Use Of Embolization Research Articles

Embolisation of the renal arteries in the treatment of nephrogenic arterial hypertension

This review article examines the possibilities of surgical treatment of one of the socially significant diseases of modern society - arterial hypertension. The reasons for the development of parenchymal arterial hypertension have been disassembled. The reasons for the development of renovascular hypertension are discussed. Illuminates the pathogenesis of nephrogenic hypertension, statistical data on its prevalence. The issue of embolization of renal arteries in the treatment of nephrogenic arterial hypertension is considered. The forms of nephrogenic arterial hypertension in which the use of embolization is indicated. The etiology and pathogenesis of arterio-venous fistulas of the kidneys are described. Details of the world literature concerning the treatment of arterio-venous fistula and malformations of the kidneys are considered in detail. A review of literature data on materials used in embolisation of renal arteries in patients with arteriovenous fistula and malformations of the kidney is given. The etiology and pathogenesis of arterio-venous malformations of the kidneys are highlighted. The goal of embolization of the renal arteries in the preparation of patients with terminal renal failure and resistant arterial hypertension to kidney transplantation is described. The issue of preoperative preparation of patients before embolization of the renal arteries, the choice of operative access is considered. Methods of embolization of the renal arteries, possible complications and methods of their prevention are described. The data of the world literature concerning application of selective and superselective embolization of renal arteries in patients with parenchymal arterial hypertension are covered. The issue of potential use of renal artery embolization in other forms of nephrogenic arterial hypertension is also highlighted.

Transcatheter Arterial Embolization in the Treatment of Maxillofacial Fractures With Life-Threatening Hemorrhage

Transcatheter arterial embolization (TAE) has gained importance in the management of maxillofacial fractures with life-threating hemorrhage (MFH). However, clinical evidence supporting the use of TAE has not been clearly established in the literature. Therefore, we evaluated the effectiveness of TAE for MFH, based on data obtained from the Japan Trauma Data Bank. Patients were identified from Japan Trauma Data Bank entries for the years 2004 to 2014. Inclusion criteria for MFH were defined using the Abbreviated Injury Scale code (Maxilla fracture, LeFort III; blood loss. > 20%). On the basis of the treatment strategy, patients were categorized into either the TAE group or the non-TAE group. A comparative analysis of the demographics, injury characteristics, and outcomes was performed. From among 198,744 documented cases of trauma, a total 118 patients were eligible for the study; 26 of these patients (22.0%) underwent TAE. The Glasgow Coma Scale score was significantly lower in the TAE group than in the non-TAE group (P = 0.019); the other variables did not significantly differ between the groups. Overall, the in-hospital mortality rate was 39.8%, and the median hospital length of stay was 21.0 days (0.0-53.5 days). The in-hospital mortality was significantly lower in the TAE group than in the non-TAE group (23.1% vs 44.6%; odds ratio [OR], 0.37; 95% confidence interval [CI], 0.14-1.02; p = 0.048). However, patients in the TAE group had a longer median hospital length of stay (39.5 [7.3-53.5] vs 14.0 [0.0-55.3] days, p = 0.072). In the logistic regression model, the use of TAE was extracted as the independent predictor for better outcomes after adjusting for potential confounders (OR, 0.32; 95% CI, 0.66-0.88; P = 0.032). Hypotension, a high Injury Severity Score, aged 60 years or older, and a low Glasgow Coma Scale score were also independently associated with mortality, with an OR of 5.48, 3.99, 3.30, and 2.89, respectively. Cases of MFH are rare, but they are associated with a high mortality. Transcatheter arterial embolization use appears to lead to successful outcomes in such cases. Further studies are required to confirm the efficacy of TAE and evaluate its indications and complications.

Palliative Embolization for Refractory Bleeding.

Bleeding is a common and often challenging complication of malignancy. Etiologies of hemorrhage in this patient population vary, and bleeding may present as an acute, life-threatening emergency or a chronic, low-volume blood loss. For patients with advanced malignancies, interventions to manage bleeding must be balanced by the patient's life expectancy and quality of life. As such, minimally invasive procedures such as transarterial embolization are useful therapeutic options in appropriately selected patients. There is a rich history of palliative transarterial embolization for refractory bleeding in cancer patients. This technique was first applied in the 1970s and has since become an established treatment tool for malignancy-related bleeding throughout the body. While the preponderance of published data comprised case reports and small retrospective studies, the use of embolization continues to expand as experience grows and techniques are refined. In this review, we summarize the literature and provide our perspective on embolization for refractory bleeding in cancer patients.

