Transcatheter Arterial Embolization For Treatment Research Articles

Transcatheter Arterial Embolization in the Treatment of Abdominal Bleeding in Patients Being Treated with Open Abdomen Due to Duodenal Fistula.

This study aimed to investigate the transcatheter arterial embolization (TAE) in treatment of abdominal bleeding in patients being treated with open abdomen due to duodenal fistula. This was a retrospective study performed at our center. From January 2005 to November 2010, all patients with abdominal bleeding were treated with surgical hemostasis (SH) and included in SH group. From January 2012 to December 2018, all patients with a bleeding were treated with TAE and included in the TAE group. Clinical data were reviewed and compared between the two groups. The effect of TAE in the management of abdominal bleeding was evaluated. A total of 131 patients were enrolled, and there were 64 in the SH group and 67 in the TAE group. The success rate of hemostasis was higher in the TAE group (89.55% vs. 73.44%, adjusted OR = 4.065, 95% CI 1.336-12.336, P = 0.013). Moreover, the recognition rate of hemorrhagic vessels in the TAE group was higher (91.04 vs. 51.56; P < 0.001). The re-bleeding occurred in 20 patients, 7(11.67%) in the TAE group and 13(27.66%) in the SH group. The re-bleeding rate in SH group was higher (adjusted HR = 2.564, 95% CI 1.023-6.428, P = 0.045) CONCLUSIONS: TAE is an effective method in treatment of abdominal bleeding in patients being treated with open abdomen due to duodenal fistula.

In-hospital mortality associated with transcatheter arterial embolization for treatment of hepatocellular carcinoma in patients on hemodialysis for end stage renal disease: a matched-pair cohort study using a nationwide database.

Objectives:No previous study has evaluated the risks associated with transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma in patients on hemodialysis (HD) for end stage renal disease (ESRD), because invasive treatment is rarely performed for such patients. We used a nationwide database to investigate in-hospital mortality and complication rates following TACE in patients on HD for ESRD.Methods:Using the Japanese Diagnosis Procedure Combination database, we enrolled patients on HD for ESRD who underwent TACE for hepatocellular carcinoma. For each patient, we randomly selected up to four non-dialyzed patients using a matched-pair sampling method based on the patient’s age, sex, treatment hospital, and treatment year. In-hospital mortality and complication rates were compared between dialyzed and non-dialyzed patients following TACE.Results:We compared matched pairs of 1551 dialyzed and 5585 non-dialyzed patients. Although the complication rate did not differ between the dialyzed and non-dialyzed ESRD patients [5.7% vs 5.8%, respectively; odds ratio, 0.99; 95% confidence interval (0.79–1.23); p = 0.90], the in-hospital mortality rate was significantly higher in dialyzed ESRD patients than in non-dialyzed patients [2.2% vs 0.97%, respectively; odds ratio, 2.21; 95% confidence interval (1.44–3.40); p < 0.001]. Among the dialyzed patients, the mortality rate was not significantly associated with sex, age, Charlson comorbidity index, or hospital volume.Conclusions:The in-hospital mortality rate following TACE was 2.2 % and was significantly higher in dialyzed than in non-dialyzed ESRD patients. The indications for TACE in HD-dependent patients should be considered carefully with respect to the therapeutic benefits v s risks.Advances in knowledge:In hospital mortality rate following TACE in dialyzed patients was more than twice compared to non-dialyzed patients. Post-procedural complication following TAE in ESRD onHD patients was 5.7%, and did not differ from that in non dialyzed patients.

Computed Tomography-Guided Radiofrequency Ablation Following Transcatheter Arterial Embolization in Treatment of Large Hepatic Hemangiomas.

The aim of the study was to evaluate the feasibility, safety, and efficacy of computed tomography (CT)-guided radiofrequency (RF) ablation combined with transcatheter arterial embolization (TAE) to treat large (≥10 cm) hepatic hemangiomas.We retrospectively reviewed our sequential experience with 15 large hepatic hemangiomas in 15 patients.The mean diameter of the 15 hemangiomas was 13.0 ± 2.2 cm (10.0–16.0 cm). RF ablation combined with TAE treatment was performed successfully in all patients. The mean diameter of the hemangiomas decreased from 13.0 ± 2.2 to 7.1 ± 2.0 cm (P < 0.001) after TAE treatment. Out of 15 hepatic hemangiomas, 14 (93.3%) showed no enhancement on CT or MRI indicating complete ablation after RF treatment. The mean diameter of the ablation zone decreased to 6.1 ± 2.0 cm 1 month after ablation and further decreased to 4.9 ± 1.6 cm 6 months after ablation. There were 6 complications related to the ablation in 4 patients. According to the Dindo–Clavien classification, all the complications were minor (Grade I).RF ablation combined with TAE is a safe and effective treatment for large hepatic hemangiomas. TAE can improve the disruption of lesion blood supply and reduce lesion size to facilitate subsequent RF ablation and reduce the risk of ablation-related complications.

