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International Journal of Surgery... Dec 2023The authors compared the efficacy and cost-effectiveness of middle meningeal artery embolization (MMAE) and conventional treatment for chronic subdural hematomas (cSDH).
Comparative study on clinical outcomes and cost-effectiveness of chronic subdural hematomas treated by middle meningeal artery embolization and conventional treatment: a national cross-sectional study.
BACKGROUND
The authors compared the efficacy and cost-effectiveness of middle meningeal artery embolization (MMAE) and conventional treatment for chronic subdural hematomas (cSDH).
METHODS
The Nationwide Readmissions Database of 9963 patients (27.2% women) with cSDH between 2016 and 2020 was analyzed. Finally, 9532 patients were included (95.7%, treated conventionally; 4.3%, treated with MMAE). Baseline demographics, comorbidities, adverse events, treatment strategies, and outcomes were compared between patients treated with MMAE and conventional treatment. After propensity score matching, the authors compared primary outcomes, including the 90-day treatment rate, functional outcome, length of hospital stays, and cost. A Markov model estimated lifetime costs and quality-adjusted life years (QALYs) associated with different treatments. The incremental cost-effectiveness ratio (ICER) was calculated to evaluate the base-case scenario. One-way, two-way, and probabilistic sensitivity analyses were performed to evaluate the uncertainty in the results.
RESULTS
After propensity score matching, MMAE had a lower 90-day retreatment rate (2.6 vs. 9.0%, P =0.001), shorter length of hospital stays (4.61±6.19 vs. 5.73±5.76 days, P =0.037), similar functional outcomes compared (favorable outcomes, 80.9 vs. 74.8%, P =0.224) but higher costs ($119 757.71±90 378.70 vs. $75 745.55±100 701.28, P <0.001) with conventional treatment. MMAE was associated with an additional cost of US$19 280.0 with additional QALY of 1.3. Its ICER was US$15199.8/QALY.
CONCLUSION
MMAE is more effective in treating cSDH than conventional treatment. Based on real-world data, though MMAE incurs higher overall costs, the Markov model showed it to be cost-effective compared to conventional treatment under the American healthcare system. These comparative and economic analyses further support the consideration of a paradigm shift in cSDH treatment.
Topics: Humans; Female; Male; Cost-Benefit Analysis; Cross-Sectional Studies; Hematoma, Subdural, Chronic; Meningeal Arteries; Embolization, Therapeutic
PubMed: 37830938
DOI: 10.1097/JS9.0000000000000699 -
The Journal of International Medical... Dec 2021Transcatheter arterial embolization (TAE) of bilateral internal iliac arteries (IIAs) in patients with a hemodynamically unstable pelvic fracture is associated with a... (Observational Study)
Observational Study
OBJECTIVE
Transcatheter arterial embolization (TAE) of bilateral internal iliac arteries (IIAs) in patients with a hemodynamically unstable pelvic fracture is associated with a low mortality rate. The persistence of unstable hemodynamics after IIA embolization indicates the involvement of other arteries, such as the median sacral artery (MSA). This study aimed to evaluate the efficacy of MSA embolization.
METHODS
In this single-center, retrospective, observational study, medical records of patients who underwent MSA angiography or embolization for pelvic fractures (n = 21) between January 2007 and August 2019 were reviewed. The percentage of patients achieving hemodynamic stabilization by MSA embolization was calculated.
RESULTS
Fifteen patients underwent MSA embolization, and the remaining six underwent MSA angiography. The shock index value was significantly higher after MSA embolization than that before MSA embolization in hemodynamically unstable patients who underwent this procedure. The success rate of MSA selection was 100%. One patient presented with urinary retention because of bladder and rectal disorders after MSA embolization. The 30-day survival rate was 85.7%.
CONCLUSIONS
Severe pelvic fractures, such as a Dennis Zone III fracture and suicidal jumper's fracture due to trauma from a fall, may require MSA embolization.
Topics: Arteries; Embolization, Therapeutic; Fractures, Bone; Humans; Pelvic Bones; Retrospective Studies
PubMed: 34878941
DOI: 10.1177/03000605211063315 -
Japanese Journal of Radiology Jun 2022Thermal rheology (TR) fluid, which comprises polyethylene (PE) particles, their dispersant, and solvent, is a material that increases in viscosity to various degrees...
PURPOSE
Thermal rheology (TR) fluid, which comprises polyethylene (PE) particles, their dispersant, and solvent, is a material that increases in viscosity to various degrees depending on the type and ratio of these constituents when its temperature rises. The viscosity of type 1 (TRF-1) increases more than that of type 2 (TRF-2) near rabbit body temperature. This preliminary animal study aimed to determine the basic characteristics and embolic effect of TR fluid by comparing TRF-1 and TRF-2.
