood. On upper endoscopy blood was seen in the second part of the duodenum with a clot adherent to the ampulla of Vater. Upon irrigation, the clot was removed and there was active bleeding from the common bile duct. Hepatic angiography was done however the culprit vessel could not be found despite two separate attempts by two separate interventional radiologists. After staying ten days and receiving fourteen units of blood, the hemobilia resolved spontaneously and the patient was discharged. DISCUSSION: Hemobilia was first published by Francis Glisson in 1654. Its incidence after liver biopsy has been reported as less than one in a thousand. The first case of hemobilia following liver biopsy was reported in 1967. It is usually due to bleeding from an intrahepatic branch of the hepatic artery into a biliary duct. The time between liver biopsy and onset of hemobilia averages about five days. In 1870, Heinrich Quincke described the triad of jaundice, biliary colic and gastrointestinal bleeding in a patient with a ruptured hepatic artery aneurysm who developed hemobilia. This triad only presents in 22% of cases. The first report of acute pancreatitis attributed to hemobilia came in 1975 as a complication of a percutaneous transhepatic cholangiogram. Management of hemobilia involves careful observation and early consultation with the interventional radiologist. The technique of choice is superselective transcatheter embolization using metallic coils with polyvinyl alcohol beads. The success rate is approximately 95% and it avoids hepatic artery ligation. Fortunately, in our patient, there was spontaneous cessation of bleeding and follow-up revealed no further episodes of bleeding.

Posttraumatic high-flow priapism in children treated with autologous blood clot embolization: long-term results and review of the literature

Usually high-flow priapism is caused by perineal or penile blunt trauma with direct cavernosal artery injury and formation of an arterial-lacunar fistula. Rarely, cavernosal artery injury may result from penetrating trauma. Treatment of high-flow priapism is not considered an emergency because patients are at low risk for permanent complications. For this type of priapism there are several options for treatment including embolization or surgical ligation. To describe the technique of superselective transcatheter embolization with the use of autologous blood clot and to discuss the long-term results. Seven children with a mean age of 10 years suffering from high-flow priapism were treated with superselective transcatheter embolization with autologous blood clot. In all cases, colour Doppler US was performed to demonstrate increased cavernous blood flow with definitive diagnosis established by superselective arteriography. After the angiographic diagnosis, superselective transcatheter embolization of the fistula with autologous blood clot was performed during the same session. The children were followed up on a monthly basis up to 1 year with clinical findings and penile colour Doppler US examinations. After 1 year, they were followed up annually with clinical assessment only. The mean follow-up period was 6.0 years. Following embolization complete detumescence was achieved in all but one child, who was treated with a second embolization 3 d after the initial session. In addition, for one child a second session of embolization was performed due to the recurrence of partial erection during the 1 week period after the initital embolization. In both cases, complete detumescence was achieved after the second embolization, and no recurrence of priapism was observed in the follow-up period. Selective arterial embolization with autologous clot achieved treatment for high-flow priapism in this study with 100% occlusion rate with a maximum of two sessions and no signs of erectile dysfunction were observed in any of the children during long-term follow-up.

Abstract No. 163: Role of Superselective Renal Tumors Transcatheter Embolization Before Laparoscopic Partial Nephrectomy. Methods, Safety and Efficacy

Abstract No. 163: Role of Superselective Renal Tumors Transcatheter Embolization Before Laparoscopic Partial Nephrectomy. Methods, Safety and Efficacy

Posttraumatic Nonischemic Priapism Treated with Autologous Blood Clot Embolization

