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PubMed2006

Evaluation of tris-acryl gelatin microsphere embolization with monochromatic X Rays: comparison with polyvinyl alcohol particles.

PURPOSE: Imaging of blood vessels 30 mum or smaller can be achieved with use of monochromatic x rays. The purpose of the present investigation was to use this method to evaluate the in vivo primary embolic effect of tris-acryl gelatin microspheres and polyvinyl alcohol (PVA) particles in small blood vessels, and specifically to assess the distribution of these particles and the resulting changes in circulation. MATERIALS AND METHODS: Twelve rabbits were divided into four groups: group 1 (PVA particles, 90-180 mum; n = 3), group 2 (tris-acryl gelatin microspheres, 40-120 mum; n = 3), group 3 (PVA, 300-500 mum; n = 3), and group 4 (tris-acryl gelatin microspheres, 300-500 mum; n = 3). After microangiography with monochromatic x rays, embolization was performed in normal auricular blood vessels, and immediately thereafter, postembolization microangiography was performed. Images acquired before and after embolization with the four embolic agents were compared, and the diameters of embolized blood vessels were measured. The mean embolized vascular diameter and its ratio to the midrange particle size of the embolic agent were calculated. RESULTS: Tris-acryl gelatin microspheres did not aggregate and tended to lodge in vessels close in size to the individual particle size, whereas PVA particles aggregated in vessels larger than the individual particle size. For tris-acryl gelatin microspheres, no blood flow was noted peripheral to the embolized region, whereas for PVA particles, blood flow was noted in regions peripheral to the embolized region. CONCLUSIONS: Monochromatic x rays allow direct visualization of in vivo embolic properties. This technique holds promise for comparative studies of embolic agents.

Acrylic Resins↗

PubMed2005

The role of transcatheter arterial embolization for patients with unresectable hepatocellular carcinoma: a nationwide, multicentre study evaluated by cancer stage.

BACKGROUND: Transcatheter arterial embolization is a major palliative treatment for unresectable hepatocellular carcinoma, but the survival benefit of transcatheter arterial embolization is controversial. AIM: To evaluate the role of transcatheter arterial embolization in different stage of unresectable hepatocellular carcinoma and to select patients who can get the best benefit from the treatment. METHODS: From 1991 to 1995, 476 patients who had unresectable hepatocellular carcinoma from four medical centres in Taiwan were enrolled. Among them, 425 underwent transcatheter arterial embolization, and 51 received supportive treatment alone. The survivals between the two groups were compared. RESULTS: Among the 476 patients, transcatheter arterial embolization can significantly prolong survival. The 1-, 2-, and 5-year survival rates for patients who underwent transcatheter arterial embolization were 60.2%, 39.3%, and 11.5%; and the rates for patients who underwent supportive treatment were 37.3%, 17.6%, and 2%, respectively (P = 0.0002). The survival benefit of transcatheter arterial embolization was observed in patients between Cancer and the Liver Italian Program 0 and Cancer and the Liver Italian Program 4. In multivariate analysis, transcatheter arterial embolization, tumour size <5 cm and earlier Cancer and the Liver Italian Program stage were independent factors associated with a better survival. CONCLUSIONS: For patients who fulfilled the criteria of transcatheter arterial embolization, embolization can serve as a primary treatment for patients with unresectable hepatocellular carcinoma. The survival benefit of transcatheter arterial embolization is regardless of tumour stages.

Carcinoma, Hepatocellular↗

PubMed1981

Hepatic artery embolization in the treatment of hepatic neoplasms.

Seventy-two hepatic artery embolizations were performed in 47 patients to treat hepatic neoplasms. Hepatic artery embolization creates tumor devascularization, but the portal flow prevents infarction of liver parenchyma because of the single vascular supply from the hepatic artery to a neoplasm, in contrast to the dual vascular supply to the liver parenchyma. Indications for the use of hepatic artery embolization are failure of chemotherapy, either systemic or intra-arterial infusion, vascular anomalies requiring combined lobar embolization and lobar infusion, and lack of effective treatment. Three types of embolization were performed: peripheral embolization using Gelfoam, proximal embolization using coils, and combined peripheral and proximal embolization. The complications after embolization were pain, fever, and transient liver function changes. No death or hepatic abscess occurred. The median survival duration of the group was 11.5 months from the time of embolization. Hepatic artery embolization is an effective treatment of hepatic neoplasm.

