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Diagnostic and Interventional Radiology... 2017We systematically reviewed the role of bronchial artery embolization (BAE) in hemoptysis. Literature search was done for studies on BAE published between 1976 and 2016.... (Review)
Review
We systematically reviewed the role of bronchial artery embolization (BAE) in hemoptysis. Literature search was done for studies on BAE published between 1976 and 2016. Twenty-two studies published in English, with sample size of at least 50 patients, reporting indications, technique, efficacy, and follow-up were included in the final analysis. Common indications for BAE included tuberculosis (TB), post-tubercular sequelae, bronchiectasis, and aspergillomas. Most common embolizing agent used was polyvinyl alcohol (size, 300-600 μm) with increasing use of glue in recent years. Overall immediate clinical success rate of BAE, defined as complete cessation of hemoptysis, varied from 70%-99%. However, recurrence rate remains high, ranging from 10%-57%, due to incomplete initial embolization, recanalization of previously embolized arteries, and recruitment of new collaterals. Presence of nonbronchial systemic collaterals, bronchopulmonary shunting, aspergillomas, reactivation TB, and multidrug resistant TB were associated with significantly higher recurrence rates (P < 0.05). Rate of major complications remained negligible and stable over time with median incidence of 0.1% (0%-6.6%). Despite high hemoptysis recurrence rates, BAE continues to be the first-line, minimally invasive treatment of hemoptysis in emergency settings, surgically unfit patients, or in patients with diffuse or bilateral lung disease.
Topics: Bronchial Arteries; Embolization, Therapeutic; Hemoptysis; Humans; Polyvinyl Alcohol; Treatment Outcome
PubMed: 28703105
DOI: 10.5152/dir.2017.16454 -
Japanese Journal of Clinical Oncology May 2021Previous reports on transarterial treatment for lung cancer were reviewed. The bronchial arterial infusion therapy has a long history since 1964. Better local control... (Review)
Review
Previous reports on transarterial treatment for lung cancer were reviewed. The bronchial arterial infusion therapy has a long history since 1964. Better local control with less doses of anti-neoplastic agents was warranted by trying transarterial administration to lung and mediastinal tumors. It is reported that both primary and metastatic tumors are fed by bronchial or other systemic arteries. The bronchial arterial embolization for hemoptysis has been introduced for clinical practice since 1973. Hemoptysis by not only benign but also malignant diseases has been well controlled by embolization. In recent decades, the technical elements for transarterial treatments have markedly improved. They make it possible to carry out precise procedures of selective catheter insertion to the tumor relating arteries. Current concepts of transarterial treatment, technical aspects and treatment outcomes are summarized. Tentative result from chemo-embolization for advanced lung cancer using recent catheter techniques was also described. It provides favorable local control and survival merits. It is considered that a population of lung cancer patients can benefit from transarterial management using small doses of anti-neoplastic agents, with less complications and less medical costs.
Topics: Bronchial Arteries; Catheterization, Peripheral; Disease Progression; Embolization, Therapeutic; Hemoptysis; Humans; Lung; Lung Neoplasms; Treatment Outcome
PubMed: 33855367
DOI: 10.1093/jjco/hyab050 -
Radiologia 2020To present our results and describe the technique used for the endovascular treatment of hemorrhoids. (Observational Study)
Observational Study
OBJECTIVE
To present our results and describe the technique used for the endovascular treatment of hemorrhoids.
MATERIAL AND METHODS
We used right femoral artery or radial artery access to catheterize the inferior mesenteric artery, proceeding to the superior rectal artery with a 2.7F microcatheter to catheterize and embolize each distal branch distally with PVA particles (300-500μm) and proximally with coils (2-3mm). Patients were discharged 24hours after the procedure and clinically followed up at one month by anoscopy.