Arterio-biliary fistulas: What to choose as endovascular treatment?

Objectives Endovascular procedures are the treatment of choice in cases of intrahepatic fistulas. Arterio-biliary fistulas are the rarest and most difficult to treat, due to high risk of infection. Methods Eight cases of persistent hemobilia that developed as a result of arterio-biliary fistulas are presented. Five cases developed as a result of iatrogenic injury, two cases as a result of chronic infection, one case as a consequence of trauma. Results Patients were treated using endovascular embolization or combined endovascular and endoscopic biliary tract revision. The results were monitored after six to seven days and one month after embolization. The embolizations were considered effective in all cases. One patient had four asynchronous fistulas requiring separate treatments sessions. Four patients required a revision of their biliary ducts after embolization and restoration of patency. In one patient, a migration of the coil to biliary ducts occurred. Conclusion Endovascular treatment of arterio-biliary fistulas is safe and effective. The use of embolization with soft and biodegradable materials like histoacrylic glue or thrombin may be the optimal method of treatment in comparison with coils which have a risk of migration or chronic infection.

Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit

ObjectiveLower GI bleeding (LGIB) is a common reason for emergency hospital admission, although there is paucity of data on presentations, interventions and outcomes. In this nationwide UK audit, we describe...

EMBOLIZATION AND CHEMOEMBOLIZATION PROSTATIC ARTERIES OF BENIGN PROSTATIC HYPERPLASIA AND PROSTATE CANCER

The article gives the results of the use of embolization of prostatic arteries in benign prostatic hyperplasia in 3 patients, two of whom have been with suprapubic drainage of the bladder. The patient was 120 ml without suprapubic drainage of the bladder residual urine. The age of patients was 68 to 70 years. According TRUS, the average prostate volume was 86.0 ± 12.6 cm3 . 4 patients» superselective prostatic artery chemoembolization was performed in prostate cancer. Chemicals for carrying out this procedure served adriamycin at a dose of 50 mg. Two of the four patients with prostate cancer was hormone-resistant form. Three patients had PCa T3b N0M0 stage T2bN0M0 histologically verified number Gleason 7, 7, 8, 9. All four had difficulty urinating, the amount of residual urine was 54 to 98 ml. As a source of transportation used chemotherapy microspheres (gepasfery) size of 300–500 microns. Treatment outcomes assessed at one month. The efficiency of the methods for the treatment of benign prostatic hyperplasia and prostate cancer in the form of return of spontaneous urination, decrease in residual urine, reducing the prostate-specific antigen.

Hemorrhagic Complications of Percutaneous Cryoablation for Renal Tumors: Results from a 7-year Prospective Study.

Cryoablation of renal tumors is assumed to have a higher risk of hemorrhagic complications compared to other ablative modalities. Our purpose was to establish the exact risk and to identify hemorrhagic risk factors. This IRB approved, 7-year prospective study included 261 renal cryoablations. Procedures were under conscious sedation and CT guidance. Pre- and postablation CT was obtained, and hemorrhagic complications were CTCAE tabulated. Age, gender, tumor size, histology, and probes number were tested based on averages or proportions using their exact permutation distribution. "High-risk" subgroups (those exceeding the thresholds of all variables) were tested for each variable alone, and for all combinations of variable threshold values. We compared the subgroup with the best PPV using one variable, with the subgroup with the best PPV using all variables (McNemmar test). The hemorrhagic complication rate was 3.5%. Four patients required transfusions, two required emergent angiograms, one required both a transfusion and angiogram, and two required bladder irrigation for outlet obstruction. Perirenal space hemorrhage was more clinically significant than elsewhere. Univariate risks were tumor size >2cm, number of probes >2, and malignant histology (P=0.005, 0.002, and 0.033, respectively). Multivariate analysis showed that patients >55years with malignant tumors >2cm requiring 2 or more probes yielded the highest PPV (7.5%). Although older patients (>55years old) with larger (>2cm), malignant tumors have an increased risk of hemorrhagic complications, the low PPV does not support the routine use of embolization. Percutaneous cryoablation has a 3.5% risk of significant hemorrhage, similar to that reported for other types of renal ablative modalities.

Current Strategies for the Treatment of Aneurysmal Bone Cysts.

Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety of treatment methods has been proposed. Traditionally, these tumors were treated with open surgery. Either intralesional surgical procedures or en bloc excisions have been described. Furthermore, a variety of chemical or physical adjuvants has been utilized in order to reduce the risk for local recurrence after excision. Currently, there is a shift to more minimally invasive procedures in order to avoid the complications of open surgical excision. Good results have been reported during percutaneous surgery, or the use of embolization. Recently, sclerotherapy has emerged as a promising treatment, showing effective consolidation of the lesions and functional results that appear to be superior to the ones of open surgery. Lastly, non-invasive treatment, such as pharmaceutical intervention with denosumab or bisphosphonates has been reported to be effective in the management of the disease. Radiotherapy has also been shown to confer good local control, either alone or in conjunction to other treatment modalities, but is associated with serious adverse effects. Here, we review the current literature on the methods of treatment of aneurysmal bone cysts. The indication for each type of treatment along reported outcome of the intervention, as well as potential complications are systematically presented. Our review aims to increase awareness of the different treatment modalities and facilitate decision-making regarding each individual patient.

Effect of a Retrievable Inferior Vena Cava Filter Plus Anticoagulation vs Anticoagulation Alone on Risk of Recurrent Pulmonary Embolism: A Randomized Clinical Trial

In hospitalized patients with acute pulmonary embolism use of a retrievable inferior vena cava filter plus anticoagulation compared with anticoagulation alone does not reduce the risk of symptomatic recurrent pulmonary embolism (PE) at 3 months.

Morphological changes of the liver parenchyma after embolization of the right branch of the portal vein

To determine the morphological changes of the parenchyma of the right and the left lobe of the liver after embolization of the right branch of the portal vein. Material and Methods: Embolization of the right branch of the portal vein was performed in 15 patients. All patients by CT of the abdomen future liver remnant (FLR) sizes were less than 30% (from 17 to 27%) in average - 19,78%. Before and after the procedure was performed a biopsy of the right and the left lobe of the liver, followed by assessment of morphological changes of the parenchyma. Results: The volume of the liver after portoembolizatsii on average increased by 12,5%, the volume of the left lobe of the liver increased by an average of 41,7%. Expected hypertrophy of the left lobe of the liver is not obtained in one patient (6,66%). In the remaining 14 patients (93,3%) the size of the left lobe of the liver, and increased by more than 30%. Radical surgical treatment performed 9 (60%) patients. Study of histological changes after hepatic parenchyma portoembolization showed that hypertrophy of the contralateral lobe of the liver, occurs due to hypertrophy of the existing and the emergence of new, functionally active hepatocytes. The use of embolization of the right branch of the portal vein in most cases allows for vicarious hypertrophy of the left lobe of the liver due to hypertrophy of the existing and the emergence of new, functionally active hepatocytes.

Embolization with Gamma Knife Radiosurgery of Giant Intracranial Arteriovenous Malformations.

Giant arteriovenous malformations (i.e., those greater than 6 cm maximum diameter or volume > 33 cc) are difficult to treat and often carry higher treatment morbidity and mortality rates. In our study, we reviewed the angiographic results and clinical outcomes for 11 patients with giant arteriovenous malformations who were treated between 1994 and 2012. The patients selected included 9 males (82%) and 2 females (18%). Their presenting symptoms were hemorrhage (n=2; 18%), seizure (n=7; 64%), and headache (n=2; 12%). Nine patients were Spetzler-Martin Grade III, 2 were Spetzler-Martin Grade IV. The mean arteriovenous malformation volume was 41 cc (33-52 cc). The mean age of the patients was 45.1 years (24-57 years) and the mean radiation dose delivered to the margin of the nidus was 14.2 Gy. Ten patients received pre-Gamma Knife radiosurgery embolization and Gamma Knife radiosurgery, 1 patient received pre-Gamma Knife radiosurgery embolization and Gamma Knife radiosurgery twice and the interval between Gamma Knife radiosurgeries was 3 months. The complete obliteration rate following Gamma Knife radiosurgery was 36%, subtotal obliteration ( > 70% decreased size of nidus) was 36%, and partial obliteration was 28%. One patient experienced a small hemorrhage after embolization. Combined embolization and Gamma Knife radiosurgery showed successful obliteration of the arteriovenous malformation nidus. The use of embolization to initially reduce nidus size followed by Gamma Knife radiosurgery improves the treatment results. Repeated Gamma Knife radiosurgery should be a treatment option when there is a small nidus remnant.

Staged-volume radiosurgery for large arteriovenous malformations: a review.