High-flow arterial priapism is rare and characterized by a prolonged nonpainful erection. Autologous clot embolization allows complete resolution of the problem in most of the cases. To review our experience with superselective transcatheter embolization in the treatment of nonischemic priapism. Advances in the understanding of the nonischemic priapism with the aid of newer techniques have altered the current management of nonischemic priapism. Between 2002 and 2006, 11 patients underwent superselective transcatheter embolization of nonischemic priapism with blunt trauma to the penis or perineum. All patients underwent diagnostic evaluation with color-flow Doppler ultrasound and superselective pudendal arteriography, revealing bilateral arteriocorporal fistula and pseudoaneurysm in two cases, bilateral arteriocorporal fistula in one case, unilateral arteriocorporal fistula in one case, and unilateral arteriocorporal fistula and pseudoaneurysm in seven cases. Autologous blood clot was used as an embolization agent in all cases combined with microcatheter guidance. The procedure was technically successful in all cases. In three (27.2%) cases, a second embolization was required due to recurrence of priapism. In all patients, erectile function was restored within 6 weeks of the procedure. Follow-ups at 6 and 12 months after the last procedure revealed that full erectile capacity was restored in 10 of 11 patients, and these patients did not experience further recurrence of priapism. One patient reported a slight decrease in the quality of his penile erection. Our experience revealed that superselective transcatheter embolization and transient occlusion of the fistula with autologous blood clot is an effective therapy for the treatment of nonischemic priapism. Furthermore, recovery of erectile function due to recanalization of the occluded vessel occurred weeks after the procedure.

Treatment of High-flow Priapism with Superselective Transcatheter Embolization in 27 Patients: A Multicenter Study

To evaluate the effectiveness and safety of treatment of high-flow priapism (HFP) with superselective transcatheter embolization at nine university hospitals. Between May 1994 and October 2006, 27 patients underwent superselective embolization of the cavernous artery for HFP. Trauma was apparent in 22 patients, there was self-administered intracavernosal injection for erectile dysfunction in two, and the remaining three did not recall any penile or perineal trauma. The embolic agents used were autologous blood clot (n = 12), gelatin sponge (n = 12), microcoils combined with gelatin sponge (n = 1), polyvinyl alcohol (n = 1), and N-butyl cyanoacrylate (n = 1). Recurrence of priapism and change in erectile function were evaluated during a mean follow-up of 13 months. Differences in results between patients treated with autologous blood clot versus gelatin sponge were statistically analyzed with use of the chi(2) test. In 24 of 27 patients (89%), a single embolization was sufficient for complete resolution of priapism. Repeat embolization was required in two patients (7%), and in the remaining patient (4%), shunt surgery was performed after embolization as a result of HFP coexisting with corporeal venoocclusive dysfunction. Eighteen of 23 patients (78%) who had premorbid normal erectile function showed maintained potency during the follow-up period. There was no significant difference affecting required repeat embolization (P = .537) and change in quality of erection (P = .615) during the follow-up period between the autologous blood clot and gelatin sponge treatment groups. Superselective transcatheter embolization in the treatment of HFP is effective and ensures a high level of preservation of premorbid erectile function.

Gastrointestinale Blutung

Modern imaging modalities such as (multislice) helical CT allow new diagnostic strategies for gastrointestinal hemorrhage. Today, interventional radiology with superselective transcatheter embolization or TIPS procedures allow minimally invasive therapeutic management which can support or replace surgery. This review is a synopsis of the possibilities and relative merits of diagnostic and therapeutic radiological procedures for gastrointestinal bleeding. Which of them to use should be decided collaboratively by gastroenterologist, surgeon, and radiologist depending on local availability, personal experience, and individual patient factors.

Post-traumatic hepatic artery pseudo-aneurysm combined with subphrenic liver abscess treated with embolization

A 23-year-old man with post-traumatic hepatic artery pseudo-aneurysm and subphrenic liver abscess was admitted. He underwent coil embolization of hepatic artery pseudo-aneurysm. The pseudo-aneurysm was successfully obstructed and subphrenic liver abscess was controlled. Super-selective trans-catheter coil embolization may represent an effective treatment for hepatic artery pseudo-aneurysm combined with subphrenic liver abscess in the absence of other therapeutic alternatives.

