Review

Authors: Kamil Bałabuszek, Michał Toborek, Radosław Pietura...

Pelvic venous disorders (PeVD) also known as Pelvic Congestion Syndrome (PCS) affect a great number of women worldwide and often remain undiagnosed. Gynecological symptoms caused by vascular background demand a holistic approach for appropriate diagnosis. This is a relevant cause of chronic pelvic pain and atypical varicose veins. The diagnosis is based on imaging studies and their correlation with clinical presentation. Although the aetiology of PCS still remains unclear, it may result from a combination of factors including genetic predisposition, anatomical abnormalities, hormonal factors, damage to the vein wall, valve dysfunction, reverse blood flow, hypertension and dilatation. The following paper describes an in-depth overview of anatomy, pathophysiology, symptoms, diagnosis and treatment of PCS. In recent years, minimally invasive interventions have become the method of first choice for the treatment of this condition. The efficacy of a percutaneous approach is high and it is rarely associated with serious complications.Key MessagesPelvic venous disorders demand a holistic approach for appropriate diagnosis.This article takes an in-depth look at existing therapies of Pelvic Congestion Syndrome and pathophysiology of this condition.Embolisation is an effective and safe treatment option.

Topics: Embolization, Therapeutic; Female; Humans; Pelvic Pain; Pelvis; Varicose Veins

PubMed: 34935563
DOI: 10.1080/07853890.2021.2014556

Review

Authors: Jingjie Hu, Hassan Albadawi, Brian W Chong...

Minimally invasive transcatheter embolization is a common nonsurgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the treatment of diseased or injured vasculature. A wide variety of embolic agents including metallic coils, calibrated microspheres, and liquids are available for clinical practice. Additionally, advances in biomaterials, such as shape-memory foams, biodegradable polymers, and in situ gelling solutions have led to the development of novel preclinical embolic agents. The aim here is to provide a comprehensive overview of current and emerging technologies in endovascular embolization with respect to devices, materials, mechanisms, and design guidelines. Limitations and challenges in embolic materials are also discussed to promote advancement in the field.

Topics: Animals; Biocompatible Materials; Embolization, Therapeutic; Endovascular Procedures; Humans; Metals; Microspheres; Polymers

PubMed: 31168915
DOI: 10.1002/adma.201901071

Review

Authors: Ananya Panda, Ashu Seith Bhalla, Ankur Goyal...

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

Authors: Jai Shankar, Susan Alcock, Genevieve Milot...

Embolization of middle meningeal artery (EMMA) for chronic subdural hematoma (cSDH) is growing in popularity over the last two decade. Several randomized control trials are underway across the world. Indeed, the recent presentation of results from the EMBOLISE (embolization of the middle meningeal artery with onyx liquid embolic system in the treatment of subacute and chronic subdural hematoma), MAGIC-MT (middle meningeal artery treatment) and STEM (squid trial for the embolization of the MMA for the treatment of cSDH) trials at the International Stroke Congress marks a significant development in the field of neurointerventional radiology. The absence of level 1 evidence for EMMA in cSDH underscores the importance of these trials and the need for rigorous evaluation of their results. While the initial findings are promising, further analysis and interpretation are necessary to inform clinical decision-making effectively. We conclude that there may be evidence supporting EMMA for non-surgical cSDH patients, but the evidence for surgical patients is questionable and requires further study. More studies are underway, and hopefully, there will be more evidence on this topic in the coming years.

Topics: Humans; Embolization, Therapeutic; Evidence-Based Medicine; Hematoma, Subdural, Chronic; Meningeal Arteries; Randomized Controlled Trials as Topic

PubMed: 38592031
DOI: 10.1177/15910199241246299

Review

Authors: Matteo Galea, Mark R Brincat, Jean Calleja-Agius...

Pelvic congestion syndrome (PCS) in females and varicoceles in males may be regarded as closely related conditions since the main pathophysiological cause for both processes is pelvic venous insufficiency. Varicoceles are more prevalent amongst sub-fertile males, with an approximate incidence of 15% in the general male population. PCS is commonly diagnosed amongst premenopausal multiparous women, representing one of the leading causes of chronic pelvic pain. Both conditions appear to be predominantly left-sided and are associated with oxidative stress and pro-inflammatory cascades with subsequent effects on fertility. Clinical examination and pelvic ultrasonography play an essential role in the assessment of varicoceles, PCS and chronic pelvic pain. Venography is generally considered as a gold-standard procedure for both conditions. There is still much debate on how these conditions should be managed. This review article provides a comparative analysis of the underlying pathophysiological mechanisms of both PCS and varicoceles, their impact on fertility, as well as their clinical management.

