Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “EMBOLISM”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 469 records · Page 26Linked to original sources
PubMed2002

Outcome analysis of preoperative embolization in cranial base surgery.

OBJECTIVE: Management of cranial base tumors requires an interdisciplinary approach. Supraselective angiography and embolization is an important adjunct to cranial base surgery. Though successful embolization facilitates resection, the morbidity of this procedure remains poorly defined. Therefore, we set out to define the morbidity associated with embolization of skull base meningiomas, thus allowing for informed decision making when considering this adjunct to tumor resection. METHODS: A retrospective analysis was performed on our experience with embolization of 167 cranial base meningiomas. Cranial base meningiomas were defined as tumors originating from the olfactory groove, tuberculum sella, medial sphenoid wing, petro-clival region or foramen magnum. RESULTS: 280 feeding vessels were embolized with an average of 1.7 vessels per lesion. In 91% of patients embolized, good to excellent embolization was achieved without permanent neurological sequelae. In 20 patients no embolization was attempted due to the risk of new neurologic deficits or lack of an appropriate vessel for embolization. Twenty-one patients (12.6%) had transient worsening of their neurologic exam or a medical complication requiring hospitalization. Fifteen patients (9%) experienced permanent neurologic deficits or medical morbidity as a result of embolization. Four of the patients who experienced major complications had a decline in previously compromised cranial nerve function. CONCLUSIONS: Embolization of cranial base tumors is an important part of the therapeutic armamentarium for the treatment of cranial base lesions. Recognition of the morbidity of this procedure will allow for the most appropriate use of this powerful adjunct to cranial base surgery.

Cerebral Angiography↗
PubMed2006

Single-vessel versus multivessel territory acute ischemic stroke: value of transesophageal echocardiography in the differentiation of embolic stroke.

OBJECTIVES: We sought to assess the presence of potential aortic or cardiac sources of embolism in patients presenting with acute ischemic stroke in one or more vascular territories. BACKGROUND: In patients with acute ischemic stroke, involvement of multiple vascular territories has been used to implicate a cardiac or aortic source of embolus. It remains unclear whether patients with multivessel stroke have a higher frequency of cardiac or aortic embolic sources on transesophageal echocardiography (TEE) compared with patients with single-territory stroke. METHODS: We identified 210 patients with acute ischemic stroke documented by neuroimaging undergoing TEE for identification of a potential embolic source. Patients were divided into 3 groups (lacunar stroke, nonlacunar stroke/single-vessel involvement, nonlacunar stroke/multivessel involvement) and the frequency of potential embolic sources on TEE was compared. RESULTS: Of the 210 patients, 121 (58%) were male and the mean age was 61 years. In all, 139 patients (66%) were classified as having single-vessel stroke, 47 (22%) as having multivessel stroke, and 24 (11%) as having lacunar stroke. On TEE, 87 patients (41%) had at least one potential source of embolism. Patients with multivessel strokes had fewer potential embolic sources on TEE than patients with single-vessel or lacunar strokes (26% vs 46% and 46%, respectively; P = .043). CONCLUSIONS: In patients with acute ischemic stroke, the incidence of a potential cardiac or aortic source of embolism is high, regardless of the vascular distribution of the stroke. TEE may be a useful tool to assess the source of stroke in single-vessel, multivessel, and lacunar territory stroke distribution. We aimed to assess the presence of potential aortic or cardiac sources of embolism in patients presenting with acute ischemic stroke in one or more vascular territories. A total of 210 patients with acute ischemic stroke were divided into 3 groups (lacunar stroke, nonlacunar stroke/single-vessel involvement, nonlacunar stroke/multivessel involvement) and the frequency of potential embolic sources on transesophageal echocardiography was compared. Patients with multivessel strokes had fewer potential embolic sources on transesophageal echocardiography than patients with single-vessel or lacunar strokes, but the frequency of a potential cardiac or aortic source of embolism was high, regardless of the vascular distribution of stroke.

Brain Ischemia↗
PubMed2004

Comparison of Tenecteplase with Alteplase on clinical rating scores following small clot embolic strokes in rabbits.

