Transcatheter Arterial Embolization Procedures Research Articles

Preoperative Arterial Embolization of Musculoskeletal Tumors: A Tertiary Center Experience.

The purpose of this study was to report the effectiveness of preoperative transcatheter arterial embolization (TAE) of musculoskeletal tumors in terms of blood loss and functional outcomes. Patients who underwent preoperative TAE of hypervascular musculoskeletal tumors between January 2018 and December 2021 were retrospectively included. The patients' characteristics, TAE procedure details, degree of post-TAE devascularization, surgical outcomes in terms of red blood cell transfusion and functional results were collected. The degree of devascularization was compared between patients who had peri-operative transfusion and those who did not. Thirty-one patients were included. The 31 TAE procedures led to complete (58%) or near-complete (42%) tumor devascularization. Twenty-two patients (71%) had no blood transfusion during surgery. Nine patients (29%) had a blood transfusion, with a median number of red blood cell packs of three (q1, 2; q3, 4; range: 1-4). Eight patients (27%) had complete improvement of the initial musculoskeletal symptoms at the end of the follow-up, 15 (50%) had partially satisfying improvement, 4 (13%) had partially unsatisfying improvement and 3 (10%) had no improvement. Our study suggests that preoperative TAE of hypervascular musculoskeletal tumors allowed for bloodless surgery in 71% of patients and minimal transfusion needs for the remaining 29%.

Transcatheter arterial embolization of the subclavian and axillary artery branches for hemorrhage control.

To evaluate the effectiveness and safety of transcatheter arterial embolization (TAE) of the branches of the subclavian and axillary arteries for hemorrhage control. Between January 2015 and June 2022, 35 TAE procedures were performed for hemorrhage from the branches of the subclavian and axillary arteries in 34 patients (22 men, 12 women; 1 male underwent TAE twice; mean age = 76 years). Pre-TAE CT showed hematomas in the chest (n = 25) and abdominal walls (n = 3), shoulder (n = 2), and lower neck (n = 2). CT showed hemothorax in eight cases. Angiographic findings, embolization technique, and technical and clinical success of TAE were retrospectively assessed in all cases. TAE was performed by transfemoral (n = 16), transradial (n = 12), and transbrachial (n = 7) approaches. Angiography revealed contrast media extravasation or pseudoaneurysms in 32 cases (91.4%). The most commonly embolized arteries were the internal thoracic (n = 12), lateral thoracic (n = 6), and thoracoacromial (n = 6) arteries. Technical and clinical success rates were 100 and 85.7%, respectively. A complication (skin necrosis after injection of the liquid embolic agent) developed in only one patient (2.9%) and was conservatively managed. TAE is an effective and safe treatment for hemorrhage from the branches of the subclavian and axillary arteries. Transfemoral approach has been used for TAE of the branches of the subclavian and axillary artery. Transradial and transbrachial approaches can also be considered.

Transcatheter Arterial Embolization for Palliation of Uterine Body Cancer Bleeding.

This study aimed to evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for bleeding due to uterine body cancer. In this retrospective study, six patients with varying types of uterine body cancer who underwent TAE for bleeding control were investigated. Angiographic findings, cross-sectional images, TAE details, and clinical outcomes were studied. Technical and clinical success rates were calculated. The identified patients had endometrioid adenocarcinoma, sarcoma, and gestational trophoblastic neoplasia, and most were patients with advanced-stage cancer. In four patients, tumor bleeding presented as vaginal bleeding. Technical success was achieved in all seven TAE procedures in six patients. Two patients with recurrent masses who had undergone hysterectomy presented with hematochezia, and TAE was able to provide technical success in these patients as well. The clinical success rate was 50%, indicating bleeding control for > 1 week. Rebleeding was directly associated with death in one patient. On the following day, mild fever was observed in one patient. TAE can be considered an effective and safe method of bleeding control for uterine body cancer, especially during critical periods throughout the disease course of patients with inoperable, advanced-stage cancer.

Inferior vena cava diameter on CT angiography predicts mesenteric angiography positive for extravasation in colonic diverticular bleeding.