Adult↗

PubMed1999

Clinical application of asymptomatic embolic signal detection in acute stroke: a prospective study.

BACKGROUND AND PURPOSE: The detection of asymptomatic embolization with the use of Doppler ultrasound has a number of potential applications in patients with acute stroke. It may provide information on the stroke pathogenesis in individual cases, identify patients with continued embolization, and allow localization of the active embolic source. METHODS: We recruited 119 patients with acute anterior circulation infarction within 72 hours of stroke onset. Transcranial Doppler recordings were possible in 100 (84.0%). Bilateral 1-hour middle cerebral artery (MCA) recordings were made and saved on digital audiotape for blinded offline analysis. When embolic signals were detected during screening of the first recording, simultaneous recording was performed from the ipsilateral MCA and common carotid artery for an additional 30 minutes. In all patients with embolic signals at screening and in matched negative controls, recordings were repeated on days 4, 7, and 14. RESULTS: Embolic signals were detected in the symptomatic MCA in 16 patients (16%). They were more common in patients with carotid stenosis (P<0.0001), occurring in 50% of this group. They were rare in patients with cardioembolic stroke (4.5%) and were not detected in patients with lacunar stroke. In the 16 patients with embolic signals, the proportion with embolic signals fell over time (P=0. 0025), but they were still present in a third at 2 weeks. In 10 patients, localization of the embolic source was possible by simultaneous recording from the MCA and the ipsilateral common carotid artery. CONCLUSIONS: Continued asymptomatic embolization is common after stroke in patients with carotid artery disease and is still present in a significant proportion at 2 weeks. The technique may identify patients at risk of further stroke for more aggressive antiplatelet therapy; this needs to be tested in large prospective studies. The technique may also allow localization of the active embolic source.

Acute Disease↗

PubMed2002

Arterial embolization: a novel approach to thyroid ablative therapy for Graves' disease.

Despite the availability of effective treatments for Graves' disease, there are patients who are unable to tolerate, or choose not to accept, current therapies (oral medication, radioactive iodine, or surgery). In this study, we have examined the use of thyroid arterial embolization as an option for patients who suffer from Graves' disease and who fit into one of the preceding patient groups. Selective arteriography, followed by embolization of thyroid arteries, was performed using Seldinger's technique in 22 patients with Graves' disease. Six of the patients received both arterial embolization and surgery at 2-3 wk after embolization. No serious complications were noted in any patient. In those who were treated with only interventional embolization, 14 of 22 (63.6%) became euthyroid and remained in this state for the duration of the study. The remaining 2 patients required a maintenance dose of antithyroid drug therapy (tapazole, 5-10 mg/d; or propylthiouracil, 50-100 mg/d). Patients were followed for a median time of 27 months (range, 6-50). At the end of the follow-up period, all 22 patients were euthyroid, the size of thyroid gland had decreased by one third to one half its original volume, but 2 patients continued to require antithyroid drugs. Histologic analysis of thyroid tissue from 6 patients who had embolization followed by surgery showed that embolization blocked both the superior and inferior thyroid arteries plus most of their branches. Evidence of chemical inflammation, necrosis, and fibrosis were observed in embolized thyroid tissue. The average diameter of capillary network within the body of the thyroid adjacent to superior and inferior artery was 0.12-0.25 mm, with the smallest ones ranging from 0.04-0.11 mm. The diameter of the capillaries in the isthmus ranged from 0.13-0.15 mm. The average diameters of the superior and inferior arteries were 2-5.5 and 3-3.75 mm, respectively, measured using radiographs from angiography. Based on the measured diameters of arteries, the appropriate size of embolizing granules can be selected, and complete embolization of the majority of the thyroid glands was achieved with a high frequency of therapeutic success. Histological examination of the thyroid tissue and clinical follow-up after embolization indicate that this procedure is an effective, minimally invasive, and safe method for the treatment of Graves' disease patients who cannot, or choose not to, accept current therapies.

Adult↗

PubMed1996

Pulmonary embolism and mortality in patients with COPD.