RESULTS
We included 20 patients (4 women and 16 men; mean age, 61.85 years (27-81 years); mean follow-up, 10.6 months (28-2 months). Technical success was achieved in 18 (90%) patients and clinical success in 15 (83.4%); one patient required a second embolization of the medial rectal artery and two required surgery. Recovery was practically painless. At the one-month follow-up, all patients were very satisfied and anoscopy demonstrated marked improvement of the hemorrhoids. There were no complications secondary to embolization.
CONCLUSIONS
Our initial results suggest that selective intra-arterial embolization is a safe and painless procedure that is well tolerated because it avoids rectal trauma and patients recover immediately.
Topics: Adult; Aged; Aged, 80 and over; Catheterization; Embolization, Therapeutic; Female; Femoral Artery; Hemorrhoids; Humans; Male; Mesenteric Artery, Inferior; Middle Aged; Radial Artery; Retrospective Studies
PubMed: 32029240
DOI: 10.1016/j.rx.2019.12.004 -
AJNR. American Journal of Neuroradiology Aug 2022Skull base tumors are commonly supplied by dural branches of the meningohypophyseal and inferolateral trunks. Embolization through these arteries is often avoided due to...
BACKGROUND AND PURPOSE
Skull base tumors are commonly supplied by dural branches of the meningohypophyseal and inferolateral trunks. Embolization through these arteries is often avoided due to technical challenges and inherent risks; however, successful embolization can be a valuable surgical adjunct. We aimed to review the success and complications in our series of tumor embolizations through the meningohypophyseal and inferolateral trunks.
MATERIALS AND METHODS
We performed a retrospective review of patients with tumor treated with preoperative embolization at our institution between 2010 and 2020. We reviewed the following data: patients' demographics, tumor characteristics, endovascular embolization variables, and surgical results including estimated blood loss, the need for transfusion, and operative time.
RESULTS
Among 155 tumor embolization cases, we identified 14 patients in whom tumor embolization was performed using the meningohypophyseal ( = 13) or inferolateral ( = 4) trunk. In this group of patients, on average, 79% of tumors were embolized. No mortality or morbidity from the embolization procedure was observed in this subgroup of patients. The average estimated blood loss in the operation was 395 mL (range, 200-750 mL). None of the patients required a transfusion, and the average operative time was 7.3 hours.
CONCLUSIONS
Some skull base tumors necessitate embolization through ICA branches such as the meningohypophyseal and inferolateral trunks. Our series demonstrates that an effective and safe embolization may be performed through these routes.
Topics: Humans; Arteries; Embolization, Therapeutic; Preoperative Care; Retrospective Studies; Skull Base Neoplasms
PubMed: 35902121
DOI: 10.3174/ajnr.A7579 -
Korean Journal of Radiology 2018Postpartum hemorrhage (PPH) is a life-threatening condition and remains a leading cause of maternal mortality. Transcatheter arterial embolization (TAE) is an effective... (Review)
Review
Postpartum hemorrhage (PPH) is a life-threatening condition and remains a leading cause of maternal mortality. Transcatheter arterial embolization (TAE) is an effective therapeutic strategy for PPH with the advantages of fast speed, repeatability, and the possibility of fertility preservation. We reviewed the vascular anatomy relevant to PPH, the practical details of TAE emphasizing the timing of embolization, and various clinical conditions of PPH according to a recent literature review.
Topics: Adult; Embolization, Therapeutic; Female; Genitalia, Female; Humans; Iliac Artery; Parturition; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Treatment Outcome; Vascular Surgical Procedures
PubMed: 29962865
DOI: 10.3348/kjr.2018.19.4.585 -
Diagnostic and Interventional Radiology... Jul 2021The study aimed to evaluate the safety and clinical efficacy of transcatheter arterial embolization (TAE) for the treatment of arterial esophageal bleeding.
PURPOSE
The study aimed to evaluate the safety and clinical efficacy of transcatheter arterial embolization (TAE) for the treatment of arterial esophageal bleeding.