Treatment of “High-Flow” Priapism with Superselective Transcatheter Embolization: A Useful Alternative to Surgery

To review the efficacy of treatment of high-flow priapism with superselective transcatheter embolization. Over a 2-year period, we reviewed five patients who were treated for traumatic high-flow priapism with superselective embolization. All patients underwent diagnostic angiography that demonstrated a communication between the cavernosal artery and the corpora cavernosa. Each identified fistula was embolized using gel-foam, blood clot, microcoils, or a combination of these. All five patients had successful detumesence of priapism postprocedure. There was normal recurrence of early morning erection with successful detumescence for each patient within a 2- to 4-week period. Two of five patients (40%) presented with recurrence of priapism at 6 months and required a repeat embolization procedure. At 1 year, four of the five patients (80%) had normal erectile function. Superselective transcatheter embolization is a useful therapeutic modality in the treatment of high-flow priapism. It provides equivalent rates of detumesence when compared to surgical techniques, and appears to have a greater success in preserving erectile function.

Polyvinyl alcohol and gelatin sponge particle embolization of splenic artery pseudoaneurysm complicating chronic alcoholic pancreatitis

To assess the effectiveness of and complications associated with polyvinyl alcohol (PVA) and gelatin sponge particles embolization of splenic artery pseudoaneurysm complicating chronic alcoholic pancreatitis. A 42-year-old man with splenic artery pseudo-aneurysm formation secondary to chronic alcoholic pancreatitis was admitted. We used PVA and gelatin sponge particles embolization of splenic artery pseudoaneurysm by superselective embolization techniques. The splenic artery pseudoaneurysm was successfully controlled with splenic embolization. The patient was discharged in 9 d with complete recovery. This case confirms that superselective transcatheter embolization by PVA and gelatin sponge particles may represent an effective treatment for pseudoaneurysm caused by chronic alcoholic pancreatitis in the absence of other therapeutic alternatives.

Lower gastrointestinal haemorrhage and superselective angiographic embolization.

Little information is available in the surgical literature regarding the use of superselective embolization for bleeding with its origin distal to the ligament of Treitz. The outcome of this treatment remains, to some extent, an unknown. The present paper evaluates the Alfred Hospital's experience using superselective transcatheter embolization in the treatment of acute lower gastrointestinal haemorrhage. An uncontrolled case series analysis was undertaken of all 15 patients who underwent arterial embolization for lower gastrointestinal bleeding, defined as distal to the ligament of Treitz, from July 1998 to January 2003 at the Alfred Hospital, Victoria. Transcatheter embolization achieved satisfactory haemostasis in 14 out of 15 patients (93%). Eight patients had rebleeding within 24 h of the initial procedure (53.3%). Two groups of patients emerged: 10 patients who had active bleeding identified on angiography (67%) and five patients whose angiograms failed to find an active bleeding site (33%). Ten per cent of patients with active bleeding observed on angiogram developed bowel ischaemia and 20% died from ischaemia or continued bleeding. Patients without active bleeding identified at the time of angiogram had a proven ischaemia rate of 60% and a 60% mortality rate from continued bleeding or intestinal ischaemia. High-risk patients, with active bleeding identified on angiography, can be successfully treated by superselective angiographic embolization and this appears to be an acceptable alternative to emergency resection. If active bleeding is not identified angiographically embolization is not recommended.

Morphologic and histopathologic changes in the bowel after super-selective transcatheter embolization for focal lower gastrointestinal hemorrhage.

To evaluate the safety of superselective arterial embolization therapy in the lower gastrointestinal tract. The sequelae on normal enteric tissue in lower gastrointestinal arterial embolization were retrospectively reviewed. To control hemorrhage and tumor blood supply, 14 patients were treated by superselective transcatheter embolization at different levels of the colonic and small intestine vessels via the superior and inferior mesenteric arteries using microcoils and/or gelatin sponge. Normal enteric tissues in the embolized areas were analyzed for the occurrence of ischemic changes by clinical follow-up, colonoscopy, and surgery. Normal bowel function was preserved in 13 patients. In 1 patient treated with numerous gelatin sponge particles delivered from the proximal arcade of the superior mesenteric artery, significant muscular fibrosis occurred. Superselective arterial embolization for lower gastrointestinal hemorrhage can be safely performed by minimizing the amount of embolic materials and delivering them as distally as possible.