MATERIALS AND METHODS
Twenty-four Japanese white rabbits underwent unilateral renal artery embolization using TRF-1 or TRF-2 and follow-up angiography at 7 or 28 days (4 subgroups, n = 6 each). Subsequently, the rabbits were euthanized, and the embolized kidneys were removed for pathological examination. The primary and final embolization rates were defined as the ratio of renal artery area not visible immediately after embolization and follow-up angiography, respectively, to visualized renal artery area before embolization. The final embolization rate and maximum vessel diameter filled with PE particles were compared between materials. Moreover, the embolic effect was determined to be persistent when a two-sided 95% confidence interval (CI) for the difference in means between the embolization rates was < 5%.
RESULTS
The final embolization rate was significantly higher for the TRF-1 than for the TRF-2 at both 7 (mean 80.7% [SD 18.7] vs. 28.4% [19.9], p = 0.001) and 28 days (94.0% [3.5] vs. 37.8% [15.5], p < 0.001). The maximum occluded vessel diameter was significantly larger for TRF-1 than for TRF-2 (870 µm [417] vs. 270 µm [163], p < 0.001). The embolic effect of TRF-1 was persistent until 28 days (difference between rates - 3.3 [95% CI - 10.0-3.4]).
CONCLUSION
The embolic effect of TRF-1 was more persistent than that of TRF-2, and the persistency depended on the type and ratio of TR fluid constituents.
Topics: Angiography; Animals; Embolization, Therapeutic; Humans; Rabbits; Renal Artery; Rheology; Temperature
PubMed: 34851500
DOI: 10.1007/s11604-021-01232-3 -
Tomography (Ann Arbor, Mich.) Sep 2023Endovascular intervention is now the primary line of therapy for arterial injury brought on by pelvic trauma since it can significantly reduce considerable morbidity...
Transcatheter Arterial Embolization for Bleeding Related to Pelvic Trauma: Comparison of Technical and Clinical Results between Hemodynamically Stable and Unstable Patients.
BACKGROUND
Endovascular intervention is now the primary line of therapy for arterial injury brought on by pelvic trauma since it can significantly reduce considerable morbidity associated with surgery and can swiftly access and control bleeding sites. Despite international guidelines and widespread awareness of the role of angioembolization in clinical practice, robust evidence comparing the outcomes of angioembolization in hemodynamically stable and unstable patients is still lacking. This study aims to directly compare the outcomes of angioembolization for the treatment of pelvic traumatic arterial injury in patients with hemodynamic stability vs. hemodynamic instability.
METHODS
In our multicenter retrospective investigation, we analyzed data from consecutive patients who underwent, from January 2020 to May 2023, angioembolization for traumatic pelvic arterial injury.
RESULTS
In total, 116 angioembolizations were performed. Gelatin sponges (56.9%) and coils (25.9%) were the most widely used embolic agents. The technical and clinical success rates were 100% and 91.4%, respectively. No statistically significant differences were observed between the two groups in terms of technical success, clinical success, procedure-related complication rate, or 30-day bleeding-related mortality.
CONCLUSIONS
Angioembolization is an effective and safe option for the management of traumatic pelvic arterial lesions even in hemodynamically unstable patients, despite technical variations such as greater use of prophylactic angioembolization.
Topics: Humans; Retrospective Studies; Embolization, Therapeutic; Arteries; Vascular Diseases; Pelvis
PubMed: 37736986
DOI: 10.3390/tomography9050133 -
Advanced Materials (Deerfield Beach,... Aug 2020Transcatheter embolization is a minimally invasive procedure that uses embolic agents to intentionally block diseased or injured blood vessels for therapeutic purposes....
Transcatheter embolization is a minimally invasive procedure that uses embolic agents to intentionally block diseased or injured blood vessels for therapeutic purposes. Embolic agents in clinical practice are limited by recanalization, risk of non-target embolization, failure in coagulopathic patients, high cost, and toxicity. Here, a decellularized cardiac extracellular matrix (ECM)-based nanocomposite hydrogel is developed to provide superior mechanical stability, catheter injectability, retrievability, antibacterial properties, and biological activity to prevent recanalization. The embolic efficacy of the shear-thinning ECM-based hydrogel is shown in a porcine survival model of embolization in the iliac artery and the renal artery. The ECM-based hydrogel promotes arterial vessel wall remodeling and a fibroinflammatory response while undergoing significant biodegradation such that only 25% of the embolic material remains at 14 days. With its unprecedented proregenerative, antibacterial properties coupled with favorable mechanical properties, and its superior performance in anticoagulated blood, the ECM-based hydrogel has the potential to be a next-generation biofunctional embolic agent that can successfully treat a wide range of vascular diseases.