Topics: Male; Humans; Female; Varicocele; Embolization, Therapeutic; Pelvic Pain; Pelvis; Venous Insufficiency

PubMed: 37190955
DOI: 10.1080/14647273.2023.2212846

Review

Authors: Zachary Haber

Embolization of bone metastases is most commonly performed for hypervascular tumors prior to surgical resection. When employed in this fashion embolization can significantly decrease perioperative hemorrhage and improve surgical outcomes. In addition, embolization of bone metastases may lead to local tumor control and decreased tumoral associate bone pain. Careful techniques and choice of embolic material are required when performing embolization of bone lesions to ensure low procedural complications and high rates of clinical success. The indications, technical considerations, and complications associated with embolization of metastatic hypervascular bone lesions will be discussed in this review with subsequent case examples.

Topics: Humans; Treatment Outcome; Embolization, Therapeutic; Bone Neoplasms; Vascular Surgical Procedures; Retrospective Studies

PubMed: 36889846
DOI: 10.1016/j.tvir.2022.100883

Review

Authors: Anna Maria Ierardi, Filippo Piacentino, Filippo Pesapane...

Good knowledge of the various approaches of embolization of peripheral bleedings and different embolic materials available is of paramount importance for successful and safe embolization. We review and illustrate the main endovascular and percutaneous techniques used for embolization, along with the characteristics of the different embolic materials, and the potential complications.

Topics: Embolism; Embolization, Therapeutic; Hemorrhage; Humans; Treatment Outcome

PubMed: 32945281
DOI: 10.23750/abm.v91i8-S.9974

Review

Authors: Charlie C-T Hsu, Gigi Nc Kwan, Hannah Evans-Barns...

BACKGROUND

Pulmonary arteriovenous malformations are abnormal direct connections between the pulmonary artery and pulmonary vein which result in a right-to-left shunt. They are associated with substantial morbidity and mortality mainly from the effects of paradoxical emboli. Potential complications include stroke, cerebral abscess, pulmonary haemorrhage and hypoxaemia. Embolisation is an endovascular intervention based on the occlusion of the feeding arteries the pulmonary arteriovenous malformations thus eliminating the abnormal right-to-left-shunting. This is an update of a previously published review.

OBJECTIVES

To determine the efficacy and safety of embolisation in patients with pulmonary arteriovenous malformations including a comparison with surgical resection and different embolisation devices.

SEARCH METHODS

We searched the Cystic Fibrosis and Genetic Disorders Group's Trials Register; date of last search: 10 April 2017.We also searched the following databases: the Australian New Zealand Clinical Trials Registry; ClinicalTrials.gov; International Standard Randomised Controlled Trial Number Register; International Clinical Trials Registry Platform Search Portal (last searched 27 August 2017). to be updatedWe checked cross-references and searched references from review articles.

SELECTION CRITERIA

Trials in which individuals with pulmonary arteriovenous malformations were randomly allocated to embolisation compared to no treatment, surgical resection or embolisation using a different embolisation device.

DATA COLLECTION AND ANALYSIS

Studies identified for potential inclusion were independently assessed for eligibility by two authors, with excluded studies further checked by a third author. No trials were identified for inclusion in the review and hence no analysis was performed.

MAIN RESULTS

There were no randomised controlled trials included in the review; one ongoing trial has been identified which may be eligible for inclusion in the future.

AUTHORS' CONCLUSIONS

There is no evidence from randomised controlled trials for embolisation of pulmonary arteriovenous malformations. However, randomised controlled trials are not always feasible on ethical grounds. Accumulated data from observational studies suggest that embolisation is a safe procedure which reduces morbidity and mortality. A standardised approach to reporting with long-term follow-up through registry studies can help to strengthen the evidence for embolisation in the absence of randomised controlled trials.

Topics: Arteriovenous Malformations; Embolization, Therapeutic; Humans; Pulmonary Artery; Pulmonary Veins

PubMed: 29298459
DOI: 10.1002/14651858.CD008017.pub5

Authors: A E Young

Topics: Embolization, Therapeutic; Gastrointestinal Hemorrhage; Hemangioma; Humans; Kidney Diseases; Liver Neoplasms

PubMed: 6794792
DOI: 10.1136/bmj.283.6300.1144

Review

Authors: Chao-Bao Luo, Feng-Chi Chang, Michael Mu-Huo Teng...

Intracranial dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous communications within the dura locating near a major venous sinus and are supplied by pachymeningeal arteries. DAVFs represent 10-15% of all intracranial arteriovenous malformations. The natural history and clinical manifestations are determined by location of the DAVFs and their angioarchitecture. Aggressive DAVF is usually associated with leptomeningeal venous drains or reflux. It may present with hemorrhagic or nonhemorrhagic stroke. The goal of embolization of DAVFs is total fistula occlusion without interfering with the normal dura-venous drains. Embolization can be performed by transarterial and/or transvenous routes or direct puncture of affected dural sinus. Selection of embolic materials depends on access route and angioarchitecture of the fistula. With the involution of endovascular devices, embolic materials, and high-quality angiography, endovascular embolization of DAVFs has been proved a safe and effective method of treating these complex cerebrovascular lesions.

Topics: Central Nervous System Vascular Malformations; Embolization, Therapeutic; Humans

PubMed: 25306069
DOI: 10.1016/j.jcma.2014.08.011