METHODS
Nine patients (8 male, 1 female; mean age, 62.3±7.5 years) who underwent TAE for arterial esophageal bleeding between January 2004 and January 2020 were included. Preceding endoscopic treatment was unsuccessful in five patients and was not attempted in four patients due to the non-cooperation of the patients in endoscopic treatment. The etiologies of bleeding were esophageal cancer (n=4), Mallory-Weiss syndrome (n=3), erosive esophagitis (n=1), and esophageal ulcer (n=1). Technical and clinical success, recurrent bleeding, procedure-related complications, and clinical outcomes were retrospectively reviewed.
RESULTS
The angiographic findings for bleeding were contrast media extravasation (n=8) or tumor staining without a definite bleeding focus (n=1). The bleeding focus at the distal esophagus (n=8) was the left gastric artery, whereas that at the middle esophagus (n=1) was the right bronchial artery. Technical success was achieved in all patients. The embolic agents were n-butyl cyanoacrylate (NBCA, n=5), gelatin sponge particles (n=2), microcoils (n=1), and NBCA with gelatin sponge particles (n=1). Clinical success was achieved in 77.8% of cases (7/9); two patients with recurrent bleeding one day after the first TAE showed culprit arteries different from the bleeding foci at the first TAE. One patient who underwent embolization of both the left and short gastric arteries died of gastric infract/perforation one month after TAE.
CONCLUSION
TAE can be an alternative to the treatment of arterial esophageal bleeding. TAE can be attempted in the treatment of recurrent bleeding, but there is a risk of ischemia/infarct in the gastrointestinal tract involved.
Topics: Aged; Arteries; Embolization, Therapeutic; Enbucrilate; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 34313237
DOI: 10.5152/dir.2021.20253 -
The British Journal of Radiology Apr 2023To evaluate the effectiveness and safety of transcatheter arterial embolization (TAE) of the branches of the subclavian and axillary arteries for hemorrhage control.
OBJECTIVE
To evaluate the effectiveness and safety of transcatheter arterial embolization (TAE) of the branches of the subclavian and axillary arteries for hemorrhage control.
METHODS
Between January 2015 and June 2022, 35 TAE procedures were performed for hemorrhage from the branches of the subclavian and axillary arteries in 34 patients (22 men, 12 women; 1 male underwent TAE twice; mean age = 76 years). Pre-TAE CT showed hematomas in the chest ( = 25) and abdominal walls ( = 3), shoulder ( = 2), and lower neck ( = 2). CT showed hemothorax in eight cases. Angiographic findings, embolization technique, and technical and clinical success of TAE were retrospectively assessed in all cases.
RESULTS
TAE was performed by transfemoral ( = 16), transradial ( = 12), and transbrachial ( = 7) approaches. Angiography revealed contrast media extravasation or pseudoaneurysms in 32 cases (91.4%). The most commonly embolized arteries were the internal thoracic ( = 12), lateral thoracic ( = 6), and thoracoacromial ( = 6) arteries. Technical and clinical success rates were 100 and 85.7%, respectively. A complication (skin necrosis after injection of the liquid embolic agent) developed in only one patient (2.9%) and was conservatively managed.
CONCLUSION
TAE is an effective and safe treatment for hemorrhage from the branches of the subclavian and axillary arteries.
ADVANCES IN KNOWLEDGE
Transfemoral approach has been used for TAE of the branches of the subclavian and axillary artery. Transradial and transbrachial approaches can also be considered.
Topics: Humans; Male; Female; Aged; Axillary Artery; Retrospective Studies; Treatment Outcome; Hemorrhage; Embolization, Therapeutic
PubMed: 36745129
DOI: 10.1259/bjr.20221132 -
Advanced Materials (Deerfield Beach,... Dec 2020Vascular embolization is a life-saving minimally invasive catheter-based procedure performed to treat bleeding vessels. Through these catheters, numerous metallic coils...