Transcatheter arterial embolization (TAE) for colonic diverticular bleeding (CDB), an established procedure for hemostasis, is sometimes complicated by spontaneous hemostasis and unclear bleeding site on angiography despite active arterial bleeding on preoperative computed tomography angiography (CTA). Therefore, to investigate and increase the feasibility of TAE, this retrospective study evaluates the clinical and radiological features related to positive extravasation on angiography. Sixty CDB patients with extravasation on CTA underwent TAE between January 2011 and February 2021 and were divided into extravasation-positive (P-group; n = 25) and -negative groups (N-group; n = 35) based on the superior or inferior mesenteric angiography. Patient characteristics, laboratory findings, the diameter of the inferior vena cava (IVCD), the diameter of superior and inferior mesenteric veins, and technical outcomes were evaluated. TAE was successful in 24 patients in the P-group (96%) and 14 in the N-group (40%) (p < 0.001). Univariate analysis revealed "usage of anticoagulant" (p < 0.05) and "larger IVCD (p < 0.05) on preoperative CTA" to be significant predictors of positive extravasation. In the multivariate analysis, IVCD remained significant with an adjusted odds ratio of 1.17. The IVCD cutoff value was 13.6mm (area under the curve = 0.72, sensitivity = 84.0%, specificity = 54.3%). There were no significant differences in other parameters. Measurement of IVCD in CDB with the cutoff value of 13.6mm can be a simple and useful indicator to predict the detectability of extravasation following TAE procedures.

Transcatheter arterial embolization for bleeding from the pancreaticoduodenal artery in patients with celiac artery stenosis: A technical report

BackgroundTranscatheter arterial embolization (TAE) is widely accepted as a treatment for bleeding from the pancreaticodoudenal artery (PDA) in patients with celiac artery stenosis. However, the technical aspect of TAE has not received much attention.PurposeTo report the technical details and success rate of TAE for bleeding from the PDA in patients with CA stenosis.Material and MethodsBetween 2015 and 2021, nine TAE procedures were performed in eight patients (five women, three men; one woman underwent TAE twice). The cause of CA stenosis was compression by the median arcuate ligament in eight cases and CA dissection in one case. The cause of bleeding was flow-related aneurysm rupture in six cases. Pre-TAE CT showed a pseudoaneurysm in all cases. The technical details of TAE were recorded, and the success rate was evaluated.ResultsThe technical and clinical success rates were 100%. In six cases, both the CA and superior mesenteric artery (SMA) were cannulated using two parent catheters: a microcatheter advancing to the pseudoaneurysm from the CA (the CA approach) to achieve embolization and another catheter for angiography advancing from the SMA to map the vascular anatomy. In five cases, the CA approach was successfully performed after failed attempts of advancing a microcatheter from the SMA.ConclusionTAE is an effective treatment for bleeding from the PDA in patients with CA stenosis. Using two parent catheters, one for CA cannulation and microcatheter advancement and another for SMA cannulation and vascular mapping, may be a useful technique.

Transcatheter arterial embolization for gastrointestinal bleeding: Clinical outcomes and prognostic factors predicting mortality.

We evaluated clinical outcome and prognostic factors predicting mortality of transcatheter arterial embolization (TAE) for acute gastrointestinal (GI) bleeding. Fifty-nine patients (42 men, 17 women; mean age 66.1 ± 17.0) who underwent 59 TAE procedures for GI bleeding during 2013–2018 were retrospectively evaluated. Clinical outcomes included technical success, adverse events, and rebleeding and mortality rate within 30 days. The technical success rate was 100%. Angiography showed contrast extravasation in 41 (69.5%) patients and indirect signs of bleeding in 16 (27.1%) patients. Two (3.4%) patients underwent prophylactic embolization. TAE-related adverse events occurred in 7 (11.9%) patients; adverse events were more common for mid GI or lower GI bleeding than for upper GI bleeding (22.6% vs 0%, P = 0.007). Rebleeding within 30 days was observed in 22 (37.3%) patients after TAE. Coagulopathy was a prognostic factor for rebleeding (odds ratio [OR] = 3.53, 95% confidence interval 1.07–11.67, P = .038). Mortality within 30 days occurred in 11 (18.6%) patients. Coagulopathy (OR = 24, 95% confidence interval 2.56–225.32, P = .005) was an independent prognostic factor for mortality within 30 days. TAE is an effective, safe, and potentially lifesaving procedure for GI bleeding. If possible, coagulopathy should be corrected before TAE as it may reduce rebleeding and mortality.