Tenecteplase (TNK) was engineered to have increased fibrin specificity and an increased half-life compared to Alteplase. Although Tenecteplase is currently being tested in a Phase II clinical trial in acute ischemic stroke patients, little is known about the pharmacology and dose-response or therapeutic window for Tenecteplase in embolic stroke models. In the present study, we compared Tenecteplase with Alteplase on behavioral outcome in rabbits with embolic strokes. Male New Zealand white rabbits were embolized by injecting a suspension of small blood clots into the middle cerebral artery (MCA) via a catheter. The rabbit small clot embolic stroke model (RSCEM) was used for a dose-response profile analysis of Tenecteplase (0.1 mg/kg-3.3 mg/kg) and Alteplase (0.9 mg/kg-3.3 mg/kg) given intravenously 1 h following embolization. In additional studies, Tenecteplase (0.9 mg/kg) or Alteplase (3.3 mg/kg) was administered 3 (or 6) h following embolization to determine the therapeutic window for the thrombolytics. For both studies, behavioral analysis was conducted 24 h following embolization, allowing for the determination of the effective stroke dose (P50) or clot amount (mg) that produces neurological deficits in 50% of the rabbits. Using the RSCEM, a drug is considered beneficial if it significantly increases the P50 compared with the control group. The P50 of controls 24 h after embolization was 1.13 +/- 0.15 mg. Rabbits treated 1 h post-embolization with Tenecteplase (0.1, 0.25, 0.9, 1.5 or 3.3 mg/kg) had P50 values of 1.48 +/- 0.33, 2.20 +/- 0.44, 2.76 +/- 0.37, 2.15 +/- 0.29 and 2.78 +/- 0.31 mg, respectively. In Alteplase-treated rabbits, only the 3.3 mg/kg dose significantly increased the group P50 by 189% compared to control. Tenecteplase was also effective at increasing the P50 value to 2.21 +/- 0.43 mg if there was a 3-h delay following embolization, but not if there was a 6-h delay before administration. Alteplase was only effective if administered 1 h following embolization where it significantly increased the P50 value to 3.27 +/- 0.40 mg. This study indicates that Tenecteplase has a wide therapeutic range, a therapeutic window of at least 3 h and a durable effect. Moreover, the safety profile for Tenecteplase is similar to that of Alteplase. Tenecteplase does not increase the rate of intracerebral hemorrhage (ICH) above that produced by Alteplase. However, the therapeutic range and window for Alteplase is more limited than that for Tenecteplase. Our preclinical studies suggest that Tenecteplase has a better pharmacological profile than Alteplase and supports further investigation of Tenecteplase in randomized double-blinded clinical trials in stroke patients.

Animals↗
PubMed2004

Percutaneous embolization of varicoceles: outcomes and correlation of semen improvement with pregnancy.

OBJECTIVES: To assess the technical feasibility and compare the semen quality in men with or without pregnancy after percutaneous embolization of varicoceles in the management of infertility. METHODS: The records of 102 patients who underwent retrograde varicocele embolization between January 1997 and January 2002 were reviewed through the Hospital Information Support System. Infertility was the indication for embolization in 71 cases. The present study consisted of this group of patients. The size of the varicoceles, the size of the testis, the pre-embolization semen analysis parameters, the technical details of embolization procedure, any anomalous vessels seen on venography, and, if unsuccessful, the reason for failure of the procedure were noted. A record of postembolization semen parameters (at least two) was made. Patients were divided into four groups depending on the pre-embolization semen density, and a correlation of this was assessed with improvements in morphology and motility. Follow-up was performed using a questionnaire to evaluate the success rate of the procedure, complications, and any treatment for infertility by the patient or his partner after the procedure. Patients who had a successful pregnancy were compared with those who did not to determine the correlation between the changes in semen quality and pregnancy rate. RESULTS: Between January 1997 and January 2002, 71 patients underwent retrograde varicocele embolization, using an embolizing coil, for infertility. In 68 (95.7%), it was technically successful. Nineteen patients (26.7%) had various anomalous vessels on venography. A statistically significant improvement (P = 0.002) was noted in the motility parameters in patients with a pre-embolization semen density between 10 and 30 million/mL. All patients were followed up by questionnaire. Follow-up was possible in 51 patients (75%). One patient had varicocele recurrence and underwent open inguinal surgical ligation. Of 45 patients, the partners of 18 (40%) had a successful pregnancy. A comparison of the postembolization semen quality between those with and without a successful pregnancy found no correlation between the changes in the semen parameters and the pregnancy rate. CONCLUSIONS: Varicocele embolization is a technically feasible, minimally invasive, outpatient procedure that improves semen quality significantly in patients with a pre-embolization semen density of 10 to 30 million/mL. However, no correlation was found between the improvements in semen quality and the pregnancy rate.

