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PubMed2004

[Study on hemodynamic changes and cardiac troponin I level in pig model of acute experimental pulmonary embolism].

OBJECTIVE: To evaluate the hemodynamic effects and cardiac troponin I (cTn I), creatine kinase-MB (CK-MB), myoglobin (Mb) releasing kinetics of acute experimental pulmonary embolism of pigs. METHODS: Sixteen juvenile pigs, of either gender and weighing 30 to 40 kg were studied, 8 in the embolism group and 8 in the control group. The 8 embolism animals received 0.1 g/kg polystyrene beads (diameter range 0.65 to 0.67 mm) suspended in 0.9% saline by venous injection. Pulmonary arterial pressure (PAP), systemic arterial pressure (SAP), pulmonary capillary wedged pressure (PCWP), cardiac output (CO), blood gases and serum cTn I, CK-MB, and Mb were measured before and immediately, 30 min, 1 hour, 2 hour, and 3 hour after acute pulmonary embolism. RESULTS: PAP was increased to 2 - 3 fold of the baseline and the control level immediately, and then decreased to the baseline level in 2 to 3 hours. Serum cTn I and Mb increased significantly after embolism and remained at a higher level through the 3 hour experimental procedure. The CK-MB was not changed after acute pulmonary embolism. CONCLUSIONS: Acute pulmonary embolism caused lung gas exchange abnormality and acute pulmonary hypertension. The hemodynamic effects of acute pulmonary embolism include injury to the myocardial cells and releasing of cTn I and Mb to blood stream. cTn I can be detected in the early phase of acute pulmonary embolism, and maybe a useful marker in diagnosis and management of acute pulmonary embolism.

Acute Disease↗
PubMed1992

[Preoperative embolization for meningiomas using PVA particles].

Preoperative embolization for highly vascularized and large meningiomas is an indispensable technique for facilitating their surgical removal by decreasing blood loss during the operation. This is a report of 4 large and highly vascularized meningiomas in the skull base, on which embolization of feeders was performed preoperatively by PVA (Polyvinyl alcohol foam) particles (150-250 micron produced by INGENOR CO, Paris) and small strips of gelfoam (0.5 x 0.5 x 3-5mm). Under EEG monitoring, Isosorbide dinitrate was used for prevention and relief of vascular spasm. Lidocaine injection tests (Xylocaine 2%: 50mg mixed in equal volumes with Iopamiron 300) were performed for checking before embolization. In the intracranial portion, standard taper steerable guide wire was changed to seeker flexible soft-tip guide wire. In two cases, the meningioma was located in the medial part of the sphenoidal ridge. In the other two cases, one meningioma was in the lateral part of the sphenoidal ridge and the other was in the olfactory groove. In all 4 cases, we successfully performed embolization without complication. In one case, we had to perform embolization twice, because of revascularization detected by angiography 3 weeks after the first embolization. In this latter case, we had performed central embolization only, by using PVA particles, having left feeder without occlusion (peripheral embolization) using gelfoam. The result suggested that it was also necessary to perform peripheral embolization especially if the tumor is fed by large tortuous and irregular abnormal vessels. Peripheral embolization may prevent PVA particles from washing out and causing progressive thrombosis by PVA particles.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Impaired cerebral vasoreactivity after embolization of arteriovenous malformations: assessment with serial acetazolamide challenge xenon CT.