BACKGROUND: Previous studies suggest that most patients with pulmonary embolism die of their underlying diseases and pulmonary embolism is itself responsible for a minority of deaths. It has not been determined whether pulmonary embolism is associated with increased mortality among patients with different specific diseases. METHODS: We assessed the mortality in 1,487 patients who had lung scans to pursue the diagnosis of pulmonary embolism. An outcome classification committee prospectively reviewed deaths occurring up to 1 year after each patient's entry into the study. RESULTS: Ninety-five (23.8%) patients with pulmonary embolism and 189 (18.9%) without pulmonary embolism died within 1 year of study entry (estimated relative risk, 1.34; 95% confidence interval, 1.01 to 1.79). Mortality according to pulmonary embolism status was different among patients with COPD from mortality among patients who did not have COPD (interaction p = 0.03). Of 45 patients with COPD and pulmonary embolism, 24 (53.3%; 95% confidence interval, 38.8 to 67.9%) died within 1 year. After adjustment for patient characteristics, the estimated risk of dying within 1 year was 1.94 times (95% confidence interval, 1.17 to 3.24) for patients with COPD and pulmonary embolism compared with those without pulmonary embolism, and 1.14 (95% confidence interval, 0.85 to 1.54) for patients without COPD (interaction p = 0.08). CONCLUSIONS: Patients with COPD and pulmonary embolism have an increased 1-year mortality. Further study is needed to clarify the reason(s) for the increase in mortality.

Adult↗

PubMed1990

Recurrent bleeding after arterial embolization in patients with hemoptysis.

Thirty-three patients with hemoptysis caused by nonmalignant diseases underwent arterial embolization. In seven (21.2 percent) of 33 patients, hemoptysis recurred after initial embolization in a follow-up period ranging from one day to four years. Although there was no difference in age and daily quantity of bleeding among patients with and without recurrences, those with mycetoma suffered the highest recurrence of bleeding after initial embolization (three [75 percent] of four patients). In the initial arteriograms of the seven patients were found six cases of markedly increased vascularity, three of increased vascularity in the bilateral lung, and three of nonbronchial systemic arterial supply to the diseased lung. Of six patients who received reexamination at the time of recurrent bleeding, the arteriogram demonstrated recanalization of previously embolized artery in five and revascularization by collateral circulation in five. In addition, hemoptysis recurred in three (60 percent) of five patients after second embolization and in one (50 percent) of two after third embolization. Four patients underwent surgical therapy: two after the initial embolization, one after the second, and one after the third, and these patients had no recurrence. While arterial embolization as initial treatment of hemoptysis is a highly useful procedure, this is a palliative procedure and potential for recurrence of hemoptysis exists as the lesion that has initially caused hemoptysis is not cured by the embolization. We emphasize that a combination therapy of repeated embolization and surgery will probably improve the efficacy of treatment of recurrent bleeding after initial embolization.

Adult↗

PubMed1991

Arteriovenous fistulas complicating biopsy of renal allografts: treatment of bleeding with superselective embolization.

The use of superselective embolization was assessed as a treatment for bleeding from postbiopsy arteriovenous fistulas (AVFs) in renal transplants. AVFs commonly occur after biopsy procedures in renal transplants, but severe bleeding is rare. Transcatheter embolization can be used to control bleeding, but unless it is sufficiently selective, the procedure results in loss of significant amounts of renal parenchyma. During a 4-year period, embolization procedures were attempted in seven patients 30-65 years old. All had AVFs shown on arteriography. Five patients underwent embolization; occlusion occurred only in the branch supplying the AVF. In one patient with three large AVFs, two were found to have occluded the day after embolization was attempted. In another, an AVF occluded when superselective catheter position was achieved but before embolization. Catheter manipulation in these cases may have precipitated occlusion. In five cases, coaxial embolization techniques were used. Embolization materials consisted of coils in three cases: 0.038 in. (0.97 mm) in one case, 0.025 in. (0.64 mm) in one case, 0.018 in. (0.46 mm) in one case; 0.038 in. (0.97 mm) coils and gelatin foam particles in one case; and localized contrast extravasation in one case. Serum creatinine level was measured before and after embolization in all patients, and radionuclide studies were undertaken in three cases. In all patients, bleeding was effectively controlled. None of the patients showed an increase in serum creatinine level after embolization, and in four, significant improvement was seen. Nuclear medicine studies showed no loss of renal function and a dramatic improvement in one patient. No complications due to the procedure were seen. Our experience suggests that superselective embolization with coaxial catheter techniques is an effective method of treating bleeding from postbiopsy AVFs in renal transplants with minimal loss of renal parenchyma.

Adult↗

PubMed1998

Correlation of diagnostic imaging and subsequent autopsy findings in patients with pulmonary embolism.