Adolescent↗
PubMed2000

Withholding treatment in patients with acute pulmonary embolism who have a high risk of bleeding and negative serial noninvasive leg tests.

PURPOSE: Patients who have nonmassive acute pulmonary embolism and a high risk of bleeding or contraindication to anticoagulants, such recent surgery or gastrointestinal bleeding, present a clinical dilemma. We sought to estimate whether such patients could be safely left untreated if serial compression ultrasound or serial impedance plethysmography were negative and cardiorespiratory reserve was adequate. SUBJECTS AND METHODS: The frequency of recurrent pulmonary embolism among patients with nonmassive acute pulmonary embolism and negative serial noninvasive leg tests who were not treated was estimated from two prospective studies of the noninvasive management of patients with suspected pulmonary embolism. One of the studies used serial impedance plethysmography of the lower extremities; the other used serial compression ultrasound. The prevalence of pulmonary embolism in patients with nondiagnostic ventilation/perfusion lung scans was determined from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). RESULTS: The estimated frequency of fatal recurrent pulmonary embolism was 1% [95% confidence interval (CI), 0% to 5%) among untreated patients with nonmassive pulmonary embolism who had negative serial impedance plethysmograms and 0% (95% CI, 0% to 4%) among those with negative serial compression ultrasonograms. The frequency of nonfatal recurrent pulmonary embolism among untreated patients was 3%, regardless of whether they had negative serial impedance plethysmograms or negative serial compression ultrasonograms. These results were comparable with the frequency of recurrent pulmonary embolism among patients treated with anticoagulants or with inferior vena cava filters. CONCLUSION: Withholding treatment of nonmassive acute pulmonary embolism, if serial impedance plethysmograms or serial venous ultrasonograms are negative and cardiopulmonary reserve is adequate, is a possible strategy for the management of patients with a high risk of bleeding or other contraindication to anticoagulants. This strategy may be associated with fewer adverse events than treatment with anticoagulants or an inferior vena cava filter. Prospective trials comparing alternative treatments are needed.

Acute Disease↗
PubMed2000

Effect of temperature and PaCO2 on cerebral embolization during cardiopulmonary bypass in swine.

BACKGROUND: Patients experience cerebral embolization during cardiopulmonary bypass (CPB). This study determined if alterations in temperature and/or PaCO2 can reduce cerebral and ocular embolization. METHODS AND RESULTS: Forty-four pigs underwent CPB: 24 animals at 28 degrees C, and 20 at 38 degrees C. The two temperature groups were randomized to undergo embolization (67-microm fluorescent microspheres) at either hypercarbia or hypocarbia. Before and after embolization, cerebral and ocular blood flow were determined at normocarbia. Reducing temperature or PaCO2 reduced cerebral and ocular embolization. Hypocarbia reduced cerebral embolization by 60% and 45% in normothermic and hypothermic groups, respectively (p < 0.0001 and p < 0.05). Relative to normothermic animals, hypothermia reduced cerebral embolization by 37% under an elevated CO2 condition (p < 0.05), but not under hypocarbic conditions. Similarly, regardless of temperature, fewer emboli were delivered to the eye in hypocarbic animals (p < 0.05), but hypothermia did not reduce ocular embolization. CONCLUSIONS: Cerebral embolization is determined by both temperature and PaCO2 at the time of embolization. In CPB practice, reductions in temperature and/or PaCO2 during periods of embolic risk may reduce brain injury.