Embolization of a portion of the nidus of an arteriovenous malformation not only may alter hemodynamics within the nidus, but also may change blood flow dynamics in adjacent normal vessels. Sequential acetazolamide-challenge xenon CT cerebral blood flow studies were performed in eight patients before and after embolization of arteriovenous malformations to assess the hemodynamic effects on the major vascular territories supplying the malformation. Acetazolamide is a potent cerebral vasodilator, and its administration combined with cerebral blood flow studies allows assessment of cerebral vasoreactivity. In seven of the eight patients, one or more parenchymal areas exhibited a normal cerebral blood flow augmentation response to acetazolamide before embolization, but diminished acetazolamide flow augmentation was seen after embolization, indicating abnormal vasoreactivity. We found that the decrease in vasoreactivity peaked 6-10 days after embolization. In one of the eight patients, a temporary delayed neurologic deficit developed during a period of impaired cerebral vasoreactivity following embolization. Our results suggest that embolization of an arteriovenous malformation can induce vasoreactivity changes in adjacent normal vessels. Because these changes appear to be somewhat time-dependent, an appropriate interval should be observed between embolization stages or before surgical resection of an arteriovenous malformation following embolization to allow hemodynamic equilibration to occur. Acetazolamide challenge combined with serial cerebral blood flow studies following embolization enables determination of this hemodynamic equilibration.

Acetazolamide↗
PubMed1990

Preoperative embolization of cerebral arteriovenous malformations with polyvinyl alcohol particles: experience in 51 adults.

In order to determine possible risk factors and to assess the value of platinum microcoils added to polyvinyl alcohol particles in preoperative embolization of cerebral arteriovenous malformations in adults, we reviewed our experience with this procedure. Between September 1985 and June 1989, we performed embolizations in 54 patients with cerebral arteriovenous malformations. Of these, procedures in 51 adults involved the use of polyvinyl alcohol particles, either alone (n = 29) or in combination with platinum microcoils (n = 21). A complication during catheterization precluded embolization in another patient. Beginning as flow-directed embolizations via carotid artery catheterizations (n = 12), newer catheters allowed progression to superselective intracerebral catheterizations (n = 38). Embolization has led to shorter surgical procedures, more clearly defined operative margins, and less bloody operative fields. We have not found recanalization to significantly hinder embolization results with polyvinyl alcohol when resection is undertaken within 1-4 weeks of embolization. Its relative safety and ease of manipulation at surgery argue for its use. We found no significant increase in complications based on patient age, venous drainage of the arteriovenous malformation, or the circulation embolized. Embolization results in cerebral arteriovenous malformations were improved with superselective catheterization and most improved with the combined use of polyvinyl alcohol for nidus embolization followed by occlusion of the feeding vessel with microcoils.

Adolescent↗
PubMed1980

[Therapeutic embolization in the external carotid artery region (author's transl)].

UNLABELLED: This paper reports our experience of therapeutic embolization in the external carotid artery region. Therapeutic embolization was done for the purpose of decreasing hemorrhage during operation. MATERIAL AND METHOD: Therapeutic embolization was done in 6 cases of meningioma, 1 case of capillary hemangioma of the cheek and one case of olfactory neuroblastoma. Catheterization was done through the common carotid artery in adults and done through the femoral artery in an infant. Small pieces of Gelfoam were used as emboli. Emboli, 1 X 1 X 0.5 mm in size, were instilled with normal saline. One embolus was used in one instillation as a rule. A larger embolus was used for occlusion of a larger artery. Heparin was not used through entire procedure. Four illustrative cases are presented. when a feeder of a tumor is occluded by artificial emboli, two kinds of effect can be resulted. when emboli lodge within the tumor or in a feeding artery distal to arterial anastomoses, blood is no longer supplied to the tumor (embolization effect). On the other hand, when a feeding artery is occluded by emboli at the point proximal to arterial anastomoses, blood supply to the tumor is transiently reduced but it is soon restored through arterial anastomoses (ligation effect). To minimize bleeding during surgery it is very important to gain embolization effect. For this purpose small emboli should be instilled repeatedly until embolization effect is established. Then ligation effect should be obtained, if necessary, by injection lower emboli. Operation was performed on the day following embolization in cases of meningioma. In a case of capillary hemangioma of the cheek operation was performed three days after embolization and in a case of olfactory neuroblastoma surgery was performed two days after embolization. In all cases the primary purpose to minimize bleeding during operation was achieved. No untoward side effects were encountered in this series. The ophthalmic artery may arise from the middle meningeal artery. The vertebral artery might be visualized through the collateral from the occipital artery. We should pay attention to these vascular anomalies before embolization to prevent possible catastrophe.