Clinical evaluation of transcatheter arterial embolization combined with propranolol orally treatment of infantile hepatic hemangioma.

To assess the efficacy of transcatheter arterial embolization (TAE) plus propranolol treatment for infantile hepatic hemangioma (IHH). A retrospective study of symptomatic IHH and hemodynamic changes in IHH was conducted between 2016 and 2019. There were five boys and seven girls with diffuse lesions (n = 7) and multifocal lesions (n = 5). Hepatomegaly and abdominal distension (n = 6) were the predominant clinical presentations. Seven patients (58.3%) had multiple cutaneous hemangiomas. Pulmonary arterial hypertension, heart failure (n = 4), and hypothyroidism (n = 4) were observed. A total of 17 TAE procedures were performed in 12 IHH cases, with a technical success rate of 100%. All patients received standard propranolol orally, and one patient was orally administered metacortandracin. Two patients died of heart failure and multiple organ dysfunction caused by an enlarged liver. In addition, one patient was not reexamined after discharge. Of the remaining nine children, the average follow-up time was 10.78months (range 2-28months), and they all responded well to TAE combined with oral propranolol. TAE combined with propranolol is safe and effective for the treatment of IHH, demonstrating low complication rates.

Urgent Transcatheter Arterial Embolization for Wunderlich Syndrome With Hypovolemic Shock Secondary to Ruptured Renal Angiomyolipoma.

Purpose: Wunderlich syndrome (WS) with hypovolemic shock secondary to ruptured renal angiomyolipoma (rAML) represents an urgent condition. Hence, we reported our experience with transcatheter arterial embolization (TAE) using different embolic materials under this condition.Methods: This retrospective study consisted of 22 patients. Embolic materials including particles, microcoils, and liquid embolic agents were selectively used based on the decisions of interventional radiologists. Technical success was defined as the complete occlusion of bleeding vessels on the final renal angiogram. Clinical success was defined as the absence of re-hemorrhage needed for repeat endovascular or surgery treatment after TAE.Results: The articulated materials were used when WS presented without aneurysms; a combination of particulate materials and microcoils or Glubran 2 alone were used for WS with aneurysms. The technical success based on 24 episodes of TAEs in 22 patients was 100% (24 of 24). Repeat TAE was achieved in two patients with hemorrhages re-occurring two days after the initial embolization with microcoils alone. The clinical success was 90.9% (20 of 22). No nontarget embolization or embolization-related complications occurred during the TAE procedure. Of the patients, 27.3% (6 of 22) experienced minor complications of post-embolization syndrome (PES). During a median follow-up time of 34 months, no recurrent hemorrhage that required repeat endovascular or surgical treatment for hemostasis occurred.Conclusion: Urgent TAE with the selective use of different embolic materials is an effective alternative to control WS with hypovolemic shock secondary to ruptured rAML. The condition of presenting with or without aneurysms may determine the embolic materials employed.

Efficacy of superselective transcatheter arterial embolization for intractable postpartum hemorrhage due to genital tract trauma after vaginal delivery

PurposeTo evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery.MethodsWe evaluated 27 patients who underwent TAE for intractable PPH due to GTT after vaginal delivery at our institution between January 2008 and December 2020. Patients were divided into two groups according to TAE procedure; TAE performed as close as possible to the bleeding point, at least more peripherally than the second branch of the anterior division of the internal iliac artery, was defined as superselective TAE (S-TAE). TAE performed from the proximal segment of the internal iliac artery was defined as proximal TAE (P-TAE). Patient characteristics, pre-procedural contrast-enhanced computed tomography (CE-CT), procedure details, technical/clinical success, and complications were evaluated separately for the S-TAE and P-TAE groups.ResultsThe combined technical/clinical success rate was 92%. No major procedure-related complications were seen (mean follow-up: 6.12 ± 3.93 days). The combined technical/clinical success rate of S-TAE was 100% and of P-TAE was 67% (p = 0.04). S-TAE was performed more frequently in patients with pre-procedural CE-CT (p = 0.01) and use of permanent embolic materials (p = 0.003).ConclusionS-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE.