Animals↗
PubMed2001

Echocardiography predicts embolic events in infective endocarditis.

OBJECTIVES: The aim of our study was to assess the value of transesophageal echocardiography (TEE) in predicting embolic events (EEs) in a large group of patients with definite endocarditis according to the Duke criteria, including silent embolism. BACKGROUND: The value of echocardiography in predicting embolism in patients with endocarditis remains controversial. Some studies reported an increased risk of embolism in patients with large and mobile vegetations, whereas other studies failed to demonstrate such a relationship. METHODS: Multiplane transesophageal echocardiograms of 178 consecutive patients with definite infective endocarditis (IE) were analyzed. The incidence of embolism was compared with the echocardiographic characteristics (localization, size and mobility) of the vegetations. To detect silent embolism, cerebral and thoraco-abdominal scans were performed in 95% of patients. RESULTS: Among 178 patients, 66 (37%) had one or more EEs. There was no difference between patients with and without embolism in terms of age, gender and left valve involved. On univariate analysis, Staphylococcus infection, right-side valve endocarditis and vegetation length and mobility were significantly related to EEs. A significant higher incidence of embolism was present in patients with vegetation length >10 mm (60%, p < 0.001) and in patients with mobile vegetations (62%, p < 0.001). Embolism was particularly frequent among 30 patients with both severely mobile and large vegetations (> 15 mm) (83%, p < 0.001). On multivariate analysis, the only predictors of embolism were vegetation length (p = 0.03) and mobility (p = 0.01). CONCLUSIONS: Our study shows that the presence of vegetations on TEE is predictive of embolism and that the morphologic characteristics of vegetations are helpful in predicting EEs in both mitral and aortic valve IE. It also suggests that early operation may be recommended in patients with vegetations > 15 mm and high mobility, irrespective of the degree of valve destruction, heart failure and response to antibiotic therapy.

Aortic Valve↗
PubMed2000

[Diagnosis of pulmonary embolism by transthoracic sonography. Sono-morphologic characterization of pulmonary lesions and comparison with spiral computed tomography].

BACKGROUND AND OBJECTIVE: Pulmonary embolism often extends to pleural surfaces, resulting in pleural-based parenchymal lesions. This study was carried out in order to evaluate the clinical value of transthoracic sonography (TS) for the diagnosis of pulmonary embolism. PATIENTS AND METHODS: A prospective study was performed in 45 patients (27 men, 18 women; mean age: 63.4 years; range: 24-88 years) with suspected pulmonary embolism. Transthoracic sonography was performed in all patients. In addition, helical computed tomography (CT) was carried out in 40 patients. Other diagnostic procedures included the estimation of D-dimeres, echocardiography, venous duplex sonography of the legs and ventilation/perfusion scanning. The diagnosis of pulmonary embolism was accepted when an embolus was detected on CT or as a conclusive result of the other investigations. RESULTS: Pulmonary embolism was established in 33 patients. Peripheral parenchymal lesions suspicious of pulmonary embolism were detected by transthoracic sonography in 26 patients (79%). In seven patients with central pulmonary embolism diagnosed by CT, no peripheral lesions could be detected by sonography. One patient with sonographic signs of pulmonary embolism had a diffuse bronchogenic adenocarcinoma which was diagnosed on autopsy. The sensitivity of transthoracic sonography (computed tomography) for pulmonary embolism was 79% (76%) and the specificity 92% (100%). The positive and negative predictive values of transthoracic sonography for the detection of pulmonary embolism were 96% and 61% (100% and 61%), respectively. The accuracy was 82% (82%). CONCLUSIONS: A substantial number of pulmonary emboli involve the peripheral lung areas. Transthoracic sonography is a non-invasive technique for diagnosing such parenchymal alterations and may serve as an alternative method in the diagnosis of pulmonary embolism.

Adenocarcinoma↗
PubMed1996

Variability in occurrence of embolic signals in long term transcranial Doppler recordings.