Aged↗
PubMed1993

Combined embolization and gamma knife radiosurgery for cerebral arteriovenous malformations.

In a study of 46 patients with cerebral arteriovenous malformations (AVMs) the value of combining embolization and gamma knife radiosurgery was assessed. In 35 patients with large grade III to V AVMs (Spetzler-Martin system) staged combined treatment was planned. In 11 patients, radiosurgery complemented embolization for a residual AVM. The number of embolization sessions ranged from 1 to 7 (median 2). Twenty-six patients needed multiple embolization sessions. In 28 patients the grade of AVMs decreased as a result of embolization. In 16 patients collateral feeding vessels developed after embolization which made delineation of the residual nidus difficult. The time lag between the last embolization and radiosurgery ranged from 1 to 24 months (median 4). Nineteen of 35 large grade III to V AVMs were possible to treat by radiosurgery following embolization. In the 46 patients complications occurred in 9 from embolization and in 2 from radiosurgery. Two patients had transient and 9 had permanent neurologic deficits. It is concluded that embolization facilitates radiosurgery for some large AVMs and therefore this combined treatment has a role in the management of AVMs.

Adolescent↗
PubMed1993

[Transesophageal echocardiography in patients with systemic arterial embolism].

The percentage of ischemic strokes or peripheral arterial embolism attributed to cardiogenic embolism is about 30% and 75%, respectively. Diagnostic work-up in patients with prior arterial embolism is of prognostic importance, because embolic events are often recurrent. Cardioembolic sources with major risk of embolism are atrial fibrillation, mechanical or biological heart valve prosthesis, left ventricular or left atrial thrombi, left atrial myxomas, bacterial endocarditis, nonbacterial thrombotic endocarditis and nonischemic dilative cardiomyopathies. Cardioembolic sources with minor risk of embolism are mitral valve prolapse, isolated mitral annular calcification, patent foramen ovale, atrial septal aneurysm and calcific aortic valve stenosis. Studies have shown that two-dimensional transthoracic echocardiography yields little useful information in patients with arterial embolism. The advent of transesophageal echocardiography in the late 1980s allowed a more reliable identification of potential cardioembolic sources. The close contact of the echoprobe in the esophagus to the heart allows better resolution of intracardiac structures, particularly when cardiovascular abnormalities at the atrial level, the base of the heart and the thoracic aorta are sought. We studied 153 patients with clinically suspected arterial embolism by transthoracic and transesophageal echocardiography. Patients with extracranial carotide occlusive disease and patients older than 60 years were excluded from the study. In 88 out of 153 patients (58%) a cardioembolic mechanism could be detected by the combination of transthoracic and transesophageal echocardiography. Using the transthoracic method alone, a cardioembolic source could only be found in 55 patients (36%). Valvular heart disease and regional or global wall motion abnormalities could be visualized by both methods with similar results. However, only two out of 22 left atrial thrombi detected by transesophageal echocardiography could be documented also with the transthoracic approach. Transesophageal echocardiography was superior in the evaluation of valvular vegetations, intracardiac tumors, diseases of the thoracic aorta and abnormalities of the interatrial septum. Only left ventricular thrombi could be better evaluated by the transthoracic method, because visualization of the left ventricular apex by the transesophageal approach is problematic. In patients with systemic arterial embolism the combination of transthoracic and transesophageal echocardiography is the diagnostic method of choice to detect a cardioembolic source. Randomized studies in the future must prove, whether the echocardiographic findings can lead to better therapeutic strategies to improve the prognosis of patients with embolic disease.

Adult↗
PubMed1997

A prospective study of risk factors for pulmonary embolism in women.

