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The Israel Medical Association Journal... Nov 2016Trauma is the leading cause of childhood morbidity and mortality. Abdominal bleeding is one of the common causes of mortality due to trauma. Angiography and embolization...
BACKGROUND
Trauma is the leading cause of childhood morbidity and mortality. Abdominal bleeding is one of the common causes of mortality due to trauma. Angiography and embolization are well recognized as the primary treatments in certain cases of acute traumatic hemorrhage in adults; however, evidence is lacking in the pediatric population.
OBJECTIVES
To assess the safety and efficacy of transcatheter arterial embolization (TAE) for blunt and penetrating abdominal and pelvic trauma in the pediatric age group.
METHODS
Three children with blunt abdominal trauma and one child with iatrogenic renal injury (age 4-13 years) were managed with TAE for lacerated liver (one patient), pelvic fractures (one patient) and renal injuries (two patients). The first two patients, victims of road accidents, had multisystem injuries and were treated by emergency embolization after fluid resuscitation in the Emergency Department (ED). The other two patients had renal injuries: a 4 year old boy with blunt abdominal trauma was diagnosed on initial computed tomography with an unexpected Wilms tumor and was treated with embolization 1 day after admission due to hemodynamic deterioration caused by active arterial tumor bleeding. The following day he underwent successful nephrectomy. The other patient was 13 year old boy with nephrotic syndrome who underwent renal biopsy and developed hemodynamic instability. After fluid resuscitation, he underwent an initial negative angiography, but second-look angiography the following day revealed active bleeding from an aberrant renal artery, which was then successfully embolized.
RESULTS
In all four patients, TAE was diagnostic as well as therapeutic, and no child required surgical intervention for control of bleeding.
CONCLUSIONS
We propose that emergency transcatheter angiography and arterial embolization be considered following resuscitation in the ED as initial treatment in children with ongoing bleeding after blunt abdominal trauma or iatrogenic renal injury. Implementation of this policy demands availability and cooperation of the interventional radiology services.
Topics: Abdominal Injuries; Adolescent; Angiography; Child; Child, Preschool; Embolization, Therapeutic; Emergency Service, Hospital; Female; Gastrointestinal Hemorrhage; Humans; Male; Renal Artery; Tomography, X-Ray Computed; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 28466615
DOI: No ID Found -
The British Journal of Radiology 2015The application of bronchial artery embolization (BAE) using N-butyl-2-cyanoacrylate (NBCA) for haemoptysis was recently reported to be useful. A triple co-axial...
OBJECTIVE
The application of bronchial artery embolization (BAE) using N-butyl-2-cyanoacrylate (NBCA) for haemoptysis was recently reported to be useful. A triple co-axial (triaxial) system consisting of a 4-Fr catheter, 2.7-Fr microcatheter and 1.9-Fr no-taper microcatheter has been developed. The aim of the present study was to evaluate the usefulness of the triaxial system in BAE using NBCA.
METHODS
12 patients with haemoptysis, 8 males and 4 females with a median age of 64 years (range, 49-88 years), underwent BAE between August 2012 and October 2014. Medical records and images were reviewed, and the technical success rate, clinical success rate, haemoptysis-free rate and complications were evaluated. Technical success was defined as the complete cessation of the target artery as confirmed by digital subtraction angiography, whereas clinical success was defined as the cessation of haemoptysis within 24 h of BAE. Recurrent haemoptysis was defined as a total of >30 ml of bleeding per day.
RESULTS
The target artery was embolized successfully in all patients, and the technical success rate was 100% (12/12). The cessation of haemoptysis was achieved in 11 out of 12 patients within 24 h, and thus, the clinical success rate was 92% (11/12). The 6-, 12- and 24-month haemoptysis-free rates were 89%, 89% and 76%, respectively. No patients exhibited any signs of complications such as spinal ischaemia.
CONCLUSION
BAE using the triaxial system and NBCA appears to be a useful and safe procedure for haemoptysis.