Topics: Animals; Arteries; Biocompatible Materials; Embolization, Therapeutic; Extracellular Matrix; Hydrogels; Nanocomposites; Shear Strength; Swine; Vascular Remodeling
PubMed: 32578337
DOI: 10.1002/adma.202002611 -
World Journal of Surgical Oncology Feb 2016The aim of this study is to evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for the treatment of...
BACKGROUND
The aim of this study is to evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for the treatment of arterial esophageal bleeding in esophageal cancer patients.
METHODS
Between November 2008 and December 2014, five esophageal cancer patients underwent TAE with NBCA for the treatment of arterial esophageal bleeding. We retrospectively evaluated the technical and clinical success, recurrent bleeding, and procedure-related complications.
RESULTS
All of the patients had bleeding from the esophageal artery and were in shock at the beginning of TAE. Four patients had a coagulopathy at the time of TAE; however, the TAE could successfully arrest bleeding in all five patients. After TAE, they immediately recovered from the shock state. Two patients were discharged without event, one patient is currently hospitalized for another complication, and the other two patients died due to multiorgan failure. In addition, no procedure-related complications such as esophageal infarction and recurrence of arterial esophageal bleeding were observed during this study.
CONCLUSIONS
TAE with NBCA can arrest bleeding in esophageal cancer patients with active arterial esophageal bleeding, even in those with a pre-existing coagulopathy.
Topics: Aged; Angiography; Arteries; Embolization, Therapeutic; Enbucrilate; Esophageal Neoplasms; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemostatics; Humans; Male; Neoplasm Staging; Prognosis; Retrospective Studies
PubMed: 26912065
DOI: 10.1186/s12957-016-0803-y -
Journal of the Formosan Medical... May 2017To assess the risk factors for intractable and controllable postpartum hemorrhage (PPH) and to evaluate the safety, efficacy, and outcome of transcatheter arterial...
BACKGROUND/PURPOSE
To assess the risk factors for intractable and controllable postpartum hemorrhage (PPH) and to evaluate the safety, efficacy, and outcome of transcatheter arterial embolization (TAE).
METHODS
An emergency PPH rescue system including the 24-hour-available TAE was established in 2004. TAE with gelatine sponge particles placed on bilateral uterine or internal iliac arteries served as the first-line treatment for intractable PPH. Delivery methods, parity, causes of bleeding, clinical vital signs, coagulopathy, success rate, resumption of menstruation, and subsequent pregnancy outcome after TAE were recorded.
RESULTS
From the years 2005 to 2013, 301 women experienced PPH, of whom 178 had controllable PPH and 123 intractable PPH. Tachycardia and disseminated intravascular coagulation were significant risk factors for intractable PPH. All of the women with intractable PPH underwent TAE, and 89 (72.3%) were transferred by ground transport to receive treatment in this system. The mean travel distance was 15 km ± 12.5 km. The mean time of order to angiography room was 24.9 minutes ± 14.2 minutes. The mean blood loss before TAE was 2247 mL ± 1482 mL (range, 900-11,110 mL). The first TAE successfully controlled bleeding in 118 of the 123 (95.9%) women with intractable PPH. Of the 70 women with complete follow-up, 69 (98.6%) recovered menstruation. Twenty-three women tried to get pregnant and 19 (82.6%) of them succeeded, giving birth to 12 full-term live infants.
CONCLUSION
TAE was safe and effective in treating intractable primary PPH with a high success rate and preservation of menstruation and fertility.
Topics: Adult; Embolization, Therapeutic; Female; Fertility; Humans; Iliac Artery; Patient Transfer; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Treatment Outcome; Uterine Artery; Uterine Artery Embolization
PubMed: 27659552
DOI: 10.1016/j.jfma.2016.06.011 -
European Journal of Radiology Sep 2022To evaluate the outcome of dual-vessel intervention (DVI), including bronchial or pulmonary arterial embolization (B/PAE), in managing massive hemoptysis caused by...
PURPOSE
To evaluate the outcome of dual-vessel intervention (DVI), including bronchial or pulmonary arterial embolization (B/PAE), in managing massive hemoptysis caused by cavitary lung lesions (with or without aspergilloma) and identify cavitary angiographic features influencing DVI procedures.
METHOD
A retrospective analysis of the medical records and angiograms of 15 patients who underwent DVI for massive hemoptysis was performed.