OBJECTIVE: To investigate risk factors for pulmonary embolism in women. DESIGN: Prospective study based on biennial, mailed questionnaires. SETTING: Nurses' Health Study with 16 years of follow-up from 1976 to 1992. PATIENTS: A group of 112822 women aged 30 to 55 years in 1976, free from diagnosed cardiovascular disease or cancer at baseline. Overall, there were 1619770 person-years of follow-up. MEASUREMENTS: Based on self-report and medical records, we documented 280 cases of pulmonary embolism, of which 125 were primary (no identified antecedent cancer, trauma, surgery, or immobilization). Information on height, weight, cigarette smoking, hypertension, diabetes, and hypercholesterolemia was collected by questionnaire. RESULTS: In multivariate analysis, obesity, cigarette smoking, and hypertension were independent predictors of pulmonary embolism. Specifically, obese women (body mass index > or = 29.0 kg/m2) had an increased risk of primary pulmonary embolism (multivariate relative risk=2.9; 95% confidence interval [CI], 1.5-5.4). Heavy cigarette smokers also had an increased risk of primary pulmonary embolism. The relative risk (RR) of primary pulmonary embolism was 1.9 (95% CI, 0.9-3.7) for women currently smoking 25 to 34 cigarettes per day and 3.3 (95% CI, 1.7-6.5) for those smoking 35 cigarettes or more daily as compared with never smokers. Hypertension, even after adjustment for body mass index, was also associated with an increased risk of primary pulmonary embolism (RR=1.9; 95% CI, 1.2-2.8). High serum cholesterol levels (RR=1.1; 95% CI, 0.62-1.8) and diabetes (RR=0.7; 95% CI, 0.3-1.9) did not appear to be related to primary pulmonary embolism. CONCLUSION: These prospective data indicate that obesity, cigarette smoking, and hypertension are associated with increased risk of pulmonary embolism in women. Control of these risk factors will decrease risks of pulmonary embolism as well as coronary heart disease.

Adult↗
PubMed1997

Evaluation of particulate embolic materials with MR imaging, scanning electron microscopy, and phase-contrast microscopy.

PURPOSE: To analyze the properties and embolic effect of microfibrillar collagen (MFC), Gelfoam powder, and polyvinyl alcohol (PVA) materials that are used in embolization procedures in the head and neck. METHODS: The shape and surface of these embolic agents were examined with scanning electron microscopy and phase-contrast microscopy. The mean number of areas of T2-weighted high signal intensity was measured on MR images in a rat embolization model to estimate the embolic effect. RESULTS: By scanning electron microscopy and phase-contrast microscopy, MFC appears fibriform and has various sizes and an irregular surface. Gelfoam is of uniform size and has a smooth surface. PVA materials are granulated and have a rough surface. MFC is somewhat suspendable and its shape changes moderately after suspension. Gelfoam is very suspendable and its shape changes rapidly. PVA showed only mild swelling. The embolic effect of MFC was the lowest of the materials examined. Large PVA particles (250 to 500 microns) showed a lesser embolic effect than Gelfoam or small PVA particles (50 to 150 microns) or medium-sized PVA particles (150 to 250 microns). No significant differences were observed among the embolic effects of Gelfoam, small PVA particles (50 to 150 microns), and medium PVA particles (150 to 250 microns). CONCLUSIONS: MFC and large PVA particles (250 to 500 microns) should be used for embolization of vascular anatomy involving potentially dangerous anastomoses. Gelfoam, PVA particles of 150- to 250-micron diameter, and PVA particles of 50- to 150-micron diameter are adequate for embolization involving homogeneous and peripheral anatomy.

Animals↗
PubMed1997

[Embolism and intramedullary femoral surgery].