Post-contrast Acute Kidney Injury Following Emergency Transcatheter Arterial Embolization for Uncontrollable Postpartum Hemorrhage.

The aim of this study was to investigate the incidence of post-contrast acute kidney injury (PC-AKI) in patients with uncontrollable postpartum hemorrhage undergoing emergency transcatheter arterial embolization (TAE). Data collected included patient characteristics, serum creatinine (SCr) level before and after TAE, iodine quantity of contrast media, time between computed tomography and TAE, diabetes mellitus, hemorrhage volume, and blood transfusion volume. For the diagnosis of PC-AKI, the criteria of the European Society of Urogenital Radiology Guidelines (version 10.0) were used. A total of 71 TAE procedures were performed over a 5-year period, and 47 patients met the inclusion criteria. Preprocedural renal function and change of SCr were positively correlated (P < .001), although no patients met the PC-AKI criteria and none showed renal impairment on the follow-up examination (95% upper confidence limit = 6.2%). Total iodine quantity was not correlated with SCr change. Postpartum hemorrhage was finally controlled in all 47 patients, and they were subsequently discharged. In conclusion, emergency TAE for patients with uncontrollable postpartum hemorrhage was a safe and effective procedure, not only in terms of bleeding-related and other outcomes but also with respect to the risk of PC-AKI.

Evaluation of Transcatheter Arterial Embolization in Treating Gastrointestinal Bleeding Due to Angiodysplasia: A Retrospective Study on Twelve Cases

Background: Angiodysplasia (AD) is a common cause of otherwise unexplained gastrointestinal bleeding and anemia and it increases in frequency with aging. Objectives: To investigate the safety and efficacy of transcatheter arterial embolization (TAE) in treating gastrointestinal bleeding caused by angiodysplasia. Patients and Methods: A total of 12 patients (five men, seven women; mean age: 50 ± 18 years; range: 31 - 82 years) with gastrointestinal bleeding, who had failed after endoscopic therapy and were not eligible for surgery, were treated via TAE. The presentations of patients included hematemesis (n = 2), melena (n = 7), and hematochezia (n = 5). The details of procedures and follow-up records were reviewed. Results: The procedures of TAE were performed using poly vinyl alcohol particles and/or coils. The procedures were achieved and the hemorrhage was controlled in all cases. In three patients, the small AD lesions were not found during the first session of angiography, but were instead detected on the repeated angiography conducted one week later. All the patients were discharged without any severe complications. No rebleeding occurred within 30 days following the embolization. Hemorrhage recurred in two patients within one year after hospital discharge. TAE procedures were performed once more using microcoils, and the bleeding was controlled. Conclusion: For the patients with refractory and repeated gastrointestinal hemorrhage due to angiodysplasia, TAE seems to be an effective alternative option when endoscopic examination and treatment do not work.

MP52-10 VOLUME REDUCTION OF POLYCYSTIC KIDNEYS AFTER EMBOLIZATION AS AN ALTERNATIVE TO NEPHRECTOMY BEFORE KIDNEY TRANSPLANTATION