OBJECTIVE: We determined the frequency of correct antemortem diagnosis in patients who underwent lung scintigraphy for suspected pulmonary embolism and for whom the pulmonary embolism was proven at autopsy. MATERIALS AND METHODS: We performed a longitudinal follow-up study of 1210 consecutive patients who underwent scintigraphic imaging for suspected pulmonary embolism. Patients for whom pulmonary embolism was proven at autopsy within 30 days of lung scintigraphy were studied. Diagnostic testing and risk factors were compared in patients with and without an antemortem diagnosis of pulmonary embolism. RESULTS: The antemortem diagnosis was made in four of eight patients with autopsy-proven pulmonary embolism, yielding a sensitivity of 0.5 (95% confidence interval, 0.16-0.84). The diagnosis was made by high-probability lung scintigraphy in two patients, by pulmonary arteriography in one patient, and by lower extremity venous sonography in another patient. The imaging investigation for suspected pulmonary embolism included only lung scintigraphy in four patients in whom the antemortem diagnosis was incorrect: two with low-probability scintigraphy and two with intermediate-probability scintigraphy. Risk factors were similar for patients with and without pulmonary embolism. CONCLUSION: In this cohort study of patients suspected of having pulmonary embolism, the antemortem diagnosis was not made in 50% of patients in whom pulmonary embolism was later proven at autopsy. Underuse of diagnostic testing may have been to blame. We therefore believe that further study is needed to help identify patients with suspected pulmonary embolism who may benefit from additional diagnostic testing after low- or intermediate-probability lung scintigraphy.

Adolescent↗

PubMed2005

Uterine artery embolization for pedunculated subserosal fibroids.

OBJECTIVE: The objective of our study was to assess the outcomes of uterine artery embolization as a treatment for pedunculated subserosal fibroids, which we defined as those in which the diameter of the stalk was 50% narrower than the diameter of the fibroid. MATERIALS AND METHODS: During a 72-month period, 196 consecutive women underwent embolization for treatment of symptomatic uterine fibroids that were confirmed on baseline sagittal and axial MR images. We identified those women with pedunculated subserosal fibroids treated with embolization and retrospectively assessed complications and out-comes of embolization using a serial questionnaire and MRI. RESULTS: Of the 196 women, 12 (age range, 34-48 years; mean age, 42.3 years) had one or more pedunculated subserosal fibroids. Fifteen pedunculated subserosal fibroids were identified on baseline MR images in the 12 patients. The mean tumor diameter was 8.3 cm (range, 4.0-15.5 cm; 95% confidence interval [CI], 6.7-9.9 cm). The mean stalk diameter was 3.1 cm (range, 2.0-5.5 cm; 95% CI, 2.5-3.7 cm). The follow-up period ranged from 5 to 51 months (mean, 18.1 months). No serious complications such as separation of the tumors from the uterus, torsion of the tumors, or infection occurred after embolization. Enhanced MR images obtained 1 week after embolization showed that complete devascularization of the tumors had been achieved in 73% (11/15) of the tumors. The rates of mean tumor volume reduction were 41% (range, 12-73%) 4 months and 53% (range, 31-85%) 1 year after embolization. The mean stalk diameter was 3.2 cm (range, 1.7-5.4 cm; 95% CI, 2.5-3.9 cm) 4 months and 2.9 cm (range, 1.1-4.2 cm; 95% CI, 1.8-3.9 cm) 1 year after embolization. No significant difference in stalk diameters was noted 4 months (p=0.617) or 1 year (p=0.963) after embolization compared with the diameters before the treatment. The rates of mean uterus volume reduction were 35% (range, 15-47%) 4 months and 47% (range, 35-60%) 1 year after embolization. Marked or moderate improvement in bulk-related symptoms was achieved in 100% (10/10) of the women at 4-month follow-up, 100% (5/5) at 1-year follow-up, and 100% (2/2) at 2-year follow-up. CONCLUSION: We found no serious complications after embolization for pedunculated subserosal fibroids with stalk diameters of 2 cm or larger. Successful outcomes can be obtained in such tumors.

Adult↗

PubMed1998

Sensitivity and specificity of a rapid whole-blood assay for D-dimer in the diagnosis of pulmonary embolism.