ADVANCES IN KNOWLEDGE
The triaxial system contributes to safe and effective BAE using NBCA.
Topics: Aged; Aged, 80 and over; Angiography, Digital Subtraction; Bronchial Arteries; Embolization, Therapeutic; Enbucrilate; Female; Hemoptysis; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 26423598
DOI: 10.1259/bjr.20150265 -
Radiology Oct 2016Purpose To assess the feasibility of a magnetically assisted remote-controlled (MARC) catheter system under magnetic resonance (MR) imaging guidance for performing a...
Purpose To assess the feasibility of a magnetically assisted remote-controlled (MARC) catheter system under magnetic resonance (MR) imaging guidance for performing a simple endovascular procedure (ie, renal artery embolization) in vivo and to compare with x-ray guidance to determine the value of MR imaging guidance and the specific areas where the MARC system can be improved. Materials and Methods In concordance with the Institutional Animal Care and Use Committee protocol, in vivo renal artery navigation and embolization were tested in three farm pigs (mean weight 43 kg ± 2 [standard deviation]) under real-time MR imaging at 1.5 T. The MARC catheter device was constructed by using an intramural copper-braided catheter connected to a laser-lithographed saddle coil at the distal tip. Interventionalists controlled an in-room cart that delivered electrical current to deflect the catheter in the MR imager. Contralateral kidneys were similarly embolized under x-ray guidance by using standard clinical catheters and guidewires. Changes in renal artery flow and perfusion were measured before and after embolization by using velocity-encoded and perfusion MR imaging. Catheter navigation times, renal parenchymal perfusion, and renal artery flow rates were measured for MR-guided and x-ray-guided embolization procedures and are presented as means ± standard deviation in this pilot study. Results Embolization was successful in all six kidneys under both x-ray and MR imaging guidance. Mean catheterization time with MR guidance was 93 seconds ± 56, compared with 60 seconds ± 22 for x-ray guidance. Mean changes in perfusion rates were 4.9 au/sec ± 0.8 versus 4.6 au/sec ± 0.6, and mean changes in renal flow rate were 2.1 mL/min/g ± 0.2 versus 1.9 mL/min/g ± 0.2 with MR imaging and x-ray guidance, respectively. Conclusion The MARC catheter system is feasible for renal artery catheterization and embolization under real-time MR imaging in vivo, and quantitative physiologic measures under MR imaging guidance were similar to those measured under x-ray guidance, suggesting that the MARC catheter system could be used for endovascular procedures with interventional MR imaging. (©) RSNA, 2016.
Topics: Animals; Catheterization, Peripheral; Embolization, Therapeutic; Endovascular Procedures; Magnetic Resonance Imaging, Interventional; Magnetics; Models, Animal; Pilot Projects; Radiography, Interventional; Renal Artery; Swine
PubMed: 27019290
DOI: 10.1148/radiol.2016152036 -
Journal of Vascular and Interventional... Jun 2021To evaluate a novel aqueous-based liquid embolic (Embrace Hydrogel Embolic System, [HES]) that has been developed to embolize hypervascular tumors by filling the tumor... (Comparative Study)
Comparative Study
PURPOSE
To evaluate a novel aqueous-based liquid embolic (Embrace Hydrogel Embolic System, [HES]) that has been developed to embolize hypervascular tumors by filling the tumor vascular bed and solidifying into a hydrogel. HES was evaluated for embolization safety and efficacy relative to microspheres in a preclinical rabbit kidney model.
MATERIALS AND METHODS
A renal embolization model in New Zealand white rabbits was utilized. Twenty-four rabbits underwent unilateral kidney embolization via the main renal artery with either HES or 40-μm microspheres. Twenty-two rabbits survived the procedure and were monitored for 2, 12, 17.5, or 26 weeks before sacrifice. All rabbits underwent a repeat renal angiogram before necropsy. HES was evaluated for nontarget embolization, safety, and embolization effectiveness as measured by recanalization and viability of embolized tissue.