Albeit still unproven, it is supposed that the presence and number of asymptomatic circulating cerebral microemboli detected by transcranial Doppler ultrasound (TCD) may be an indicator of stroke risk. Little research has been done to assess the reproducibility of these data and the required time for recording. We examined one middle cerebral artery in 7 subjects with carotid, aortic or cardiac embolic source for 24 h by TCD. Analysis for embolic signals was done off line completely blinded to the diagnosis and the time of the day during the recording. Embolic signals were found in all 7 subjects varying from 0 per h to 13 per h. Embolic signals occurred throughout the day with a nonsignificant tendency towards higher values in the early morning hours. Half an hour recording would not have been suitable to rule out or to confirm the presence of embolic signals as there were too many gaps between embolic signals of more than 1/2 h. One hour is the required minimum. Concerning the number of embolic signals, even a recording of four hours yielded variabilities of 0.25 and 8 embolic signals per hour in the same person. We recommend to perform follow-up studies the same time of the day. In patients with a low number of embolic signals longer recordings or a lower detection threshold with a higher number of detected embolic signals are necessary to compare frequencies of embolic signals.

Aged↗
PubMed1995

Asymptomatic cerebral embolic signals in symptomatic and asymptomatic carotid artery disease.

Transcranial Doppler ultrasound of middle cerebral arteries (MCAs) was used to detect asymptomatic embolic signals in a prospective study in patients with symptomatic and asymptomatic carotid stenosis. Recording from each artery for 20 min, embolic signals were more common ipsilateral to symptomatic arteries (eight of 38) than ipsilateral to asymptomatic arteries (one of 28, P = 0.04), or than in the MCAs of age-matched normal controls (none of 52, P < 0.005). Recording a subgroup of patients revealed that previously embolic-signal negative symptomatic stenoses frequently became embolic-signal positive when recording was repeated on another day. Including all recording periods (mean time: symptomatic 36.2 min, asymptomatic 46.2 min) embolic signals were detected ipsilateral to 13 of 38 symptomatic stenoses but only one of 28 asymptomatic stenoses (P = 0.003). In symptomatic subjects with embolic signals, median number of signals per hour was three (mean 26). One month following carotid endarterectomy embolic signals were not detected except in one patient who continued to experience frequent amaurosis fugax; in this patient following aspirin both symptoms and embolic signals were abolished. These studies suggest asymptomatic embolic signals correlate with clinical risk. Outcome studies are required to determine whether embolic signal detection may allow prediction of stroke risk and monitoring of the effectiveness of therapy. The technique may also prove useful in studying the pathophysiology of cerebral embolism.

Adult↗
PubMed2000

Incidence of venous air embolism during craniectomy for craniosynostosis repair.

BACKGROUND: Investigations to determine the incidence of venous air embolism in children undergoing craniectomy for craniosynostosis repair have been limited, although venous air embolism has been suspected as the cause of hemodynamic instability and sometimes death. A precordial Doppler ultrasonic probe is an accepted method for detection of venous air embolism and is readily available at most institutions. METHODS: A prospective study was conducted using a precordial Doppler ultrasonic probe in children undergoing craniectomy for craniosynostosis repair. The Doppler signal was continuously monitored intraoperatively for characteristic changes of venous air embolism. A recording was made of the precordial Doppler probe pulses, which was later reviewed by a neuroanesthesiologist, blinded to the intraoperative events. This information was correlated with the intraoperative events and episodes of venous air embolism were graded. RESULTS: Twenty-three patients were enrolled in the study during the 2-yr study period. Nineteen patients (82.6%) demonstrated 64 episodes of venous air embolism; six patients (31.6%) had hypotension associated with venous air embolism. Thirty-two episodes of hypotension were demonstrated in eight patients (34.7%). None of the patients developed cardiovascular collapse. CONCLUSION: The incidence of venous air embolism in our study of 23 children undergoing craniectomy for craniosynostosis was 82.6%. Though most episodes of venous air embolism during craniosynostosis repair are without hemodynamic consequences, the preemptive placement of a precordial Doppler ultrasonic probe is a noninvasive, economic, and safe method for the detection of venous air embolism. Prompt recognition may allow for the early initiation of therapy, thereby decreasing morbidity and mortality rates related to venous air embolism.