BACKGROUND: Patients with suspected pulmonary embolism often have nondiagnostic lung scans and may present in circumstances where lung scanning is unavailable. Levels of D-dimer, a fibrin-specific product, are increased in patients with acute thrombosis; this may simplify the diagnosis of pulmonary embolism. OBJECTIVE: To determine the sensitivity and specificity of a whole-blood D-dimer assay in patients with suspected pulmonary embolism and in subgroups of patients with low pretest probability of pulmonary embolism or nondiagnostic lung scans. DESIGN: Prospective cohort. SETTING: Four tertiary care hospitals. PATIENTS: 1177 consecutive patients with suspected pulmonary embolism. MEASUREMENTS: All patients underwent an assessment of pretest probability by use of a standardized clinical model, a D-dimer assay, ventilation-perfusion lung scanning, and bilateral compression ultrasonography. Patients in whom pulmonary embolism was not initially diagnosed were followed for 3 months. Accordingly, patients were categorized as positive or negative for pulmonary embolism. RESULTS: Of the 1177 patients, 197 (17%) were classified as positive for pulmonary embolism. Overall, the D-dimer assay showed a sensitivity of 84.8% and a specificity of 68.4%. In 703 patients (3.4%) with a low pretest probability of pulmonary embolism, the likelihood ratio associated with a negative D-dimer test result was 0.27, resulting in a posterior probability of 1.0% (95% CI, 0.3% to 2.2%). In 698 patients with nondiagnostic lung scans (previous probability, 7.4%), the likelihood ratio associated with a negative D-dimer test result was 0.36, resulting in a posterior probability of 2.8% (CI, 1.4% to 4.8%). CONCLUSIONS: A normal D-dimer test result is useful in excluding pulmonary embolism in patients with a low pretest probability of pulmonary embolism or a nondiagnostic lung scan.

Algorithms↗

PubMed2001

N-butyl 2-cyanoacrylate embolization of spinal dural arteriovenous fistulae.

BACKGROUND AND PURPOSE: Because they are not well established, we investigated the technical success and recurrence rates of n-butyl 2-cyanoacrylate (NBCA) embolization of spinal dural arteriovenous fistulae (SDAVF), and assessed clinical outcomes. METHODS: We retrospectively studied all patients with SDAVF treated by NBCA embolization at our institution over an 8-year period. Gait and micturition disabilities were analyzed. Follow-up periods averaged 3.1 years (range, 1 month to 8.9 years). RESULTS: NBCA embolization was feasible in 74% (20/27) of patients. Of 20 patients who underwent embolization, initial embolization failure occurred in two (10%) and fistula occurrence in three (15%). All five patients in whom NBCA embolization failed underwent surgery. All patients who underwent embolization had either improved (55%) or unchanged (45%) gait disability at last follow-up. Seventeen (85%) patients had improved (40%) or unchanged (45%) micturition disability, but three (15%) had worsened. Mean Aminoff gait disability grade significantly decreased at last follow-up (2.4 [1.4] average [SD] vs 3.2 [1.4] [P = .0008]). Mean micturition disability grade decreased, but not significantly (1.4 [1.0] vs 1.7 [1.1] [P = .28]). CONCLUSION: NBCA embolization of SDAVF was technically feasible in 75% of patients. Initial apparent successful embolization was achieved in 90%; the fistula recurrence rate (failure to occlude the draining vein) for NBCA was 15%. Comparing favorably to surgical series, NBCA embolization of SDAVF appears efficacious, significantly improving mean gait disability by almost one grade at last follow-up. Close clinical and angiographic surveillance is mandatory. Longer and more uniform follow-up is needed to determine if clinical improvement and stabilization after NBCA embolization are sustained.

Aged↗

PubMed2002

Liquid 2-poly-hydroxyethyl-methacrylate embolization of experimental arteriovenous malformations: feasibility study.