RESULTS
Both embolization materials were found to be safe, with targeted tissue necrosis and absence of nontarget embolization. Prenecropsy angiograms found vascular recanalization in 0/14 (0%) HES-embolized kidneys and in 3/8 (38%) microsphere-embolized kidneys (P = .036). Viable kidney tissue was observed in 2/14 (14%) kidneys embolized with HES and 5/8 (63%) kidneys embolized with microspheres (P = .052). All kidneys embolized with microspheres that showed vascular recanalization had viable tissue on histological sections. HES was observed in vessels as small as 10 μm in diameter in histological analysis.
CONCLUSIONS
HES provided deep, durable vascular bed embolization that resulted in less recanalization and, on an average, less viable target tissue compared with 40-μm microspheres. No systemic effects or nontarget tissue embolization was identified.
Topics: Animals; Embolization, Therapeutic; Hydrogels; Injections, Intra-Arterial; Kidney; Microspheres; Models, Animal; Particle Size; Polyethylene Glycols; Rabbits; Renal Artery
PubMed: 33677119
DOI: 10.1016/j.jvir.2021.02.018 -
AJNR. American Journal of Neuroradiology Nov 2019Despite several retrospective studies showing the safety and efficacy of transradial access for cerebral angiography, neurointerventionalists are apprehensive about...
BACKGROUND AND PURPOSE
Despite several retrospective studies showing the safety and efficacy of transradial access for cerebral angiography, neurointerventionalists are apprehensive about implementing TRA for neurointerventions. This reluctance is mainly due to anatomic factors, technical factors, and a long learning curve (relative to transfemoral access). We present here our experience of TRA transition for cerebral aneurysm embolization. Our aim was to demonstrate the feasibility and safety of radial access for consecutive embolizations of ruptured and unruptured cerebral aneurysms.
MATERIALS AND METHODS
We performed a retrospective review of a prospective data base on cerebral aneurysm embolizations. Between April and December 2018, radial access was considered for all consecutive patients referred to our institution for cerebral aneurysm embolization. Technical success was defined as radial access with insertion of the sheath and completion of the intervention without a crossover to conventional femoral access. The primary safety end point was the in-hospital plus 30-day incidence of radial artery occlusion. Secondary end points included intraoperative complications and neurologic complications at discharge and in the following 30 days.
RESULTS
Seventy-one patients with a cerebral aneurysm underwent 73 embolization procedures at our institution. The first-choice access route was the radial artery in 62 patients (87.3%) and the femoral artery in 9 (12.6%). Thirty-four embolizations were performed using coils, 22 used a balloon-assisted coil technique, 6 used a stent-assisted coil technique, and 2 used a flow diverter. Crossover to femoral access was observed in 2 patients (3.1%). Four patients developed coil-induced thrombi requiring intra-arterial tirofiban injections. In 1 case, an aneurysm ruptured during the operation but did not have a clinical impact. No cases of radial artery occlusion or hand ischemia were observed.
CONCLUSIONS
A transition to radial access for cerebral aneurysm embolization is feasible and does not increase the level of risk associated with the procedure.
Topics: Adult; Aged; Embolization, Therapeutic; Endovascular Procedures; Female; Humans; Intracranial Aneurysm; Intraoperative Complications; Male; Middle Aged; Radial Artery; Retrospective Studies; Stents; Treatment Outcome
PubMed: 31582386
DOI: 10.3174/ajnr.A6234 -
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 -
Journal of Vascular Surgery Sep 2015Degenerative hepatic artery aneurysms (HAAs) are an uncommon pathologic process. The aim of this study was to evaluate the approach to and outcomes of operative...
OBJECTIVE
Degenerative hepatic artery aneurysms (HAAs) are an uncommon pathologic process. The aim of this study was to evaluate the approach to and outcomes of operative management of HAA with open techniques (OTs) and endovascular techniques (ETs).