RESULTS
The most frequent causes of cavitary lung lesions were tuberculosis (TB) (8/15, 53%) and bronchiectasis (6/15, 40%). Eight patients were diagnosed with aspergilloma (8/15, 53%). In all, 24 systemic arteries, including the orthotopic and ectopic bronchial arteries and 1 pulmonary artery branch, were embolized in 16 procedures. Clinical success and immediate cessation of hemoptysis were achieved in 12 patients (80%). Hemoptysis was controlled in 10 patients (67%) and recurred in 2 patients (17%), while 1 patient (7%) required repeat embolization. The bronchopulmonary fistula (shunting) rate was 73.3% (11/15). The average fistula emergence time was 1.28 ± 1.27 s (M ± SD), and the average vessel diameter was 3.974 ± 1.57 mm. There were no significant differences in angiographic features, clinical success, or recurrence of cavitary lesions with or without aspergilloma. The complication rates were low, with only transient chest pain and ventricular arrhythmia reported.
CONCLUSIONS
BAE is an effective and safe procedure for most cavitary lesions causing massive hemoptysis, and DVI is needed under certain circumstances. High bronchopulmonary fistula rates and early fistula emergence times were observed for cavitary lesions. The DVI strategy depends on the culprit vessel diameter, fistula type, and fistula emergence time.
Topics: Bronchi; Bronchial Arteries; Embolization, Therapeutic; Hemoptysis; Humans; Retrospective Studies; Treatment Outcome
PubMed: 35917756
DOI: 10.1016/j.ejrad.2022.110448 -
Folia Morphologica 2022Modern medicine is developing towards application of endovascular techniques such as trans-arterial hepatic chemoembolisation. They displace classic open procedures.... (Review)
Review
Modern medicine is developing towards application of endovascular techniques such as trans-arterial hepatic chemoembolisation. They displace classic open procedures. However, their correct planning and performance depend on the knowledge pre-operative detection of hepatic arterial anatomical variations. The main abnormality that may generate complications during radiological and surgical procedures is occurrence of an accessory hepatic artery. In the present study we propose our own classification of the variability observed in the vessels based on cases reported in the literature. It analyses more types of variations as compared to previous trials. A great advantage of this study is also a description of different pathological and frequently life-threatening conditions associated with hepatic arteries. This study is of value to medical practitioners, e.g. surgeons.
Topics: Embolization, Therapeutic; Hepatic Artery; Humans; Incidence; Liver; Liver Transplantation
PubMed: 34608985
DOI: 10.5603/FM.a2021.0081 -
Journal of Cancer Research and... 2020The objective of this study was to evaluate the degradation characteristics and embolic effect of gelatin microspheres (GMSs) produced domestically in China through an...
OBJECTIVE
The objective of this study was to evaluate the degradation characteristics and embolic effect of gelatin microspheres (GMSs) produced domestically in China through an experimental study comparing the embolization of rabbit renal arteries using GMSs and tris-acryl microspheres.
MATERIALS AND METHODS
Sixteen healthy adult New Zealand white rabbits were randomly divided into two groups. Group A was embolized with GMSs produced in China with a diameter of 150-200 μm (n = 8), and Group B was embolized with tris-acryl microspheres with a diameter of 100-200 μm (n = 8). The renal arteries were embolized through femoral artery puncture and catheterization. Renal artery angiography rechecks and hematoxylin and eosin staining of tissue sections were performed at 1 day, 4 days, 7 days, and 14 days after embolization, respectively, to observe vascular recanalization, degradation of microspheres, and embolic effect.
RESULTS
Group A: Digital subtraction angiography showed complete recanalization at 14 days. The changes in embolic necrotic areas at different time points after embolization were similar in the two groups. At 4 days after embolization, changes in glomerular structure were observed in the kidney on the embolic side. At 7 days after embolization, atrophy, degeneration, and necrosis of the glomeruli, as well as degeneration and inflammatory cell infiltration of the renal tubules, were observed in the kidney on the embolic side. At 14 days after embolization, extensive atrophy and hyalinization of the glomeruli were observed, and local renal tissue showed patchy fibrosis with calcification of internal tissue. Hyperplasia of fibrillar connective tissue was observed in the renal interstitium.
CONCLUSION
The GMSs produced domestically in China can be completely degraded after embolizing blood vessels for 14 days. The GMSs are similar to tris-acryl microspheres in arterial embolization effect and are safe and effective.
Topics: Angiography, Digital Subtraction; Animals; Catheterization, Peripheral; Embolization, Therapeutic; Femoral Artery; Gelatin; Microspheres; Models, Animal; Rabbits; Renal Artery
PubMed: 33565508
DOI: 10.4103/jcrt.JCRT_1065_19