Stereotactic radiosurgery is an effective management strategy for properly selected patients with arteriovenous malformations (AVMs). However, the risk of postradiosurgical radiation-related injury is higher in patients with large AVMs. Multistaged volumetric management of large AVMs was undertaken to limit the radiation exposure to the surrounding normal brain. This strategy offers a promising method for obtaining high AVM obliteration rates with minimal normal tissue damage. The use of embolization as an adjunctive method in the treatment of large AVMs remains controversial. Unfortunately, staged-volume radiosurgery (SVR) has a number of potential pitfalls that affect the outcome. The aim of this article is to highlight the role of SVR in the treatment of large AVMs, to discuss the outcome comparing it to other treatment modalities, and to discuss the potential improvement that could be introduced to this method of treatment.

Embolization of hypervascular bone metastases reduces intraoperative blood loss: a case-control study.

Small case series suggest that preoperative transcatheter arterial embolization minimizes bleeding and facilitates surgery for hypervascular metastatic bone tumors. However, control groups would make our confidence in clinical recommendations stronger, but small patient numbers make prospective trials difficult to conduct on this topic. In this case-control study, we asked whether (1) patients who undergo embolization have less estimated blood loss and/or shorter operative time than patients who do not have embolization; (2) larger tumor size, greater initial tumor vascularity, and longer interval from embolization to surgery are associated with greater estimated blood loss and packed red blood cell transfusion volume; and (3) embolization does not affect renal function in patients with normal preoperative renal function. We retrospectively reviewed records of patients with hypervascular bone metastases treated at our institution between 1998 and 2008. Twenty-seven patients with renal cell carcinoma and 12 with thyroid carcinoma who underwent embolization before 41 surgical procedures were matched to 41 patients who did not have embolization with respect to age, diagnosis, tumor size and potential vascularity, and procedure type; matching was performed without knowledge of outcomes. In univariate and multivariate analyses, age, tumor size, use of embolization, surgery type and risk, embolization-to-surgery interval, and degree of devascularization were evaluated for correlations with estimated blood loss, packed red blood cell transfusion volume, operative time, and postembolization renal function. Overall, patients who had embolization had less mean estimated blood loss (0.90 versus 1.77 L; p = 0.002), packed red blood cell transfusion volume (2.15 versus 3.56 U; p = 0.020), and operative time (3.13 versus 3.91 hours; p < 0.001). Larger tumor size correlated with greater estimated blood loss (r = 0.451; p = 0.003), packed red blood cell transfusion volume (r = 0.50; p = 0.002), and operative time (r = 0.595; p < 0.001). Neither the interval for embolization to surgery nor the degree of devascularization correlated with estimated blood loss or transfusion volume. In open rodding with intralesional curettage, transcatheter arterial embolization was associated with reduced estimated blood loss, transfusion volume, and operative time. Packed red blood cell transfusion volume was not reduced by embolization in intramedullary nailing procedures with the patient numbers available. Among patients with normal preoperative renal function who had embolization, creatinine levels remained normal. Mild transient, reversible renal function change occurred in one patient with preoperatively abnormal renal function. This study suggests that preoperative embolization probably reduces estimated blood loss, particularly for large tumors and during open femoral procedures.

Drug-Eluting Beads Loaded with Antiangiogenic Agents for Chemoembolization: In Vitro Sunitinib Loading and Release and In Vivo Pharmacokinetics in an Animal Model

PurposeThe combination of embolic beads with a multitargeted tyrosine kinase inhibitor that inhibits tumor vessel growth is suggested as an alternative and improvement to the current standard doxorubicin-eluting beads for use in transarterial chemoembolization. This study demonstrates the in vitro loading and release kinetics of sunitinib using commercially available embolization microspheres and evaluates the in vitro biologic efficacy on cell cultures and the resulting in vivo pharmacokinetics profiles in an animal model. Materials and MethodsDC Bead microspheres, 70–150 µm and 100–300 µm (Biocompatibles Ltd., Farnham, United Kingdom), were loaded by immersion in sunitinib solution. Drug release was measured in saline in a USP-approved flow-through apparatus and quantified by spectrophotometry. Activity after release was confirmed in cell culture. For pharmacokinetics and in vivo toxicity evaluation, New Zealand white rabbits received sunitinib either by intraarterial injection of 100–300 µm sized beads or per os. Plasma and liver tissue drug concentrations were assessed by liquid chromatography–tandem mass spectroscopy. ResultsSunitinib loading on beads was close to complete and homogeneous. A total release of 80% in saline was measured, with similar fast-release profiles for both sphere sizes. After embolization, drug plasma levels remained below the therapeutic threshold (< 50 ng/mL), but high concentrations at 6 hours (14.9 µg/g) and 24 hours (3.4 µg/g) were found in the liver tissue. ConclusionsDC Bead microspheres of two sizes were efficiently loaded with sunitinib and displayed a fast and almost complete release in saline. High liver drug concentrations and low systemic levels indicated the potential of sunitinib-eluting beads for use in embolization.