METHODS
Twenty-one patients who underwent intervention for HAA from January 1, 1992, to January 30, 2015, at a single institution were retrospectively reviewed. Patient presentation, risk factors, and operative approach were reviewed. The primary outcome was operative morbidity and mortality. Secondary outcomes included long-term survival, patency, and need for reintervention.
RESULTS
Of the 21 patients, 14 (67%) were men. The mean age of all patients was 66 years (range, 30-85 years), with a mean HAA size of 45 ± 28 mm (12 common hepatic, 5 common and proper hepatic, 3 right hepatic, and 1 accessory left hepatic). Nine patients (43%) had connective tissue disorders. More than half of the patients (63%) had synchronous aneurysms (29% in the aorta, 24% in the splenic and iliac arteries, and 10% in the celiac arteries). Ten patients (48%) were asymptomatic. Right upper quadrant pain was the most common symptom at presentation (43%), followed by transaminitis (5%) and obstructive jaundice (5%). Five patients (24%) presented with rupture (size, 15-40 mm). OT was performed in 17 patients; 4 patients had ET. Fourteen patients (67%) underwent open reconstruction of the common hepatic (n = 10), the common and proper hepatic (n = 2), and the right and left accessory hepatic arteries (n = 1 each). Seven bypasses were performed with saphenous vein, six with Dacron, and one with polytetrafluoroethylene. Endoaneurysmorrhaphy alone, patch, and ligation were performed in one instance each. Postoperative complications occurred in six patients (29%), including hemorrhage, graft thrombosis, common bile duct stricture that required reoperation, duodenal perforation, and enterocutaneous fistula. ET was attempted in five patients; coil embolization was performed in four patients (two of the common and two of the right hepatic arteries). Overall mortality was 14% (6% after elective OT, 40% for emergency OT, 0% for ET). Mean follow-up was 32 ± 46 months. Overall survival was 86% at 5 years. Primary and secondary graft patency was 86% at 5 years. One patient underwent reintervention because of occlusion of saphenous vein graft.
CONCLUSIONS
Open repair remains the mainstay treatment for degenerative HAA repairs to preserve arterial flow to the liver, with notable morbidity and mortality, particularly in the setting of rupture. However, coil embolization may be applied safely in select patients with aneurysms not involving the proper hepatic artery if adequate collateral circulation ensures hepatic perfusion.
Topics: Adult; Aged; Aged, 80 and over; Aneurysm; Aneurysm, Ruptured; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Collateral Circulation; Embolization, Therapeutic; Female; Hepatic Artery; Humans; Liver Circulation; Male; Middle Aged; Minnesota; Patient Selection; Postoperative Complications; Prosthesis Design; Retrospective Studies; Risk Factors; Saphenous Vein; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 26094044
DOI: 10.1016/j.jvs.2015.03.077 -
Biomaterials Jan 2021Degradable embolic agents that provide transient arterial occlusion during embolization procedures have been of interest for many years. Ideally, embolic agents are...
Degradable embolic agents that provide transient arterial occlusion during embolization procedures have been of interest for many years. Ideally, embolic agents are visible with standard imaging modalities and offer on-demand degradability, permitting physicians to achieve desired arterial occlusion tailored to patient and procedure indication. Subsequent arterial recanalization potentially enhances the overall safety and efficacy of embolization procedures. Here, we report on-demand degradable and MRI-visible microspheres for embolotherapy. Embolic microspheres composed of calcium alginate and USPIO nanoclusters were synthesized with an air spray atomization and coagulation reservoir equipped with a vacuum suction. An optimized distance between spray nozzle and reservoir allowed uniform size and narrow size distribution of microspheres. The fabricated alginate embolic microspheres crosslinked with Ca demonstrated highly responsive on-demand degradation properties in vitro and in vivo. Finally, the feasibility of using the microspheres for clinical embolization and recanalization procedures was evaluated with interventional radiologists in rabbits. Digital subtraction angiography (DSA) guided embolization of hepatic arteries with these embolic microspheres was successfully performed and the occlusion of artery was confirmed with DSA images and contrast enhanced MRI. T2 MRI visibility of the microspheres allowed to monitor the distribution of intra-arterial (IA) infused embolic microspheres. Subsequent on-demand image-guided recanalization procedures were also successfully performed with rapid degradation of microspheres upon intra-arterial infusion of an ion chelating agent. These instant degradable embolic microspheres will permit effective on-demand embolization/recanalization procedures offering great promise to overcome limitations of currently available permanent and biodegradable embolic agents.