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II (MP52)1 Apr 2020MP52-10 VOLUME REDUCTION OF POLYCYSTIC KIDNEYS AFTER EMBOLIZATION AS AN ALTERNATIVE TO NEPHRECTOMY BEFORE KIDNEY TRANSPLANTATION Francisco Gómez-Palomo*, Saturnino Luján Marco, Enrique Broseta Rico, José Martínez-Rodrigo, Daniel Pérez-Enguix, Raul García-Marcos, Jordi Espí Reig, and Francisco Boronat Tormo Francisco Gómez-Palomo*Francisco Gómez-Palomo* More articles by this author , Saturnino Luján MarcoSaturnino Luján Marco More articles by this author , Enrique Broseta RicoEnrique Broseta Rico More articles by this author , José Martínez-RodrigoJosé Martínez-Rodrigo More articles by this author , Daniel Pérez-EnguixDaniel Pérez-Enguix More articles by this author , Raul García-MarcosRaul García-Marcos More articles by this author , Jordi Espí ReigJordi Espí Reig More articles by this author , and Francisco Boronat TormoFrancisco Boronat Tormo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000914.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Autosomal dominant polycystic kidney disease (ADPKD) is responsible for progressive end-stage renal disease (ESRD). In the event of a massive enlargement of a polycystic kidney, renal transplantation surgery may be hindered due to the limited pelvic space. In such cases a radical nephrectomy prior to renal trasplantation is warranted. Recently, transcatheter arterial embolization (TAE) has been described as an alternative to nephrectomy. Our objective was to evaluate the safety and efficacy of TAE procedures on long-term kidney volume reduction in a group of patients with ADPKD before renal transplantation. METHODS: Between January 2016 and December 2018, 16 patients with ESRD and ADPKD were prospectively recruited in the transplant clinic. Patients under 18 years were excluded. Informed consent was obtained from all participants. All procedures were carried out according to the ethical standards of the institutional and national research committee. All TAE procedures were performed under local anesthesia and sedation and using cyanoacrylate as embolic agent. The renal volume evaluation was made with a computer tomography (CT) scan and physical examination. Follow up was made with CT scan at 6 and 12 months after TAE. The variables collected were: age, gender, size, renal volume measured by volumetry, the visual analog scale (VAS) for pain and complications. A descriptive statistical analysis was made. RESULTS: A total of 16 patients (9 men and 7 women) were included. The average age was 52.38 (± 9.19) years. The average hospital stay was 2.71 (± 1.32) days. Eleven patients presented with mild complications, mainly postoperative pain (Clavien-Dindo I). The average score on the VAS scale was 3.38 (± 2.46) points. Only one patient presented a partial embolization of the renal artery, which was solved by a new TAE with cyanoacrylate and a coil. Before embolization average kidney volume was 2509.08 ± 946.7 cc. Six months later volume was 1303.71 ± 836.2 cc and 12 months later 1098.41 ± 684.9 cc (Image 1). The reduction in renal volume after TAE was of 48.05% at 6 months and 56.22% at 12 months. Of these patients, 9 (56.25%) have received a kidney transplant without problem of space. CONCLUSIONS: In patiens with ADPKD, TAE is a safe and effective alternative to nephrectomy before renal transplantation. Source of Funding: The authors received no specific funding for this work. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e775-e776 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francisco Gómez-Palomo* More articles by this author Saturnino Luján Marco More articles by this author Enrique Broseta Rico More articles by this author José Martínez-Rodrigo More articles by this author Daniel Pérez-Enguix More articles by this author Raul García-Marcos More articles by this author Jordi Espí Reig More articles by this author Francisco Boronat Tormo More articles by this author Expand All Advertisement PDF downloadLoading ...

Hemorrhagic complications after percutaneous nephrolithotomy: angiographic diagnosis and management by transcatheter arterial embolization.

ObjectiveTo identify the main hemorrhagic complications after percutaneous nephrolithotomy, as well as the results obtained with transcatheter arterial embolization (TAE) at an interventional radiology center.Materials and MethodsThis was a retrospective analysis of patients undergoing TAE for the treatment of hemorrhagic complications after percutaneous nephrolithotomy. All patients underwent computed tomography angiography (CTA).ResultsWe evaluated a total of nine patients. At emergency department readmission, the most common symptom was macroscopic hematuria, which was seen in five patients. Three patients had an isolated pseudoaneurysm, two had a pseudoaneurysm together with active bleeding (perirenal hematoma), and one had a pseudoaneurysm together with arteriocalyceal fistula. Arteriovenous fistula was diagnosed in three patients and was not seen in combination with other vascular lesions. We did not identify arteriocalyceal fistula in isolation. Five patients underwent TAE with 6 × 15 mm and 6 × 20 mm microcoils. Four patients underwent TAE with n-butyl-2-cyanoacrylate and ethiodized oil. Follow-up CTAs revealed no complications.ConclusionBecause of its high diagnostic accuracy, CTA provides the interventional radiologist with valuable data for individualized therapeutic planning. The TAE procedure is safe and effective. It can therefore be used as a first-line treatment for hemorrhagic complications resulting from percutaneous renal procedures.