Vascular embolization is a life-saving minimally invasive catheter-based procedure performed to treat bleeding vessels. Through these catheters, numerous metallic coils are often pushed into the bleeding artery to stop the blood flow. While there are numerous drawbacks to coil embolization, physician expertise, availability of these coils, and their costs further limit their use. Here, a novel blood-derived embolic material (BEM) with regenerative properties, that can achieve instant and durable intra-arterial hemostasis regardless of coagulopathy, is developed. In a large animal model of vascular embolization, it is shown that the BEM can be prepared at the point-of-care within 26 min using fresh blood, it can be easily delivered using clinical catheters to embolize renal and iliac arteries, and it can achieve rapid hemostasis in acutely injured vessels. In swine arteries, the BEM increases cellular proliferation, angiogenesis, and connective tissue deposition, suggesting vessel healing and durable vessel occlusion. The BEM has significant advantages over embolic materials used today, making it a promising new tool for embolization.
Topics: Animals; Arteries; Biocompatible Materials; Blood; Catheters; Cell Proliferation; Embolization, Therapeutic; Neovascularization, Physiologic; Swine
PubMed: 33174305
DOI: 10.1002/adma.202005603 -
The British Journal of Radiology Aug 2021Renal artery aneurysm (RAA) is a rare disease. With modern non-invasive imaging modalities, the disease is being increasingly diagnosed. It is a slow-growing aneurysm... (Review)
Review
Renal artery aneurysm (RAA) is a rare disease. With modern non-invasive imaging modalities, the disease is being increasingly diagnosed. It is a slow-growing aneurysm with high mortality in the event of rupture; especially in pregnant females for in which case patients were treated surgically. With advances in endovascular therapy, numerous techniques have been employed to manage complex RAA in artery bifurcation, branch and segmental arteries with excellent technical and clinical success. The various recent techniques include the use of flow diverter stents, remodelling with stent-assisted coil embolization (SACE), balloon-assisted coil embolization (BACE), selective embolization with coils-sac packing, inflow occlusion and coil trapping and selective embolization with liquid embolic agents-hystroacril and onyx. A combination of stent-graft with liquid embolization and liquid with microcoil embolization has been advocated with success. The most common complication encountered is renal infarction. This is mostly without impairment of renal function and secondary to embolization. Endovascular therapy has shorter operative time, less blood loss, shorter intensive care stay, done under conscious sedation and is associated with lesser postoperative morbidity compared to surgery. Reduction in hypertension, improvement of renal function and symptoms has been seen in most studies. Endovascular management of RAA has become the management of choice even with complex anatomy and technically challenging lesions.
Topics: Aneurysm; Embolization, Therapeutic; Endovascular Procedures; Humans; Renal Artery
PubMed: 34111371
DOI: 10.1259/bjr.20201151 -
The Journal of the American Academy of... Feb 2018The use, timing, and priority of angioembolization in the management of bleeding pelvic fractures remain ambiguous. The most common vessels for angioembolization are, in... (Review)
Review
The use, timing, and priority of angioembolization in the management of bleeding pelvic fractures remain ambiguous. The most common vessels for angioembolization are, in decreasing order, the internal iliac artery and its branches, the superior gluteal artery, the obturator artery, and the internal pudendal artery. Technical success rates for this treatment option range from 74% to 100%. The fracture patterns most commonly requiring angioembolization are the Young and Burgess lateral compression and anterior-posterior compression types and Tile type C. Mortality rates after angioembolization of 16% to 50% have been reported, but deaths are usually related to concomitant injuries. The sensitivity and specificity of contrast-enhanced CT in detecting the need for angioembolization range from 60% to 90% and 92% to 100%, respectively. Angioembolization can be effective in the management of bleeding pelvic fractures, but as with any treatment, the risks of complications must be considered. Availability of angioembolization and institutional expertise/preference for the alternative strategy of pelvic packing influence its use.
Topics: Angiography; Arteries; Embolization, Therapeutic; Fractures, Bone; Hemorrhage; Humans; Patient Selection; Pelvic Bones; Sensitivity and Specificity; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 29351135
DOI: 10.5435/JAAOS-D-16-00600