Use Of Endovascular Embolization Research Articles

THE FEATURES OF ENDOVASCULAR SURGERY FOR DUODENAL ULCER BLEEDING

Aim of the research was to study improvement of the results of surgical treatment of duodenal ulcer bleeding based on the use of endovascular embolization. Gastrointestinal bleeding is a relatively common condition with a wide range of underlying causes. In most cases, this acute bleeding is effectively managed by conservative, medical or endoscopic procedures. However, the proportion of endoscopically unrecognized or controlled non-variceal gastrointestinal bleeding still requires alternative, sometimes surgical, treatment. The current S2k guideline Gastrointestinal Bleeding gives importance to interventional radiology in considering its minimally invasive endovascular interdisciplinary therapy options, guideline-oriented endovascular treatment of Gastrointestinal bleeding by embolization and implantation of covered stents is a treatment approach with good technical and clinical success rates and low complication rates. Gastrointestinal bleedings (GIBs) are pathological conditions associated with significant morbidity and mortality. Embolization without angiographic evidence of contrast media extravasation is proposed as an effective procedure in patients with clinical and/or laboratory signs of bleeding. The purpose of this systematic review is to define common clinical practice and clinical and technical outcomes of blind and preventive embolization for upper and lower gastrointestinal bleeding. Knowledge of vascular anatomy is essential to achieve adequate hemostasis. Endovascular embolization dramatically reduces the mortality rate in high-risk patients who require open surgery after failed endoscopy, further studies are needed to fully address these objectives.

Endovascular Embolization of the Uterine Arteries in Giant Uterine Fibroids

Choosing a treatment option for uterine fibroids is today one of the most relevant problems in gynecological practice. Thanks to the success of modern medicine and the increased level of the population’s culture, female patients seek medical help without waiting for the tumor to acquire significant sizes. However, in practice, there are cases when fibroids reach gigantic sizes. Hysterectomy is a traditional approach to treating uterine fibroids of these sizes according to the current clinical guidelines. The introduction of new high-tech treatments, such as uterine artery embolization, has led to a revision of radical surgery, by giving preference to alternative approaches especially in cases where the patient desires to preserve the reproductive organ. The paper describes a clinical case that confirms an individual approach to choosing a treatment option towards organ-sparing surgery for giant uterine fibroids. The use of endovascular embolization of the uterine arteries as a treatment for giant uterine fibroids is shown to be justified as an organ-sparing surgery if the patient desires to preserve reproductive function.

Efficacy and Safety of Combined Endovascular Embolization and Stereotactic Radiosurgery for Patients with Intracranial Arteriovenous Malformations: A Systematic Review and Meta-Analysis.

Whether the use of endovascular embolization could provide additional benefits in patients treated with stereotactic radiosurgery (SRS) for intracranial arteriovenous malformations (IAVMs) remains controversial. The current meta-analysis was conducted to assess the efficacy and safety of SRS with and without prior endovascular embolization in patients with IAVMs. The electronic databases of PubMed, EmBase, and Cochrane Library were systematically searched for eligible studies published from inception to August 12, 2020. The pooled results for obliteration rate, rehemorrhage rate, and permanent neurological deficits were calculated by odds ratios (ORs) with 95% confidence intervals (CIs) using the random-effects model. The sensitivity analysis, subgroup analysis, and publication bias for investigated outcomes were also evaluated. Nineteen studies (two prospective and 17 retrospective studies) involving a total of 3,454 patients with IAVMs were selected for the final meta-analysis. We noted that prior embolization and SRS were associated with a lower obliteration rate compared with SRS alone (OR, 0.57; 95% CI, 0.44–0.74; P < 0.001). However, prior embolization and SRS were not associated with the risk of rehemorrhage (OR, 1.05; 95% CI, 0.81–1.34; P = 0.729) and permanent neurological deficits (OR, 0.80; 95% CI, 0.48–1.33; P = 0.385) compared with SRS alone. The sensitivity analysis suggested that prior embolization might reduce the risk of permanent neurological deficits in patients with IAVMs treated with SRS. The treatment effects of prior embolization in patients with IAVMs could be affected by nidus volume, margin dose, intervention, and follow-up duration. This study found that prior embolization was associated with a reduced risk of obliteration in patients with IAVMs treated with SRS. Moreover, prior embolization might reduce the risk of permanent neurological deficits in patients with IAVMs.

Periprocedural intracranial hemorrhage after embolization of cerebral arteriovenous malformations: a meta-analysis.