BACKGROUND AND PURPOSE: We investigated the use of 2-poly-hydroxyethyl-methacrylate (2-P-HEMA) as an embolic agent in swine arteriovenous malformations (AVMs). METHODS: In seven mini swine, experimental AVMs were created surgically. The aim of treatment was complete embolization of the nidus compartment filled by the feeding artery, without brain embolization. Six animals received pure liquid 2-P-HEMA, and one, 50% 2-P-HEMA. For radiopacity, liquid 2-P-HEMA was mixed with tungsten powder. Six animals underwent angiographic follow-up within 5-8 mo (mean, 6.5 mo). Evaluation criteria were controllability, procedural reproducibility, and duration of the nidus occlusion. To detect complications, brain MR imaging and CT were performed. Histopathologic studies were performed to prove occlusion and assess histopathologic responses. RESULTS: 2-P-HEMA was easily injected through microcatheters, with a reproducible technique. Because of the radiopacity of the mixture, deep nidus penetration was controlled with fluoroscopy and confirmed with CT and histopathologic examination. In five AVMs embolized with pure 2-P-HEMA, feeder obliteration was long term. One animal had vasospasm during embolization, and complete obliteration of the main feeder was maintained for 3 mo, but partial recanalization developed 2 mo later. One animal receiving pure 2-P-HEMA had an infarction. In the animal embolized with 50% 2-P-HEMA, angiography and CT revealed embolic material in the circle of Willis; the animal died after embolization. No marked inflammatory reaction in the vessel wall or perivascular tissue was observed in the embolized AVMs. CONCLUSION: Experimental AVM embolization with pure 2-P-HEMA, made radiopaque with tungsten, is technically feasible in swine. Because of its properties, 2-P-HEMA has great potential as a therapeutic embolic agent.

Angiography, Digital Subtraction↗

PubMed2003

Angiographic embolization for emergent and prophylactic management of obstetric hemorrhage: a four-year experience.

BACKGROUND: To retrospectively evaluate the efficacy and safety of emergent and prophylactic arterial embolization for obstetric hemorrhage within the past 4 years. METHODS: We retrospectively collected 21 obstetric patients with treatment of selective arterial embolization between 1999 and 2002. Two groups of patients were identified. The first group consisted of 15 patients who experienced postpartum hemorrhage and underwent emergent embolization. The second group was made up of 6 patients who underwent prophylactic embolization with risk factors of severe obstetric bleeding. They had abnormal placentation antepartum diagnosed and accepted termination of pregnancy followed by hysterectomy. RESULTS: In the first group, 12 of 15 cases had a favorable outcome treated by single embolization session. One patient expired 4 days after embolization due to severe disseminated intravascular coagulopathy and multiple organ failure. One retained placenta with recurrent bleeding was controlled by repeated selective arterial embolization. One uterine subinvolution with persistent mild bleeding and genital tract infection was improved by conservative treatment. Further surgical procedure was not necessary for all cases. One woman delivered her next baby 13 months after embolization. In the second group, all women had abnormal placentation with histopathological confirmation, including 1 accreta, 3 increta, and 2 percreta. No immediate complication was noted after embolization. The estimated blood loss during operation ranged from 300 to 3000 mL (mean, 1770 mL). CONCLUSIONS: Our study indicates that selective arterial embolization should be the early management for intractable postpartum hemorrhage after conservative treatment fails and before more invasive surgical intervention is considered. Our experience also confirms the effectiveness and safety of prophylactic selective arterial embolization for anticipated high morbidity or mortality of obstetric surgery.

Adult↗

PubMed2004

Complication analysis of intracranial aneurysm embolization with controllable coils.

OBJECTIVE: To explore the causes, prevention, and management of the complications during intracranial aneurysm embolization with controllable coils (mechanical detachable spiral, MDS; and Guglielmi detachable coil, GDC). METHODS: Retrospective review of 120 cases with 125 intracranial aneurysms embolized with controllable coils from March 1995 to July 1999 was conducted. The 20 accidents (in 18 cases) including aneurysm rupture, over-embolization, protrusion of coil end into the parent artery, and thrombosis of the parent artery were analyzed. RESULTS: Among the 20 accidents, there were 6 aneurysm ruptures, 6 over-embolizations (in 5 cases), 6 coil protrusions, and 2 thromboses (one was secondary to coil protrusion). The embolization-related mortality was 3.33% (4/120), the permanent neurological deficit was 1.67% (2/120), and the transitory neurological deficit was 3.33% (4/120). The occurrence and outcome of the complications were related to the embolizing technique, the pattern of aneurysm and its parent artery, the imperfection of embolic materials, and the observation and management during embolization. CONCLUSION: Skilled embolizing technique, better understanding of the angio-anatomy of an aneurysm and its parent artery, correct judgement and management during embolization, and improvement of embolic materials are beneficial to the reduction of complications and to the melioration of the outcome of complications.

Aneurysm, Ruptured↗

PubMed2004

[Hepatosplenic and renal embolisms in infective endocarditis].