Transcatheter arterial embolization for treatment of hepatocellular carcinoma in a cat

A 16-year-old 6.8-kg (15-lb) castrated male domestic shorthair cat was evaluated because of a 3 × 6-cm mass in the right medial lobe of the liver. The cat had a history of frequent vomiting and anorexia along with 10% weight loss over the past year. Transcatheter arterial embolization was selected because surgery (standard first-line treatment) was declined and only 1 vessel feeding the tumor was apparent on contrast-enhanced CT. A 4F sheath was placed in the left carotid artery, and a 3.3F guide catheter was advanced into the celiac artery. A 0.014-inch guidewire and 1.7F microcatheter were inserted into the hepatic artery through the guiding catheter and advanced into the feeding vessel. A mixture of polyvinyl alcohol particles and contrast agent was injected for embolization. A hypoechoic area in the tumor was identified on ultrasonography on posttreatment day 6, and necrotic and degenerated cells in the area were identified cytologically. By posttreatment day 71, vomiting had resolved and CT revealed decreased tumor size, but altered attenuation suggested a more solid mass on day 205. No feeding vessel for embolization was found on contrast-enhanced CT, so ultrasonic emulsification to remove the tumor was performed on day 231. No recurrence was seen on contrast-enhanced CT on day 420 or day 721. Findings suggested that transcatheter arterial embolization may be suitable for treating hepatic tumors in cats, but alternative approaches are needed in cats, compared with dogs, owing to anatomic differences.

Application of emergency transcatheter arterial embolization on liver and spleen rupture

Objective To investigate the value of emergency transcatheter arterial embolization in the treat-ment of liver and spleen rupture,in order to provide the reference for clinical therapeutic strategies.Methods In our hospital,58 patients with liver and spleen rupture were selected.Operation time,catheter angiography,embolization of success rate,postoperative survival rates and the postoperative complications were recorded.Then follow-up,patients with sequela of occurrence was recorded.Results Embolizations of 55 cases were successful,3 cases accounted for 94.8%,2 were successful, no embolization failed, the success rate of catheter angiography in the diagnosis was 100.0%.31 cases of arterial embolization for splenic artery,10 cases of hepatic artery,8 cases of right hepatic artery, 2 cases of left hepatic artery.The average operation time was （57.8 ±15.6） min.All the patients were successfully hemostatic,postoperative survival rate was 100.0%for patients.2 cases of postoperative biliary leakage,1 cases with splenic abscess,the incidence of postoperative complications was 5.2%.Recovery of all patients was good,without the occurrence of sequelae.Conclusion Rupture has good clinical efficacy of emergency transcatheter arterial emboliza-tion in treatment of liver and spleen,liver,spleen can be retained in the circumstances,the effective control of hemor-rhage,improve the clinical success rate. Key words: Liver rupture; Splenic rupture; Embolization,therapeutic

Super selective transcatheter arterial embolization for treatment of focal nodular hyperplasia of the liver: report of 21 cases

To evaluate the efficiency and safety of transcatheter arterial embolization (TAE) for treatment of focal nodular hyperplasia (FNH). From January 2005 to December 2010, super selective TAE was performed for 21 patients with FNH. The patients consisted of 16 men and 5 women with age range of 16 to 44 years (mean age, 28 ± 12). Liver contrast enhancement CT and ultrasonography (US) were performed in all patients, dynamic contrast enhancement MRI was performed in 17 patients. All patients underwent percutaneous needle biopsies and the diagnosis of FNH was proven histologically. The indications for TAE were patients with progressive increase in size of FNH, who were not candidates for surgical treatment, or who refused for surgery. Embolic materials used in this series included emulsion of iodized oil and bleomycin and polyvinyl alcohol particle (PVA). Follow-up examinations included the routine blood tests, liver and renal function tests, US, CT or MRI. Eighteen patients (85.7%) had a single solitary focus and 3 (14.3%) had multiple foci. The diameter of the mass varied from 3.5 cm to 9.5 cm with a mean of 5.5 cm (5.5 ± 3.0 cm). All patients presented angiographically with characteristic findings, such as feeding artery that was distributed with a spinning wheel appearance, an extensive hypervascular mass, without arterio-venous shunt or portal vein invasion. A single session of TAE was performed in all patients. Technical success of TAE was achieved in all cases. No major complications were encountered in any of our patients. All patients were regularly followed up ranging from 1 to 6 years (3.5 ± 2.0) and they were healthy without recurrence. Marked reduction in the size of the FNH without arterial blood supply was found in 16 patients, and almost complete resolution of the FNH was observed in 6 patients. TAE is a safe and effective therapy for the management of patients with FNH. TAE could control FNH very well and even could be considered as a radical treatment.