Child↗
PubMed1998

Embolization of neurosurgical lesions involving the ophthalmic artery.

OBJECTIVE: A number of anteriorly located cranial base and extracranial lesions receive their vascular supply wholly or in part from the ophthalmic artery, and embolization of the ophthalmic artery can be helpful in the management of these lesions, either as the primary treatment or as an adjunct to surgery. We present situations in which the embolization of lesions involving the ophthalmic artery was performed to effect a partial or total cure of the lesion. METHODS: Twelve patients underwent a total of 15 embolization attempts on lesions involving the ophthalmic artery. Four patients had arteriovenous malformations of the orbit, four had dural arteriovenous fistulae, two had orbital meningiomas, one had a planum sphenoidale meningioma, and one had a juvenile nasal angiofibroma. In each case, a Tracker No. 18 microcatheter (Target Therapeutics, Inc., Fremont, CA) was navigated into the ophthalmic artery using a steerable guidewire and digital road mapping. Embolic agents included polyvinyl alcohol particles ranging from 350 to 1500 microm in diameter, 2-mm platinum microcoils, and n-butyl-cyanoacrylate. In 12 of 15 cases, lidocaine and amytal provocation tests were conducted before any attempt at embolization to assess the role of the ophthalmic artery in vision. RESULTS: Embolization was successfully performed in the 14 situations in which it was attempted. Positive results of two lidocaine/amytal tests were noted. In one case, embolization was not attempted. In the other case, a larger caliber embolic agent (2-mm platinum coils) was used. A single transient decrease in visual acuity lasting 4 days was the only embolization-related complication. CONCLUSION: Proper case selection, judicious use of embolic agents, and use of provocative testing can result in safe embolization of lesions supplied by the ophthalmic artery.

Adolescent↗
PubMed2002

Delayed surgical resection reduces intraoperative blood loss for embolized meningiomas.

OBJECTIVE: Embolization before surgical resection of tumors has been demonstrated to reduce intraoperative blood loss, but the optimal time that should elapse between embolization and tumor resection has not been established. We evaluated whether immediate surgical resection (< or =24 h) after embolization or delayed surgical resection (>24 h) was more effective in minimizing intraoperative blood loss. METHODS: We retrospectively analyzed the records for 50 patients with meningiomas who underwent preoperative embolization between 1993 and 1999. We divided the patients into two groups, i.e., those who underwent surgical resection of their meningiomas < or =24 hours after embolization and those who underwent surgery more than 24 hours after embolization. The extent of embolization, intraoperative blood loss, duration of surgery, and length of the hospital stay were compared for the two groups. Postoperative pathological specimens were examined for assessment of the extent of vascularity and necrosis caused by embolization. RESULTS: Intraoperative blood loss was greater for the immediate group than for the delayed group (29% with blood loss of >1000 ml [median, 475 ml] versus 0% with blood loss of >700 ml [median, 337.5 ml]; P = 0.01). There were no statistically significant differences between the groups with respect to tumor volume, extent of embolization, degree of devascularization, necrosis, duration of surgery, or length of the hospital stay. CONCLUSION: Contrary to previous studies that emphasized a need for tumor removal immediately after embolization, to prevent revascularization, surgical resection of meningiomas should be delayed more than 24 hours after embolization, because there is less intraoperative blood loss.

Adolescent↗
PubMed2003

Efficacy of embolization in traumatic uterine vascular malformations.