INTRODUCTION AND OBJECTIVES: Among the complications of infective endocarditis, systemic embolisms are an ominous prognostic sign. The aim of the present study was to compare the demographic, clinical, microbiologic and echocardiographic features of episodes of endocarditis accompanied and unaccompanied by embolisms in the spleen, kidney or liver. We also assessed the prognostic impact of these embolisms. MATERIAL AND METHOD: Prospective, multicenter clinical cohort study. We analyzed 338 consecutive episodes of left-sided infective endocarditis in 308 patients. Episodes were classified in two groups: group I, episodes with hepatosplenic or renal embolisms (n=34); group II, episodes without embolisms (n=304). RESULTS: There were 41 embolisms in 34 episodes (10%). Of these, 34 were located in the spleen, 5 in the kidney and 2 in the liver. Some forms of clinical presentation predominated in group I, e.g., abdominal pain, splenomegaly, cutaneous stigmata, hematuria, embolisms in other locations, and septic shock. Staphylococcus aureus and enterococci were more commonly isolated in group I. Detection of vegetations (by transesophageal echocardiography) was more frequent in group I, and they were larger than vegetations in group II. Hepatosplenic and renal embolisms were not independently associated with the need for cardiac surgery or death. CONCLUSIONS: Hepatosplenic and renal embolisms occur in 10% of left-sided episodes of infective endocarditis. The clinical presentation of these episodes has characteristic features. Vegetations are larger than in episodes without these embolism. Hepatosplenic and renal embolisms do not increase neither the need of cardiac surgery nor the risk of death.

Adult↗

PubMed2006

Clinical evaluation of cellulose porous beads for the therapeutic embolization of meningiomas.

BACKGROUND AND PURPOSE: Cellulose porous beads (CPBs) are a new, exceptionally uniformly sized, nonabsorbable embolic agent. We evaluated their efficacy in the preoperative embolization of meningiomas. METHODS: In 141 consecutive patients, we used CPBs (200-microm diameter) for the preoperative embolization of meningiomas. We selected patients whose tumors were > or =4 cm with 50% of blood to the tumor supplied by the external carotid artery (ECA). All patients underwent a provocation test before embolization. The percentage of blood supplied to the tumor by the internal carotid artery and ECA was determined angiographically. Nonenhanced areas on postembolization MR imaging were calculated. Intraoperative blood loss, units of blood transfusion, and hemostasis at the time of surgery were recorded for each patient. The interval between embolization and surgery was intentionally longer than 7 days. RESULTS: Of the 141 patients, 128 underwent CBP embolization. Eleven patients had positive provocation test results, and 2 had vasospasm; they were not CBP embolized. In 72% of the patients CBP embolization achieved reduction in the flow of the feeding artery by more than 50%. The nonenhanced area on MR imaging was not significantly correlated with the degree of ECA supply or devascularization. The interval between embolization and surgery was 8-26 days (mean, 9.9 days). The longer this interval, the greater was the tumor-softening effect and the rate of tumor removal. CONCLUSIONS: CPBs may be useful for the preoperative embolization of meningiomas. To increase the efficacy of CPB embolization, the interval to surgery should be at least 7 days.

Adult↗

PubMed1985

[Renal arterial embolization for renal cell carcinoma].

Renal arterial embolization is often used in the treatment of patients with renal cell carcinoma, either preoperatively to facilitate nephrectomy or as palliative therapy in advanced cases. Eighteen patients (18/58; 31%) underwent renal arterial embolization in our department since 1979, initial 10 cases with Gelfoam and steel coil (group G) and recent 8 cases with absolute ethanol (group A). Clinical studies of daily changes of symptoms and blood chemistry in both groups after embolization were compared and the results were as follows: Severe flank pain was noted immediately after embolization but thereafter well controlled without analgesics in group A. The patients in group G experienced no pain during the procedure of embolization but have had moderate flank pain of two or three days' duration with nausea and/or vomiting and required surgical procedure within a few days after embolization. Post embolization fever in group A was described as higher than that in group G significantly. Leukocytosis was noted to be persistent for up to seven days and blood chemistry showed transient marked elevations of GOT, GPT and LDH immediately after the procedure without significant value in both groups. Embolization to advanced tumor with many parasitic vessels or massive local invasion may not always be available for remaining of viable-appearing tumor cells in venous lumen, as if palliative treatment. Absolute ethanol may be more useful as the embolizing substance than Gelfoam and steel coil by reason of producing wide severe infarction of diseased kidney. Broad marked infarction due to renal arterial embolization may make pathological diagnosis difficult. Immunological effects of renal arterial embolization were not observed in short term patients survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