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Cardiovascular and Interventional... Apr 2021Microspheres are effective embolic agents, especially for the management of bleeding and oncologic lesions. The first FairEmbo study reported the effectiveness of... (Comparative Study)
Comparative Study
PURPOSE
Microspheres are effective embolic agents, especially for the management of bleeding and oncologic lesions. The first FairEmbo study reported the effectiveness of embolization using suture fragments. The effectiveness and safety of arterial embolization with suture-based microparticles (SBM) were assessed in a swine model.
MATERIALS AND METHODS
In this ethical-approved animal study, a polar artery in each kidney was embolized in four swine: one side with hand-cut non-absorbable SBM (Flexocrin 2®) and the contralateral side with Embozene® 900 for comparison. Swine were followed for 3 months (M3) to evaluate the effectiveness and the safety of SBM. Follow-up protocol included clinical monitoring, computed tomography (CT) control and digital subtraction angiography (DSA), followed by histological analyses. The SBM confection parameters were evaluated by automatic microscopic sizer. RStudio software and Mann-Whitney test (significance at P < 0.05) were used for statistics.
RESULTS
The average size of SBM was 1002 μm (SD = 258). All targets were effectively embolized by SBM with an angiogram defect estimated at 45.6% (95% CI [35.9-55.2]), compared to 40.5% (95% CI [30.6-55.5]) for Embozene® group (P = 0.342). The average duration of SBM embolization procedure was significantly increased compared to Embozene® embolization (1202 s versus 222 s, P = 0.029). There were no statistical differences in M3 DSA and CT for SBM and Embozene®, with persistence of partial arterial occlusion and atrophic embolized area. No postoperative complications were observed on clinical and CT controls.
CONCLUSION
This experimental study suggests that embolization with SBM is feasible, safe and effective in short- and medium-term follow-up as compared to microspheres.
Topics: Angiography, Digital Subtraction; Animals; Arteries; Disease Models, Animal; Embolization, Therapeutic; Feasibility Studies; Microspheres; Renal Artery; Suture Techniques; Sutures; Swine; Tomography, X-Ray Computed; Vascular Surgical Procedures
PubMed: 33099701
DOI: 10.1007/s00270-020-02678-0 -
The Journal of Cardiovascular Surgery Feb 2024The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal...
Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM).
The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the GRADE-SIGN version, and followed the instructions of the AGREE quality of reporting checklist. Clinical questions, structured according to the PICO (Population, Intervention, Comparator, Outcome) model, were formulated, and systematic literature reviews were carried out according to them. Selected articles were evaluated through specific methodological checklists. Considered Judgments were compiled for each clinical question in which the characteristics of the body of available evidence were evaluated in order to establish recommendations. Overall, 79 clinical practice recommendations were proposed. Indications for treatment and therapeutic options were discussed for each arterial district, as well as follow-up and medical management, in both candidate patients for conservative therapy and patients who underwent treatment. The recommendations provided by these guidelines simplify and improve decision-making processes and diagnostic-therapeutic pathways of patients with visceral and renal arteries aneurysms. Their widespread use is recommended.
Topics: Humans; Renal Artery; Radiology, Interventional; Aneurysm; Embolization, Therapeutic; Italy
PubMed: 38037721
DOI: 10.23736/S0021-9509.23.12809-6 -
Macromolecular Bioscience Feb 2022Locally blocking blood flow to tumors with embolic materials is the key to transcatheter arterial embolization for treating hepatocellular carcinoma. Current...
Locally blocking blood flow to tumors with embolic materials is the key to transcatheter arterial embolization for treating hepatocellular carcinoma. Current microparticle agents do not deeply penetrate target tissues and are compatible with a very limited selection of therapeutic agents. Silk-elastinlike protein polymers (SELPs) combine the solubility of elastin and the strength of silk to create an easily injected liquid embolic that transition into a solid depot amenable to loading with drugs, gene therapy agents, or biologics. SELP, injected as liquid solution, penetrates the vasculature before transitioning to a solid hydrogel. The objective of this manuscript is to evaluate SELP embolization, stability, and biocompatibility at 7-, 30-, and 90-day survival intervals in a porcine model. SELP embolics selectively block blood flow in the kidneys and livers, with no off-target infarctions. As assessed with angiography, SELP renal embolization exhibits decreasing persistence for the duration of the 90-day study period. There is an increased presence of microscopic SELP emboli in the renal setting, compared to Embosphere. Histologically scored inflammatory reactions to SELP are decreased in both the renal and hepatic implantations compared to Embosphere. In conclusion, a bioresorbable SELP liquid embolic system deeply penetrates target tissue and selectively embolizes blood vessels in vivo.