Clinical application of partial splenic embolization.

Partial splenic embolization (PSE) is one of the intra-arterial therapeutic approaches of diseases. With the development of interventional radiology, the applications of PSE in clinical practice are greatly extended, while various materials are developed for embolization use. Common indications of PSE include hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia, autoimmune hemolytic anemia, splenic trauma, idiopathic thrombocytopenic purpura, splenic hemangioma, and liver cancer. It is also performed to exclude splenic artery aneurysms from the parent vessel lumen and prevent aneurysm rupture, to treat splenic artery steal syndrome and improve liver perfusion in liver transplant recipients, and to administer targeted treatment to areas of neoplastic disease in the splenic parenchyma. Indicators of the therapeutic effect evaluation of PSE comprise blood routine test, changes in hemodynamics and in splenic volume. Major complications of PSE include the pulmonary complications, severe infection, damages of renal and liver function, and portal vein thrombosis. The limitations of PSE exist mainly in the difficulties in selecting the arteries to embolize and in evaluating the embolized volume.

Obliteration of thyroid arteries as a new method of treatment of thyroid diseases

Standard methods including pharmacotherapy, radioiodine and surgery cannot always be applied in treatment of thyroid diseases. The limitations of these methods are: drug intolerance and their side effects, too low radioiodine uptake, high risk of surgery. The obliteration of thyroid arteries seems to be an alternative method which could be used in the stiuation of ineffective standard treatment. It is based on shut down of blood flow in chosen thyroid arteries by injection of embolizative material (histoacryl or particles of polyvinylic alcohol) into the vessels. The consequence of acute ischemia is a septic necrosis of the glandular tissue in a field being supplied by this particular artery. Further repair processes and fibrosis lead to the reduction of an active thyroid hormone synthesis and decrease of thyroid volume. Effects of the embolization on apoptosis induction and modulation of autoimmune reactions are also observed. Preoperative selective embolization of a huge goiter or thyroid cancer improves surgery outcomes, reduces the risk of haemorrhage and damage to surrounding tissue. Palliative use of embolization in advanced stages of thyroid cancer reduces symptoms and improves quality of life. Little invasive nature of this procedure in comparison to surgery, the lack of serious undesirable coincidence makes the embolization of thyroid arteries an attractive form of therapy, which may become a therapeutic option in many difficult clinical situations and may improve the effectiveness of treatment of thyroid disease. The authors present the experiences gained in their institution with conclusions as follows: 1. As a result of using embolization of thyroid arteries in the treatment of selected thyroid diseases the following observations have been made: a significant reduction in goiter volume with resolution of compression symptoms of adjacent organs, reduction of the concentration of thyroid antibodies characteristic for patients with Graves' disease (TRAb), cure of hyperthyroidism in 71% of patients with thyrotoxicosis. Embolization procedure was not associated with the occurrence of undesirable side effects, such as the clinical symptoms associated with increased concentration of free thyroid hormones, and induction or exacerbation of pre-existing autoimmune thyroid disease. 2. Thyroid artery embolization had no significant influence on activity of the parathyroid glands, regardless of the number and quality of closed vessels. 3. Thyroid artery embolization is an effective and safe treatment of selected thyroid diseases as an alternative to conventional forms of therapy.