Transcatheter arterial embolization for postoperative arterial complications after pelvic or hip surgery

We aimed to study the technical and clinical outcome of urgent transcatheter arterial embolization (TAE) for postoperative arterial complications after pelvic or hip surgery, and to accumulate additional experience about the role of embolization for these injuries. Patients who received TAE procedure for arterial complications after pelvic or hip surgery between September 1st, 2002 and December 1st, 2014 were screened on medical records and included in the analysis. Angiographic findings included active contrast agent extravasation, pseudoaneurysm formation, arteriovenous fistula, and other suspicious signs such as sighting of coarse margin or distortion of vessels. Embolic agents consisted of coils, gelatin sponge, and polyvinyl alcohol. Technical success was defined as complete occlusion of targeted artery through angiography, and clinical success as sustained resolution of symptoms. A total of 22 patients (15 males, 19-76 years old) were enrolled. Prior to TAE, 12 patients developed hemorrhagic shock and the remaining 10 patients had hemorrhage-related pain, hematoma, or anemia. Contrast agent extravasation occurred in 12 cases, pseudoaneurysm formation in 5 cases, and other suspicious signs in 5 cases. Injury occurred in the internal iliac artery stem in 6 cases, inferior gluteal artery in 6 cases and superior gluteal artery in 6 cases. Multiple vascular lesions appeared in 5 cases. After TAE, technical success occurred in 22 patients and clinical success in 21 patients (95.5%). A 36-year-old woman died of irreversible multiple organ failure; no other severe procedure-related complications were recorded. TAE is safe and effective for postoperative arterial complications after pelvic or hip surgery.

Novel transcatheter arterial embolization method for hemodynamically unstable pelvic fractures to prevent complications of gluteal necrosis

PurposeTo validate our previously designed transcatheter arterial embolization (TAE) technique for bilateral iliac arteries in unstable pelvic fractures, which is designed to also prevent gluteal necrosis and avoid vasopressors.MethodsWe retrospectively analyzed the data of patients with pelvic fractures who underwent our new TAE procedure to determine the incidence of subsequent gluteal necrosis. We also compared certain variables between patients who underwent TAE before 2005 using a different technique and developed gluteal necrosis and patients who underwent TAE in 2005 and onward using our technique. Gluteal necrosis was confirmed by a radiologist based on imaging findings.ResultsSeventy patients with pelvic fractures who underwent our TAE technique met the inclusion criteria (bilateral iliac arterial embolization and no embolic agent other than a gelatin sponge). Patients’ median age was 47.5 years, 33 were male, and 92.9% (65/70) had unstable fractures. Sixty-eight patients had severe multiple trauma. No patients developed gluteal necrosis following our TAE procedure and the overall survival rate was 82.9% (58/70). We found no statistically significant difference in procedure time between the previous and new technique, although the new procedure tended to be shorter. Furthermore, overall survival did not significantly differ between the groups. Multiple regression analysis revealed that TAE procedure time and external pelvic fracture fixation were independently related to gluteal necrosis.ConclusionsOur non-selective bilateral iliac arterial embolization procedure involves arresting shock quickly, resulting in no post-procedure gluteal necrosis. The procedure involves cutting the gelatin sponge rather than “pumping” and avoids the use of vasopressors.