Topics: Animals; Embolization, Therapeutic; Hydrogels; Neoplasms; Polymers; Silk; Swine
PubMed: 34978152
DOI: 10.1002/mabi.202100401 -
Advances in Clinical and Experimental... 2015Renal arterial embolization (RAE) is one of the adjunctive methods in the treatment of renal tumors. Embolization is performed in patients prior to nephrectomy, in...
BACKGROUND
Renal arterial embolization (RAE) is one of the adjunctive methods in the treatment of renal tumors. Embolization is performed in patients prior to nephrectomy, in patients with inoperable renal tumors as palliative treatment.
OBJECTIVES
The purpose of the study was to present and to analyze our own experiences in the embolization of renal tumors.
MATERIAL AND METHODS
A retrospective analysis of 33 patients treated using RAE between 2011 and 2013 was carried out. In 30 cases (91%), embolization was performed due to renal carcinoma and in 3 cases (9%) due to angiomyolipoma. In 11 patients intervention was performed as a palliative procedure because of advanced disease. Histoacrylic glue, polyvinyl alcohol, sponge pledgets and embolization coils were used for embolization.
RESULTS
In 20 patients (61%), selective RAE was performed, whereas superselective RAE was carried out in 13 patients (39%). The technical success rate of RAE was 100%. In one case the procedure was complicated by reflux of the histoacrylic glue into the common femoral artery with its embolization that required surgical embolectomy. We used histoacrylic glue in 26 embolizations (79%), in 19 procedures (58%) as the only embolization agent. Polyvinyl alcohol was used in 10 procedures (30%), gelatin sponge pledgets and absolute ethanol in 6 patients (18%). In 4 cases (12%), coils were implemented. In 22 patients (67%), one or more components of postembolization syndrome (PES) developed. In all 22 patients with PES (100%), severe lumbar pain was observed and administration of analgesics proved necessary. In 10 patients treated by palliative embolization, both a regression of macrohaematuria and an increase in hemoglobin level were observed. In 10 further patients, the creatinine level decreased following RAE.
CONCLUSIONS
RAE is an effective and minimally-invasive intervention burdened with low risk of major complications. PES occurs in about two-third of patients. In the majority of patients after palliative embolization, haematuria decreases and the quality of life improves.
Topics: Adult; Aged; Aged, 80 and over; Embolization, Therapeutic; Female; Humans; Kidney Neoplasms; Low Back Pain; Male; Middle Aged; Nephrectomy; Palliative Care; Preoperative Period; Quality of Life; Renal Artery; Retrospective Studies; Treatment Outcome
PubMed: 26768635
DOI: 10.17219/acem/29143 -
Interventional Neuroradiology : Journal... Apr 2022
Topics: Embolization, Therapeutic; Head; Hematoma, Subdural, Chronic; Humans; Meningeal Arteries
PubMed: 35392702
DOI: 10.1177/15910199221091896 -
European Journal of Trauma and... Oct 2020To validate our previously designed transcatheter arterial embolization (TAE) technique for bilateral iliac arteries in unstable pelvic fractures, which is designed to...
PURPOSE
To 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.
METHODS
We 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.
RESULTS
Seventy 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.
CONCLUSIONS
Our 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.
Topics: Adult; Aged; Buttocks; Embolization, Therapeutic; Female; Fractures, Bone; Humans; Iliac Artery; Male; Middle Aged; Necrosis; Pelvic Bones; Retrospective Studies; Trauma Severity Indices
PubMed: 30623196
DOI: 10.1007/s00068-018-01066-1 -
European Journal of Medical Research Dec 2022Chronic subdural hematoma (CSDH) is a common disease that forms between the dura and arachnoid membranes of the brain. With the development of medications and surgery,...