The primary goal of the treatment of cerebral arteriovenous malformations (AVMs) is angiographic occlusion to eliminate future hemorrhage risk. Although multimodal treatment is increasingly used for AVMs, periprocedural hemorrhage after transarterial embolization is a potential endovascular complication that is only partially understood and merits quantification. Searching the period between 1990 and 2019, the authors of this meta-analysis queried the PubMed and Embase databases for studies reporting periprocedural hemorrhage (within 30 days) after liquid embolization (using cyanoacrylate or ethylene vinyl alcohol copolymer) of AVMs. Random effects meta-analysis was used to evaluate the pooled rate of flow-related hemorrhage (those attributed to alterations in AVM dynamics), technical hemorrhage (those related to procedural complications), and total hemorrhage. Meta-regression was used to analyze the study-level predictors of hemorrhage, including patient age, Spetzler-Martin grade, hemorrhagic presentation, embolysate used, intent of treatment (adjuvant vs curative), associated aneurysms, endovascular angiographic obliteration, year of study publication, and years the procedures were performed. A total of 98 studies with 8009 patients were included in this analysis, and the mean number of embolization sessions per patient was 1.9. The pooled flow-related and total periprocedural hemorrhage rates were 2.0% (95% CI 1.5%-2.4%) and 2.6% (95% CI 2.1%-3.0%) per procedure and 3.4% (95% CI 2.6%-4.2%) and 4.8% (95% CI 4.0%-5.6%) per patient, respectively. The mortality and morbidity rates associated with hemorrhage were 14.6% and 45.1%, respectively. Subgroup analyses revealed a pooled total hemorrhage rate per procedure of 1.8% (95% CI 1.0%-2.5%) for adjuvant (surgery or radiosurgery) and 4.6% (95% CI 2.8%-6.4%) for curative intent. The treatment of aneurysms (p = 0.04) and larger patient populations (p < 0.001) were significant predictors of a lower hemorrhage rate, whereas curative intent (p = 0.04), angiographic obliteration achieved endovascularly (p = 0.003), and a greater number of embolization sessions (p = 0.03) were significant predictors of a higher hemorrhage rate. There were no significant differences in periprocedural hemorrhage rates according to the years evaluated or the embolysate utilized. In this study-level meta-analysis, periprocedural hemorrhage was seen after 2.6% of transarterial embolization procedures for cerebral AVMs. The adjuvant use of endovascular embolization, including in the treatment of associated aneurysms and in the presurgical or preradiosurgical setting, was a study-level predictor of significantly lower hemorrhage rates, whereas more aggressive embolization involving curative intent and endovascular angiographic obliteration was a predictor of a significantly higher total hemorrhage rate.

Two-stage surgical treatment of subarachnoid and paryhymatous blood effects with the use of endovascular embolization of damaged aneurysm

Introduction. Aneurysmal subarachnoid hemorrhage (SAH) is complicated by concomitant intracerebral hemorrhage (IUD) with a frequency of 4% to 42.5%. More than 80% of patients die in conservative therapy, and when removing only hematomas without occlusion of an aneurysm, the mortality rate reaches 75%. Objectives. The aim of the study was the optimization of treatment of aneurysmatic subarachnoid haemorrhage complicated by the formation of intracerebral hematoma. Materials and methods. The analysis of the results of surgical treatment of 101 patients in the acute period of cerebral aneurysm rupture was performed. The first group of observations in which the surgical treatment was limited to endovascular occlusion of cerebral aneurysms. In the second group of observations, multi-stage surgical treatment was performed - endovascular embolization of cerebral aneurysm with subsequent removal of parenchymal hematoma for 24–48 hours. Results. In most cases, surgical treatment was limited to endovascular embolization of the ruptured aneurysm. In 3 observations, multistage surgical treatment was performed - endovascular embolization of cerebral aneurysm with subsequent removal of intracerebral hematoma. In two cases, positive dynamics with a regression of neurological deficits in the postoperative period was noted. In one observation, partial regression of motor deficit. Conclusions. Two - stage surgical treatment of subarachnoid haemorrhage with intracerebral hematoma the use of endovascular embolization of the ruptured aneurysm and subsequent evacuation of hematoma is effective and can be used in cases where there is a technical possibility of occlusion of the aneurysm s and the compensated state of the patient.

Uterine artery embolization in cervical pregnancy - alternative to total hysterectomy

In article experience of use of endovascular embolization of uterine arteries in treatment of cervical pregnancy is described. Super selective uterine artery embolization followed by removal of the ovum devascularization held 7 patients aged 27,8 ± 2,2 years with cervical pregnancy in terms of 5 and 7 weeks. After the reduction of level of chorionic gonadotropin, and in the absence of blood-groove in the fetal ovum, its evacuation was carried out under the control arteriography. Blood loss during the operation does not exceed 100 ml. Postoperative period lasted 4,6 ± 0,4 days. Thus, uterine artery embolization is effective method of complex treatment with cervical pregnancy thus reducing the risk of bleeding and to keep the reproductive function at young women.

Neurological outcomes and cure rates of embolization of brain arteriovenous malformations with n-butyl cyanoacrylate or Onyx: a meta-analysis

BackgroundIn the past decade, preoperative endovascular embolization of cerebral arteriovenous malformations (AVMs) became an essential tool in the treatment of these entities. With the current expansion of technology and wide...