Topics: Alginates; Animals; Arteries; Embolization, Therapeutic; Humans; Magnetic Resonance Imaging; Microspheres; Rabbits
PubMed: 32992115
DOI: 10.1016/j.biomaterials.2020.120408 -
Experimental and Clinical... Nov 2015Hypersplenism (thrombocytopenia, leukopenia, anemia) syndrome and ascites occur after orthotopic liver transplant. These conditions can be treated by open splenectomy....
OBJECTIVES
Hypersplenism (thrombocytopenia, leukopenia, anemia) syndrome and ascites occur after orthotopic liver transplant. These conditions can be treated by open splenectomy. Splenic artery embolization has been practiced as an alternative surgical method.
MATERIALS AND METHODS
Between January 2013 and January 2015, twenty-one orthotopic liver transplants were performed at the National Scientific Medical Research Center, Astana, Kazakhstan. Of these patients, 3 subsequently received splenic artery embolization 12, 8, and 6 months after transplant: 2 patients who had been diagnosed with primary biliary cirrhosis and 1 patient with hepatitis B virus -related liver cirrhosis. Two patients received a right-lobe living orthotopic liver transplant, and 1 patient received a deceased donor transplant. Indications for splenic artery embolization (ascites, splenomegaly) were based on clinical and ultrasonographic investigation and laboratory findings (thrombocytopenia, platelet count < 60 × 109/L, leukocytopenia, and white blood cell count < 2 × 109/L). Two recipients had leukothrombocytopenia and refractory ascites, and 1 had only thrombocytopenia. Splenic artery embolization was performed via a percutaneous femoral artery approach under local anesthesia. Transcatheter splenic artery branch occlusion was performed by deploying occlusion material. Preoperative spleen size ranged from 17.5 × 8.0 cm to 22.0 × 12.5 cm; ascites volumes were > 1000 mL.
RESULTS
In all patients, ascites and platelet levels decreased after splenic artery embolization. In 1 patient with leukopenia, white blood cell count normalized. After embolization, 1 patient had severe abdominal pain requiring analgesia medication, and 2 patients had fever that lasted 3 days. Patients were discharged 6 to 9 days after embolization. One patient developed a perisplenic abscess without fever 1 month after discharge, and the abscess was drained using an ultrasound-guided percutaneous procedure.
CONCLUSIONS
Splenic artery embolization is a safe and effective minimally invasive method for treating hypersplenism and ascites in orthotopic liver transplant recipients and an alternative to open splenectomy.
Topics: Ascites; Embolization, Therapeutic; Humans; Hypersplenism; Kazakhstan; Liver Transplantation; Risk Factors; Splenic Artery; Syndrome; Treatment Outcome
PubMed: 26640912
DOI: 10.6002/ect.tdtd2015.O43 -
Revue Medicale de Liege Apr 2022Arterial aneurysms of visceral branches are rare, even more if they occur on the superior mesenteric artery and its branches (among which ileal branches). Rupture is its...
Arterial aneurysms of visceral branches are rare, even more if they occur on the superior mesenteric artery and its branches (among which ileal branches). Rupture is its major complication, thus rapid treatment is mandatory. CT angiography is the gold standard for diagnosis and therapeutic planification. Usual treatment is surgical, even though percutaneous embolization can be safely and precisely performed. Use of coils with sandwich technique is preferred.
Topics: Aneurysm; Aneurysm, False; Embolization, Therapeutic; Humans; Mesenteric Artery, Superior; Treatment Outcome
PubMed: 35389001
DOI: No ID Found