Surgical tactics treatment of the peptic ulcer of the stomach, complicated by bleeding

Currently, endoscopic hemostasis is the «gold» standard in the treatment of patients suffering from ulcerative gastroduodenal bleeding. General mortality in ulcerative gastroduodenal bleeding according to the Department of ambulance organization of the research Institute of emergency care. I.I. Dzhanelidze in St. Petersburg in 2016 was 5%, and postoperative8,5%. Transcatheter arterial embolization, due to the development of endovascular hemostasis techniques, is an alternative to palliative surgery in the failure of conservative treatment of ulcerative gastroduodenal bleeding using endoscopic hemostasis techniques, especially in the group of patients with high risk of surgery and adverse outcome. It was found that the reduction in mortality in patients with gastric ulcer bleeding can be achieved by reducing the number of palliative interventions, wider use of angiographic embolization for the prevention and treatment of recurrent bleeding and expanding indications for urgent radical operations outside the recurrence of hemorrhage. The use of transcatheter arterial embolization in elderly patients with severe somatic pathology and recurrent gastric ulcer bleeding can prevent the recurrence of bleeding and perform hemostasis. The success of the transcatheter arterial embolization procedure depends on many factors. Primarily from the anatomical features of the patient. In one case, the patient had a 60% stenosis of the proximal segment of the gastrointestinal splenic trunk, which did not allow the procedure to be performed. Important is the choice of agents for embolization depending on the location and diameter of the source of bleeding. Success also depends on the technical equipment of the hospital and the experience of the surgeon. The absence of significant differences in mortality between the main and control groups, in our opinion, is due to the severity of the General somatic condition of patients included in the study. The obtained results determine the need for further studies to optimize the indications and methods of transcatheter arterial embolization in emergency surgery of gastroduodenal bleeding.

Transcatheter arterial embolization for iatrogenic bleeding after endoscopic ultrasound-guided pancreaticobiliary drainage.

The purpose of this study was to report the incidence of massive bleeding after endoscopic ultrasound-guided transmural pancreaticobiliary drainage (EUS-TPBD) and the clinical outcomes in patients with this condition treated with transcatheter arterial embolization (TAE). We performed a 9-year retrospective analysis of 797 EUS-TPBD procedures (excluding gallbladder or pseudocysts) in 729 patients. Among them, twelve (12/729, 1.65%) patients were referred for TAE to manage active bleeding adjacent to the TPBD sites. There were 8 men and 4 women with a mean age of 66.1 years±13.4 (SD) (range: 45-89 years). The clinical and procedure data of these 12 patients were reviewed. Thirteen TAE procedures in 12 patients were performed. The bleeding sites were the left hepatic artery (n=7), the right hepatic artery (n=3), the left gastric artery (n=1), the left accessory gastric artery (n=1) and gastroduodenal artery (n=1). TAE was performed with gelatin sponge particles (n=1), coil (n=1) and n-butyl-2 cyanoacrylate with/without coils (n=11), with technical and clinical success rates of 100% (13/13) and 85% (11/13), respectively. Re-bleeding following embolization with gelatin sponge particles occurred in one patient. Procedure-related ischemic hepatitis was observed in another patient with pancreatic cancer with portal vein involvement. On the basis of our results, TAE using n-butyl-2 cyanoacrylate seems safe and effective for the treatment of bleeding after EUS-TPBD procedures. When the portal vein is compromised, TAE of the hepatic artery can cause ischemic liver damage.

Transcatheter Arterial Embolization for Gastrointestinal Bleeding Secondary to Gastrointestinal Lymphoma.

To evaluate the effectiveness of transcatheter arterial embolization (TAE) for gastrointestinal (GI) bleeding caused by GI lymphoma. The medical records of 11 patients who underwent TAE for GI bleeding caused by GI lymphoma between 2001 and 2015 were reviewed retrospectively. A total of 20 TAE procedures were performed. On angiography, contrast extravasation, and both contrast extravasation and tumor staining were seen in 95% (19/20) and 5% (1/20) of the procedures, respectively. The most frequently embolized arteries were jejunal (n=13) and ileal (n=5) branches. Technical and clinical success rates were 100% (20/20) and 27% (3/11), respectively. The causes of clinical failure in eight patients were rebleeding at new sites. In four patients who underwent repeat angiography, the bleeding focus was new each time. Three patients underwent small bowel resection due to rebleeding after one (n=2) or four (n=1) times of TAEs. Another two patients underwent small bowel resection due to small bowel ischemia/perforation after three or four times of TAEs. The 30-day mortality rate was 18% due to hypovolemic shock (n=1) and multiorgan failure (n=1). Angiogram with TAE shows limited therapeutic efficacy to manage GI lymphoma-related bleeding due to high rebleeding at new sites. Although TAE can be an initial hemostatic measure, surgery should be considered for rebleeding due to possible bowel ischemic complication after repeated TAE procedures.