Long-term Results of Radiosurgery for Cerebral Arteriovenous Malformations

Stereotactic radiosurgery (SRS) is known to safely result in a high obliteration rate for small and medium sized arteriovenous malformations (AVM). To evaluate the long-term outcome of patients treated with SRS, with special emphasis given to obliteration and toxicity rates. We performed a review of 43 cerebral AVM patients, treated from 1998 to 2008 with a single SRS dose ranging from 21-25 Gy. Of these, 37 had a minimal follow-up of one year. Medical files were reviewed to assess patient and AVM characteristics, the SRS treatment, therapy prior to SRS, the obliteration rate and toxicities. Whenever necessary, outcome data was supplemented by telephone interviews with the patient or treating physician. AVM size was ≥3cm in diameter in 21% of patients. Five patients (11.6%) underwent surgery prior to SRS and 31 patients (72.1%) received one or more embolizations prior to SRS. Of the patients followed with angiography ≥1 year post-SRS, 89% (33/37) had a complete obliteration of the nidus, after a median time of 24.7 months post-treatment. Embolization prior to SRS was not predictive of outcome. One patient suffered a non-fatal haemorrhage between treatment and obliteration. The rate of symptomatic radiation-induced radiological changes was 8.1%. Our study shows both obliteration and complication rates in the upper limit of those reported in the literature. SRS seems an attractive treatment option for small AVMs. Unlike other reports, the prior use of embolization did not impact negatively on obliteration rates.

Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas

Background:Chronic subdural hematoma (CSDH) is generally treated by burr hole irrigation. However, sometimes repeated recurrence is observed, and treatment may consequently become difficult. We examined the efficacy of embolization of the middle meningeal artery (MMA) for such cases.Methods:We considered embolization of the MMA for three patients who had refractory CSDH with repeated recurrence and two CSDH patients who were at risk of recurrence and showed signs of recurrence after surgery. A microcatheter was advanced through the MMA as peripherally as possible, and embolization was performed with 15-20% n-butyl-2-cyanoacrylate or 200 μm polyvinyl alcohol particles.Results:Embolization was performed in the three patients who had refractory CSDH with repeated recurrence: The procedure was performed after burr hole irrigation of the hematoma in two patients and before the irrigation in one patient. In the two CSDH patients at risk of recurrence, embolization was performed when signs of recurrence appeared. The timing of embolization differed for each patient. However, in all the patients, the hematoma tended to decrease in size, and no recurrence was observed.Conclusion:Embolization of the MMA is effective for refractory CSDH or CSDH patients with a risk of recurrence, and is considered an effective therapeutic method to stop hematoma enlargement and promote resolution.

P04.12: Caesarean section scar pregnancy: case series at a single tertiary center

We aim to present the various clinical presentations, management and outcomes of Caesarean scar pregnancies (CSP) managed in our unit. We report four patients with CSP who presented to our gynecological unit from October 2008 to May 2009. Post-operative ultrasound scanning and trending of beta-hCG levels were done to establish resolution of the CSP post-treatment All the four patients presented for routine early pregnancy followup. Three had two previous lower segment Caesarean section (LSCS) while one had a previous LSCS. One patient was initially thought to have an intra-uterine pregnancy on ultrasound and had undergone a failed surgical termination. She presented with persistent heavy per-vaginal bleeding and was diagnosed with help of imaging studies to have a arterio-venous malformation (AVM) within the CSP. The other three patients had elective intra-gestational sac methotrexate (MTX) injection. One patient developed an AVM following treatment. Both patients with AVMs responded to bilateral uterine arteries embolisation and gonadotropin releasing hormone (GnRH)-agonist use. These cases highlight the difficulty of making an early diagnosis of a CSP and the complications of misdiagnosis as an intrauterine pregnancy. As patients with only one previous LSCS can still present with a CSP, one should be suspicious when the gestational sac is seen close to the LSCS scar in such patients. AVMs are possible complications following treatment and the use of embolisation and GnRH agonist may be considered.

Use of Embolization with Liquid Agent in Glomus Surgery

Objective: Evaluate the effects of embolization using liquid embolic agent (Onyx) in surgery for jugulotympanic tumors with regard to length of stay in hospital, duration of procedure, signs of facial palsy, intraoperative hemorrhage, and postoperative complications. Method: Six patients were admitted for evaluation therapeutic options. Two patients were treated with radiotherapy and 4 proceeded to surgery. The selection criteria for the therapeutic choice were staging of the lesion, intraoperative risks of the procedure and patient expectations. The embolization with liquid material was performed 2 days prior to surgery by the radiology department in the operative cases. The evaluation was done retrospectively using medical data. Results: Four patients underwent surgery and 2 patients maintained follow-up after radiotherapy. In comparison with the literature, a reduction of days in the hospital without requiring intensive care a reduction in (average time of 3 days) and a reduction in duration of surgery time (average length of 150 minutes) was noted. There was no need for hemotransfusion, neither facial palsy nor infection of wound was reported after the surgery in patients that underwent preoperative embolization. Conclusion: We have a shorter duration of surgery and reduced bleeding and reduced length of hospitalization days with a secure embolization, and as a consequence, less postoperative complications.