All intramedullary femoral surgery entails embolic phenomena which explain peroperative collapses formally known as bone cement implantation syndrome, as well as perioperative fat embolism syndromes. Locally, the bigger the cavity is, the higher the number of accidents: 2.5-5 per cent for GUEPAR hinged-knee prosthesis, 1.75 per cent for total hip arthroplasty with long stem, and 0.1 per cent during classic THA with cement limited to the metaphysis. Anomalies in bone vascularization also increase risk: 10.5-13 per cent during prophylactic nailing for shaft metastases, 1-11.5 per cent during hemiarthroplasty cemented in osteoporotic bone of femoral neck fractures, and only 0.1 per cent during THA implanted because of arthrosis. Not only cement, but also rods, reamers, nails, implants, ultrasonic tool for cement extraction, increase the pressure inside the cavity. Methylmethacrylate is no longer the only incriminated factor, even if it is responsible for a major part of the compressive load. The intensity and duration of the pressure are correlated with the number of embolic phenomena and with measured cardiopulmonary parameters. The intracavity fat content is expelled (an empty cavity, as in THA revision, does not lead to embolic phenomena). Then filters through the intraosseous veins whose diameter limit the size of the extruded embolic phenomena. The ultrasonography of the inferior vena cava shows innumerable fine particles and thrombi which are already organized under the influence of procoagulant factors released from the operative shield and which remain crumbly. These emboli cross the cardiac cavities. Transesophageal echocardiography (TEE), of recent use, does quantify the amount of right atrial filling, duration of echogenesis and size of particles: the result is higher in patients who underwent cemented versus noncemented THA: however the embolism score is no an indicator of seriousness because it is not correlated with cardiorespiratory manifestations; TEE shows only one fourth of the patent foramen ovale, whereas the atrial septal defect is surely one of the most efficient systemic invasion mechanisms to produce perioperative fat embolism. Lung response is most often asymptomatic, even if all patients undergoing intramedullary surgery display an increase in pulmonary vascular resistance which is managed by the right heart only, as well as pulmonary (and sometimes systemic) microvascular fat obstruction. Common operating room monitoring procedures do not detect successive embolic phenomena before they cause pulmonary arterial hypertension which then has repercussions on the left heart and in turn causes peroperative hemodynamic accidents. Only pulmonary arterial pressure measurement with a Swan-Ganz catheter gives early and durable signs of an intolerance to embolic load. Preventive treatment is surgical as there is an inverse relation between embolic marrow and marrow eliminated by large volume washes (which is often more effective than draining). Cement indications in older patients as well as the choice of fixation techniques in femoral fractures must take into account the cardio-pulmonary condition of the patient. Resuscitation procedures dealing with these complications end in the patient's death in half of the cases.

Animals↗
PubMed1997

Renal angiomyolipomas: long-term follow-up of embolization for acute hemorrhage.

OBJECTIVE: To determine if elective, angiographically directed embolization of enlarged renal angiomyolipomas can be used to prevent future hemorrhagic episodes in patients with tuberous sclerosis and thus avoid nephrectomy. PATIENTS AND METHODS: Records were reviewed for all 5 patients who underwent elective, subtotal embolization of large, symptomatic angiomyolipomas at the authors' institution between 1975 and 1996. RESULTS: All 5 patients had tuberous sclerosis and bilateral renal angiomyolipomas. Initial embolization in these patients was performed in 1975, 1981, 1993 (2 patients) and 1994. In 1 patient only a single embolization session was required. In another, initial embolization on the left side was followed by embolization on the right 13 months later. Two patients underwent 2 sessions, and 1 patient had 4 sessions over a 13-year period. Subtotal embolization with particulate material led to a decrease in size of the most severely affected portion of the kidney. One large angiomyolipoma underwent sterile liquefaction after embolization; percutaneous catheter drainage was required. The embolization allowed subsequent partial nephrectomy in this patient. CONCLUSION: Embolization is effective for the long-term management of renal angiomyolipomas in patients with tuberous sclerosis; in this way nephrectomy and loss of renal function can usually be avoided.

Acute Disease↗
PubMed1977

[Unusual cases of maternal death caused by amniotic fluid embolism].