Preliminary investigation of the dissolution behavior, cytocompatibility, effects of fibrinogen conformation and platelet adhesion for radiopaque embolic particles.

Experimental embolic particles based on a novel zinc-silicate glass system have been biologically evaluated for potential consideration in transcatheter arterial embolization procedures. In addition to controlling the cytotoxicity and haemocompatibility for such embolic particles, its glass structure may mediate specific responses via dissolution in the physiological environment. In a 120 h in-vitro dissolution study, ion release levels for silicon (Si4+), sodium (Na+), calcium (Ca2+), zinc (Zn2+), titanium (Ti4+), lanthanum (La3+), strontium (Sr2+), and magnesium (Mg2+), were found to range from 0.04 to 5.41 ppm, 0.27–2.28 ppm, 2.32–8.47 ppm, 0.16–0.20 ppm, 0.12–2.15 ppm, 0.16–0.49 ppm and 0.01–0.12 ppm, respectively for the series of glass compositions evaluated. Initial release of Zn2+ (1.93–10.40 ppm) was only evident after 120 h. All compositions showed levels of cell viabilities ranging from 61.31 ± 4.33% to 153.7 ± 1.25% at 25%–100% serial extract dilutions. The conformational state of fibrinogen, known to induce thrombi, indicated that no changes were induced with respect of the materials dissolution by-products. Furthermore, the best-in-class experimental composition showed equivalency to contour PVA in terms of inducing platelet adhesion. The data generated here provides requisite evidence to continue to in-vivo pre-clinical evaluation using the best-in-class experimental composition evaluated.

Detecting active pelvic arterial haemorrhage on admission following serious pelvic fracture in multiple trauma patients

BackgroundThe early diagnosis of pelvic arterial haemorrhage is challenging for initiating treatment by transcatheter arterial embolization (TAE) in multiple trauma patients. We use an institutional algorithm focusing on haemodynamic status on admission and on a whole-body CT scan in stabilized patients to screen patients requiring TAE. This study aimed to assess the effectiveness of this approach. MethodsThis retrospective cohort study included 106 multiple trauma patients admitted to the emergency room with serious pelvic fracture [pelvic abbreviated injury scale (AIS) score of 3 or more]. ResultsOf the 106 patients, 27 (25%) underwent pelvic angiography leading to TAE for active arterial haemorrhage in 24. The TAE procedure was successful within 3h of arrival in 18 patients. In accordance with the algorithm, 10 patients were directly admitted to the angiography unit (n=8) and/or operating room (n=2) for uncontrolled haemorrhagic shock on admission. Of the remaining 96 stabilized patients, 20 had contrast media extravasation on pelvic CT scan that prompted pelvic angiography in 16 patients leading to TAE in 14. One patient underwent a pelvic angiography despite showing no contrast media extravasation on pelvic CT scan. All 17 stabilized patients who underwent pelvic angiography presented a more severely compromised haemodynamic status on admission, and they required more blood products during their initial management than the 79 patients who did not undergo pelvic angiography. The incidence of unstable pelvic fractures was however comparable between the two groups. Overall, haemodynamic instability and contrast media extravasation on the CT-scan identified 26 out of the 27 patients who required subsequent pelvic angiography leading to TAE in 24. ConclusionsAn algorithm focusing on haemodynamic status on arrival and on the whole-body CT scan in stabilized patients may be effective at triaging multiple trauma patients with serious pelvic fractures.