PURPOSE: To evaluate the efficacy of embolotherapy in patients with bleeding traumatic uterine arteriovenous malformations (AVMs). MATERIALS AND METHODS: A retrospective review of all patients who underwent pelvic arterial embolization at our institution between July 1992 and September 2002 was performed. Fifteen patients were diagnosed with a uterine vascular malformation on duplex ultrasonography and correlative MR imaging. Serial beta-human chorionic gonadotropin levels were measured to exclude gestational trophoblastic neoplasia. All patients underwent transcatheter embolization of the uterine arteries. Embolizations were performed with use of standard 4-5-F catheters and microcatheters when necessary. Embolic agents in the 25 procedures included glue only (n = 13), polyvinyl alcohol (PVA) particles and glue (n = 4), PVA particles (n = 2), Gelfoam (n = 2), coils (n = 1), PVA particles and coils (n = 1), glue and Gelfoam (n = 1), and glue and coils (n = 1). PVA particle size ranged from 350 to 1,000 micro m. Outcomes assessed were cessation of bleeding, persistence or resolution of the AVM, complications, and pregnancy after embolization. These were assessed by chart, laboratory, and imaging reviews. RESULTS: A total of 25 embolization procedures were performed in 15 patients. Six patients required repeat embolization (one patient underwent embolization on six occasions; five patients had two embolization procedures each) for recurrence of bleeding. Sixteen procedures were performed on an elective basis and nine were performed on an emergent basis. The technical success rate of embolization was 100%. The clinical success rate was 93%: bleeding was controlled in 14 of 15 patients and one patient underwent a hysterectomy. Four of the 15 patients subsequently had a total of five uneventful intrauterine pregnancies carried to term. The 14 patients who underwent successful embolization had no recurrence of bleeding at a median follow-up of 53 months (range, 3-124 months) after treatment. Three patients were eventually lost to follow-up. One minor complication (0.4%) of non-flow-limiting dissection of the internal iliac artery occurred. CONCLUSION: Percutaneous embolotherapy is a safe and effective treatment for traumatic AVMs. This procedure allows for preservation of uterine function with the possibility of future pregnancy and should be considered as a primary treatment option.

Adult↗
PubMed2004

Embolization of peripheral vascular malformations with ethylene vinyl alcohol copolymer (Onyx).

PURPOSE: To demonstrate the feasibility and preliminary efficacy of endovascular embolization of peripheral congenital vascular malformations (VMs) with use of a nonadhesive liquid embolic agent, Onyx. MATERIALS AND METHODS: Nine patients with a mean age of 20.8 years had local low-flow (n = 4), local high-flow (n = 3), or diffuse high-flow (n = 2) VMs located in the upper or lower extremities. In all patients, endovascular embolization was performed via the superselective catheterization of arterial feeders of VMs with use of microcatheters in a coaxial technique. A total of 15 embolization procedures were performed with Onyx, which was composed of 6%, 8%, or 20% ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide. RESULTS: In two of four patients with local low-flow VMs, the lesions were embolized completely. In the other two patients with local low-flow VMs, embolizations were incomplete. The remaining five high-flow lesions of local (n = 3) or diffuse (n = 2) types were also embolized incompletely. In all patients with local low-flow VMs and in one patient with a local high-flow VM, clinical signs and symptoms were resolved significantly. Other patients did show clinical benefit from embolization to varying degrees. CONCLUSION: In our experience in a limited number of cases, Onyx promises and provides important advantages over conventional embolic agents in the endovascular transcatheter embolization of congenital peripheral VMs. However, as with other embolic agents, it is far from perfect.

Adolescent↗
PubMed2004

N-butyl cyanoacrylate embolization for control of acute arterial hemorrhage.

PURPOSE: To report the initial clinical experience with the use of n-butyl cyanoacrylate (NBCA) for embolization of acute arterial hemorrhage from varied etiologies and at varied anatomic sites. MATERIALS AND METHODS: Sixteen patients who demonstrated active extravasation of contrast material and/or arterial abnormality underwent NBCA embolization. Sites of embolization included the gastrointestinal tract, kidney, liver, uterus, adrenal gland, extremity, and chest wall. Standard coil or particulate embolization had previously failed in 10 patients. NBCA was used as the initial embolic agent in the remaining six patients. After treatment, serial hematocrit levels, transfusion requirements, and clinical signs and symptoms were monitored for stabilization. Patients were evaluated for signs and symptoms of end-organ damage. RESULTS: NBCA embolization was successful in 12 of 16 patients (75%), who exhibited complete cessation of bleeding. In four patients (25%), NBCA embolization was of no benefit. Embolization failed in two of 16 patients (12.5%), who showed evidence of recurrent bleeding after use of NBCA. The remaining two patients (12.5%) died within 24 hours of the procedure. None of the 16 patients developed clinical signs of end-organ damage or iatrogenic ischemia attributable to NBCA. CONCLUSIONS: In this initial limited series, NBCA embolization was shown to be a feasible and effective method to control acute arterial hemorrhage. NBCA embolization was able to stop arterial bleeding even when previous coil or particulate embolization had failed.