Early Outcomes of Empiric Embolization of Tumor-related Gastrointestinal Hemorrhage in Patients with Advanced Malignancy

To report short-term results of empiric transcatheter embolization for patients with advanced malignancy and gastrointestinal (GI) hemorrhage directly from a tumor invading the GI tract wall. Between 2005 and 2011, 37 mesenteric angiograms were obtained in 26 patients with advanced malignancy (20 men, six women; mean age, 56.2 y) with endoscopically confirmed symptomatic GI hemorrhage from a tumor invading the GI tract wall. Angiographic findings and clinical outcomes were retrospectively evaluated. Clinical success was defined as absence of signs and symptoms of hemorrhage for at least 30 day following embolization. Active extravasation was demonstrated in three cases. Angiographic abnormalities related to a GI tract tumor were identified on 35 of 37 angiograms, including tumor neovascularity (n = 21), tumor enhancement (n = 24), and luminal irregularity (n = 5). In the absence of active extravasation, empiric embolization with particles and/or coils was performed in 25 procedures. Cessation of hemorrhage (ie, clinical success) occurred more frequently when empiric embolization was performed (17 of 25 procedures; 68%) than when embolization was not performed (two of nine; 22%; P = .03). Empiric embolization resulted in clinical success in 10 of 11 patients with acute GI bleeding (91%), compared with seven of 14 patients (50%) with chronic GI bleeding (P = .04). No ischemic complications were encountered. In patients with advanced malignancy, in the absence of active extravasation, empiric transcatheter arterial embolization for treatment of GI hemorrhage from a direct tumor source demonstrated a 68% short-term success rate, without any ischemic complications.

Transcatheter Arterial Embolization for Treatment of Maxillofacial Trauma

Department of Neurosurgery; National Defense Medical College; Saitama, Japan (Takeuchi) Department of Neurosurgery; National Hospital Organization Disaster Medical Center; Tokyo, Japan (Takasato)

Abstract No. 201: Transcatheter arterial embolization of spontaneous life threatening extraperitoneal hemorrhage

The number of patients taking anticoagulants is increasing. Spontaneous extraperitoneal hemorrhage(SEH) is usually due to small vessel disease and thus not amenable to surgical treatment. The largest single study in the current literature addressing Interventional Radiological based treatment of SEH is a case series of 10 patients. The purpose of this study was to evaluate the clinical outcomes of transcatheter arterial embolization for treatment of SEH.

Selective Transcatheter Arterial Embolization for Treatment of Bleeding Complications or Reduction of Tumor Mass of Hepatocellular Adenomas

Hepatocellular adenomas (HCAs) are benign liver lesions which may be complicated by spontaneous intratumoral bleeding, with or without rupture into the abdominal cavity, or malignant degeneration. Recent advances in radiological interventional techniques now offer selective transcatheter arterial embolization (TAE) as an alternative approach to surgery as the initial treatment to stop the bleeding or as an elective treatment to reduce the tumor mass of the HCA. Herein, we report our initial experience using TAE in the management of HCA. Five female patients and one male patient presented with spontaneous hemorrhage of HCA. Four patients were initially treated with selective TAE to stop the bleeding. In two patients in whom the bleeding stopped spontaneously, TAE was electively undertaken 1 year after presentation to reduce the tumor mass of HCAs >5 cm. Selective TAE as initial treatment in patients with spontaneous bleeding of HCA with or without rupture is effective and will change the need for urgent laparotomy to control bleeding. Selective TAE may also be used as an elective treatment to reduce the tumor mass of larger HCAs.

Abnormal Uterine Bleeding Due to Vascular Abnormality Caused by D&amp;E : Doppler Sonography for Diagnosis and Transcatheter Arterial Embolization for Treatment

Abnormal Uterine Bleeding Due to Vascular Abnormality Caused by D&amp;E : Doppler Sonography for Diagnosis and Transcatheter Arterial Embolization for Treatment