Trends in Epistaxis Embolization in the United States: A Study of the Nationwide Inpatient Sample 2003–2010

PurposeEndovascular embolization has emerged as a viable adjunct and alternative to surgical ligation in selected cases of epistaxis refractory to nasal packing. A large administrative database was used to study outcomes, complications, and trends in utilization of surgical and endovascular treatments for epistaxis. Materials and MethodsWith the Nationwide Inpatient Sample from 2003 to 2010, patients with a primary diagnosis of epistaxis undergoing surgical ligation and/or endovascular embolization were identified. Trends in the use of these procedures from 2003 to 2010 were examined. Three groups of patients were defined: those who underwent (i) surgical ligation, (ii) endovascular embolization, or (iii) both. Demographic variables, comorbidities, and outcomes were compared across groups. ResultsAmong a total of 69,410 patients identified, 64,289 (92.6%) underwent surgical ligation alone for epistaxis, 4,440 (6.4%) underwent endovascular embolization alone, and 681 (1.0%) underwent both treatments. Use of endovascular embolization for epistaxis increased from 2.8% of cases in 2003 to 10.7% of cases in 2010 (P<.0001). Patients who underwent endovascular embolization had similar mortality rates as those who underwent surgical ligation (2.1% [93 of 4,440] vs 2.1% [1,328 of 64,289]; P = .89). Endovascular embolization was associated with significantly higher rates of stroke (0.9% [41 of 4,440] vs 0.1% [34/64,289]; P<.0001) and hematoma (1.9% [83 of 4,440] vs 0.4% [239 of 64,289]; P<.0001). ConclusionsUse of endovascular embolization for treatment of epistaxis increased significantly between 2003 and 2010. Patients who underwent endovascular embolization had similar mortality rates but higher stroke rates compared with those who underwent surgical ligation.

Use of endovascular embolization to treat a ruptured arteriovenous malformation in a pregnant woman: a case report

IntroductionPregnancy has been linked to increased rates of arteriovenous malformation rupture. This link remains a matter of debate and very few studies have addressed the management of arteriovenous malformation in pregnancy. Unruptured arteriovenous malformations in pregnant woman generally warrant conservative management due to the low rupture risk. When pregnant women present with ruptured arteriovenous malformation, however, surgery is often indicated due to the increased risk of re-rupture and associated mortality. Endovascular embolization is widely accepted as an important component of contemporary, multimodal therapy for arteriovenous malformations. Although rarely curative, embolization can facilitate subsequent surgical resection or radiosurgery. No previous reports have been devoted to the endovascular management of an arteriovenous malformation in a pregnant woman.Case presentationA 23-year-old Caucasian woman presented with headache and visual disturbance after the rupture of a left parieto-occipital arteriovenous malformation in the 22nd week of her pregnancy. After involving high-risk obstetric consultants and taking precautions to shield the fetus from ionizing radiation, we proceeded with a single stage of endovascular embolization followed soon after by open surgical resection of the arteriovenous malformation. There were several goals for the angiography in this patient: to better understand the anatomy of the arteriovenous malformation, including the number and orientation of feeding arteries and draining veins; to look for associated pre-nidal or intra-nidal aneurysms; and to partially embolize the arteriovenous malformation via safely-accessible feeders to facilitate surgical resection and minimize blood loss and operative morbidity.ConclusionFrom our experience and review of the literature, we maintain that ruptured arteriovenous malformations in pregnancy may be managed in a similar manner to those in non-gravid women. Precautions should be taken to reduce the operative time and exposure of the fetus to ionizing radiation and contrast agents.

Sacral epithelioid angiosarcoma associated with a bleeding diathesis and spinal epidural hematoma

Epithelioid angiosarcoma of bone is a rare, high-grade lesion that is highly vascular and can be associated with a bleeding diathesis. An association has been reported in angiosarcomas in other locations with coagulopathy from tumor-related disseminated intravascular coagulopathy and fibrinolysis. The authors report the case of a rare occurrence of a primary sacral epithelioid angiosarcoma associated with a large epidural hematoma and a severe bleeding diathesis. A 25-year-old woman presented with weakness, fatigue, neck and low-back pain, and progressive left S-1 radiculopathy. Imaging studies revealed a large ventral epidural hematoma extending from the sacral region rostrally to C-2 and a vascular tumor located in the sacrum. The patient underwent a sacral laminectomy, complicated by postoperative bleeding from the wound, and required massive transfusions. Ultimately, multimodal therapy was required to obtain hemostasis, including the use of endovascular embolization, radiation therapy, and an infusion of epsilon-aminocaproic acid with heparin. This case represents the first report of a primary epithelioid angiosarcoma in the sacrum and emphasizes that the coagulopathy seen in angiosarcoma is also a feature of this epithelioid variant.

Endovascular embolization and surgical excision for the treatment of cerebellar and brain stem hemangioblastomas

Hemangioblastomas are histologically benign tumors that comprise 7%-10% of all posterior fossa lesions in the adult. Treatment of these lesions is often complicated by significant vascularity and difficulty of surgical resection in sensitive neural tissue, especially when the tumor has a significant solid component. We report the combined use of endovascular embolization of feeding pedicles and subsequent operative resection in two patients with solid hemangioblastomas of the cerebellum and brain stem. Preoperative embolization facilitated operative excision in sensitive neural areas and allowed complete surgical resection of tumors involving the lateral brain stem and cervicomedullary junction. Goals of preoperative embolization are control of inaccessible arterial supply and reduction of tumor vascularity.