Acute Disease↗
PubMed2005

Portal vein embolization with N-butyl cyanoacrylate before partial hepatectomy in patients with hepatocellular carcinoma and underlying cirrhosis or advanced fibrosis.

PURPOSE: To describe the safety, complications, and liver regeneration associated with the left liver after embolization of the right portal vein (PV) in patients with hepatocellular carcinoma (HCC) developed in the setting of advanced liver fibrosis and cirrhosis. MATERIALS AND METHODS: Forty patients (31 men, nine women; mean age, 62 years) with HCC underwent PV embolization over a 4-year period. Embolization was performed from a left PV percutaneous access with use of n-butyl cyanoacrylate (NBCA) mixed with iodized oil. Computed tomography (CT) volumetry was performed before and 1 month after PV embolization to measure the left lobe volume as well as the functional liver ratio defined by the ratio between the left lobe and the total liver volume minus tumoral volume. PV pressure and liver enzyme levels were compared before and 1 month after the procedure and complications were registered. Factors potentially affecting regeneration (age, sex, diabetes, chemoembolization, functional liver ratio before PV embolization, and Knodell histologic score) were evaluated by one-way and stepwise regression analysis. RESULTS: PV embolization could be achieved successfully in all cases. Two patients had partial PV thrombosis on the 1-month follow-up CT and two patients developed transient ascites after PV embolization. The left lobe volume increase was 41% +/- 32% after PV embolization and the functional liver ratio increased from 28% +/- 10% to 36% +/- 10% (P < .0001). Hypertrophy of the left lobe was greater in patients with a low functional liver ratio before PV embolization and those with an F3 fibrosis score. Other factors had no influence on left lobe regeneration. CONCLUSION: PV embolization with use of NBCA is feasible in patients with advanced fibrosis and cirrhosis. Hypertrophy of the left lobe of the liver after PV embolization has a statistically significant correlation with lower functional liver ratio and lower degrees of fibrosis.

Adult↗
PubMed2006

Measurement of blood flow before and after embolization with use of fluorescent microspheres in an animal model.

PURPOSE: Catheter-directed embolization has become a widespread technique for the treatment of benign and malignant neoplasms. The mechanism whereby embolization leads to selective atrophy of these neoplasms is largely speculative. As a potential model for the large regional perfusion differences between normal and neoplastic tissues, renal perfusion was studied before and after catheter-directed embolization. The working hypothesis was that embolization would create measurable changes in blood flow in the renal cortex and medulla. MATERIALS AND METHODS: Microspheres (l0 microm in diameter) containing a series of different fluorophores were injected into the arterial system before and after the renal arteries were embolized with a series of larger (100-300 microm) particulate embolic agents. The distribution of the microspheres in the renal cortex, renal medulla, and liver was analyzed by fluorescence microscopy as well as by extraction of the fluorophores. RESULTS: The distribution of the fluorescent microspheres was readily assessed by fluorescence microscopy or extraction of the fluorophores. Before embolization, the renal cortex received approximately three times more flow than the medulla. After embolization, perfusion of the renal cortex and medulla decreased in parallel. CONCLUSIONS: Fluorescent microspheres are a powerful tool for measuring the changes in flow that occur after catheter-directed embolization. The fact that parallel decreases in flow were found in the renal cortex and medulla indicates that the distribution of each embolic agent was flow-directed. These results might provide insight into the mechanism of tumor atrophy after uterine artery embolization or hepatic chemoembolization.

Animals↗