BACKGROUND
Chronic subdural hematoma (CSDH) is a common disease that forms between the dura and arachnoid membranes of the brain. With the development of medications and surgery, significant progress has been made in the diagnosis and treatment of CSDH. However, there is no comprehensive analysis available on CSDH-related studies published in the literature. This study aimed to collect and analyze CSDH-related studies published since the twenty-first century using bibliometric analysis and to summarize the current status of research in this field for the sake of providing systematic data for further study of CSDH.
METHODS
CSDH-related studies were searched in the Web of Science Core Collection (WoSCC) database using the Medical Subject Heading (MeSH) term 'chronic subdural hematoma'. Data analysis and visualization were performed by R and CiteSpace software.
RESULTS
This study retrieved 1424 CSDH-related articles published since the beginning of the twenty-first century. There was a general increase in both the number of published articles and the mean number of citations. The authors, institutions and journals that contributed the most to the field of CSDH were Jianning Zhang, Tianjin Medical University, and world neurosurgery, respectively. The reference co-citation network identified 13 clusters with significant modularity Q scores and silhouette scores (Q = 0.7124, S = 0.8536). The major research categories were (1) evolution of the therapeutic method and (2) the etiology and pathology of CSDH. Keyword analysis revealed that 'middle meningeal artery embolization' was the latest burst keyword.
CONCLUSIONS
This study identified the most influential countries, authors, institutions and journals contributing to CSDH research and discussed the hotspots and the latest subjects of CSDH research.
Topics: Humans; Embolization, Therapeutic; Hematoma, Subdural, Chronic; Meningeal Arteries; Neurosurgical Procedures; Bibliometrics
PubMed: 36572939
DOI: 10.1186/s40001-022-00959-7 -
Journal of Cardiothoracic Surgery Jun 2023Bronchial Dieulafoy's disease (BDD) is a rare disease that causes massive hemoptysis. This paper reports a case of BDD treated surgically. At the same time, we summarize... (Review)
Review
OBJECTIVE
Bronchial Dieulafoy's disease (BDD) is a rare disease that causes massive hemoptysis. This paper reports a case of BDD treated surgically. At the same time, we summarize the data of BDD patients reported in domestic and foreign literature to improve the understanding, diagnosis and treatment of this disease.
METHODS
A case of BDD with hemoptysis during bronchoscopy was reported. In addition, we searched for "bronchial Dieulafoy disease" through Pubmed, Web of Science, CNKI and Wanfang databases, covering the literature related to BDD that was definitely diagnosed or highly suspected from January 1995 to December 2021, and summarized the clinical characteristics, chest imaging, bronchoscopic manifestations, angiographic characteristics, pathological characteristics, treatment and outcome of patients.
RESULTS
The patient was a 68 year old male. Tracheoscopy revealed nodular and mass like changes in the basal segment of the left lower lobe, which appeared massive hemorrhage when touching the surface. The computed tomography angiophy of the bronchial artery confirmed that the branches of the left bronchial artery were tortuous and dilated, and then the left lower lobe of the lung was resected. During the operation, 3 thick tortuous nutrient artery vessels were sent out from the descending aorta, and 1 thick tortuous nutrient artery was sent out from the autonomic arch. All of them were ligated and cut. The pathology after the operation was in accordance with BDD; The patient did not have hemoptysis after discharge and is still under follow-up. The database identified 65 articles from January 1995 to December 2021. After removing repeated reports, meetings, incomplete information and nursing literature, 60 articles were included to report 88 cases of BDD. BDD can occur at all ages, with a male to female ratio of about 1.6:1. It mainly starts with hemoptysis, and can also be seen due to cough, infection, and respiratory failure; Inflammatory changes such as pulmonary patch shadow, exudation shadow and ground glass shadow of pulmonary hemorrhage were more common in chest imaging; The diagnosis of BDD is mainly based on the bronchoscopy, bronchial angiography and pathological findings of surgical or autopsy specimens. Bronchoscopic findings were mostly non pulsating, smooth nodular or mucosal processes. Bronchial angiography mainly showed tortuous dilatation of bronchial artery, and the lesions were mainly located in the right bronchus, more from the bronchial artery; Diagnosis depends on pathology, showing submucosal expansion of bronchus or abnormal artery rupture and bleeding; 54 cases underwent selective bronchial artery embolization, 39 cases underwent pulmonary lobectomy, 66 cases improved, and 10 cases died (all of them were caused by massive hemorrhage during bronchoscopic biopsy).
CONCLUSION
BDD is rare, but may cause fatal massive hemoptysis. Bronchial angiography is considered to be an effective method to diagnose BDD. Since pathological biopsy may lead to fatal bleeding, the necessity of pathological diagnosis remains controversial. Interventional and surgical treatment plays an important role in patients with cough accompanied by massive hemoptysis.
Topics: Humans; Male; Female; Aged; Hemoptysis; Bronchial Diseases; Cough; Bronchoscopy; Lung; Bronchial Arteries; Embolization, Therapeutic
PubMed: 37370170
DOI: 10.1186/s13019-023-02279-1 -
RoFo : Fortschritte Auf Dem Gebiete Der... Mar 2022Hemorrhoids are a widespread disease. Treatment options range from dietary measures to open surgery. A novel treatment approach is the embolization of the hemorrhoidal...
BACKGROUND
Hemorrhoids are a widespread disease. Treatment options range from dietary measures to open surgery. A novel treatment approach is the embolization of the hemorrhoidal arteries.
METHOD
A review was performed based on a selective literature search in PubMed representing the current state of research. The keywords "hemorrhoid" and "embolization" and "emborrhoid" were used. In addition, technical details of the hemorrhoidal embolization procedure are explained.
RESULTS AND CONCLUSION
Embolization of hemorrhoidal arteries is a safe treatment, which allows efficient symptom control even in patients with contraindications for open surgery.
KEY POINTS
· Embolization of hemorrhoidal arteries is a new approach to the treatment of hemorrhoids.. · Embolization of hemorrhoidal arteries is feasible in patients with contraindications for open surgery such as hypercoaguable states and contraindications for general anesthesia.. · The endovascular approach causes no rectal and anal trauma and associated complications can be avoided.. · The treatment of bleeding hemorrhoids seems to be particularly effective.. · No ischemic complications have been reported so far when coils as well as particles were used..
CITATION FORMAT
· Feyen L, Freyhardt P, Schott P et al. Hämorrhoidenembolisation: Eine neue minimalinvasive endovaskuläre Therapieoption bei Hämorrhoidalleiden. Fortschr Röntgenstr 2022; 194: 266 - 271.
Topics: Arteries; Embolization, Therapeutic; Endovascular Procedures; Hemorrhoids; Humans; Treatment Outcome
PubMed: 34794188
DOI: 10.1055/a-1662-5487 -
Journal of Cancer Research and... 2020To study the arterial distribution of embosphere microsphere (EM) and polyvinyl alcohol (PVA) particles in rabbit mesenteric artery using in vivo microscopy.To study the...
PURPOSE
To study the arterial distribution of embosphere microsphere (EM) and polyvinyl alcohol (PVA) particles in rabbit mesenteric artery using in vivo microscopy.To study the arterial distribution of embosphere microsphere (EM) and polyvinyl alcohol (PVA) particles in rabbit mesenteric artery using in vivo microscopy.
METHODS
Sixteen New Zealand rabbits were divided into four groups, namely large PVA (560-710 μm), small PVA (150-350 μm), large EM (500-700 μm), and small EM (100-300 μm). The mesenteric arteries of the experimental animals were embolized under fluoroscopic guidance and visualized using in vivo microscopy. The embolized vessel diameter and arterial distribution of embolic agents were compared.
RESULTS
The diameters of occluded vessels in large PVA, small PVA, large EM, and small EM groups were 430.60 ± 67.30, 200.95 ± 70.54, 387.79 ± 92.51, and 143.81 ± 39.65 μm, respectively. PVA occluded significantly larger vessels than EM when the particle size was similar (P < 0.001). The proportion of EM at the bifurcation of the artery was significantly higher than that of PVA particles (large PVA < large EM, χ = 4.325, P < 0.038; small PVA < small EM, χ = 6.68, P < 0.01).
CONCLUSION
Both PVA and EM could occlude vessels smaller than the particle size, and EM resulted in deeper penetration. The location of embolic particles in the artery is mainly related to the shape of particles.
Topics: Angiography; Animals; Drug Delivery Systems; Embolization, Therapeutic; Intravital Microscopy; Mesenteric Arteries; Microspheres; Models, Animal; Particle Size; Polyvinyl Alcohol; Rabbits
PubMed: 32474513
DOI: 10.4103/jcrt.JCRT_435_19