Five cases of amnion fluid embolism are reported. In the first case the cause of the death was the obstruction of the lung-vessels. In the lung tissue calcium embolia could also been detected. In the second case embolization started--at unruptured amnionsac--with ecclampsia-like convulsions, later it was followed by coagulopathia. In the third case amnion fluid embolism was complicated by coagulopathia. In the fourth case in addition to amnion fluid embolism endometritis purulenta complicated by endotoxinaemia and coagulopathia were also present. In all four cases rupture of the uterus was revealed. In the fifth case amnion fluid embolism developed without the rupture of the uterus. At the autopsy of cases of maternal death the possibility of amnion fluid embolism should always be considered. Although macroscopic changes seen at amnion fluid embolism are not pathognomic, when clinical and pathological symptoms of haemorrhagic diathesis are present, there always arises the suspicion of amnion fluid embolism. Since lungs are relatively resistant to putrefaction amnion fluid embolism in optimal cases can be diagnosed histologically even in exhumated lung specimen. Reliable diagnosis of amnion fluid embolism in cases of sudden maternal death gives possibility to exclude medical negligence.

Adult↗
PubMed1998

Guglielmi detachable coil embolization for unruptured aneurysms in nonsurgical candidates: a cost-effectiveness exploration.

PURPOSE: We calculated the incremental cost-utility ratio for Guglielmi detachable coil (GDC) embolization versus no therapy for unruptured intracranial aneurysms considered inappropriate for surgical clipping procedures. METHODS: Decision tree and Markov analyses that employ cohort simulation were applied to determine the incremental cost-utility ratio of GDC embolization versus no therapy for unruptured cerebral aneurysms. Clinical values required as input data were estimated from the literature for the following variables: relative frequencies of complete aneurysmal occlusion, partial aneurysmal occlusion, and attempted coiling (no coils detached); morbidity and mortality of GDC embolization; frequency, morbidity, and mortality of spontaneous aneurysmal rupture in untreated and GDC-embolized aneurysms; annual rate of recanalization of GDC-embolized aneurysms; quality of life when knowingly living with untreated or GDG-embolized aneurysms and of living with fixed neurologic deficit; costs of GDC embolization, spontaneous aneurysmal rupture, stroke, and rehabilitation; and discount rate. Cost-utility ratios below $50000 per quality-adjusted life year saved were considered acceptable. Sensitivity analyses were performed for all relevant input variables. RESULTS: Baseline input values resulted in acceptable cost-utility ratios for GDC embolization of unruptured intracranial aneurysms. These ratios remained within acceptable limits across wide ranges of various input parameters. Cost-effectiveness was markedly affected by the natural course of unruptured, untreated aneurysms; rates of spontaneous rupture greater than 2% per year resulted in favorable cost-utility ratios that were relatively unaffected by variation in GDC efficacy, while rates of rupture less than 1% per year resulted in unfavorable ratios that were highly dependent on GDC efficacy. Many of the GDC efficacy indexes, such as rate of failed coiling, early recanalization, and progressive aneurysmal thrombosis, have mild effects on the cost-utility ratios. GDC complication rate as well as life expectancy had moderate effects on the analysis. The influence of late aneurysmal recanalization was mild unless high rates of rupture for partially coiled aneurysms were applied. Suboptimal clip placement resulting from the presence of GDC coils within a ruptured aneurysm had no demonstrable consequence on cost-utility ratios. CONCLUSIONS: The single most influential variable determining the cost-effectiveness of GDC embolization in our analysis was the natural course of untreated aneurysms. Other important variables included GDC-related morbidity and life expectancy at the time of GDC embolization.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Personal experience in embolization of liver hemangiomas].

INTRODUCTION: Cavernous haemangioma is the most often found benign liver tumour. Its size usually does not change, although there are cases in which it grows. Large haemangiomas can cause hepatomegaly, pain in the right subcostal area, and spontaneous ruptures. By modern diagnostic procedures they are detected more often and therefore gained more diagnostic importance. Cavernous haemangiomas, especially giant ones, can be treated surgically (enucleation or resection of a part of the liver), by embolization or by other procedures. The aim of the study was to determine the important role of embolization in the treatment of symptomatic haemangiomas with risk of rupture. MATERIAL AND METHODS: Over a period of 5 years, at the Department of Gastroenterology and Hepatology, haemangioma was discovered in 35 of 178 patients with focal liver lesions. Eighteen (51%) patients were males and 17 (49%) females. In 21 (60%) patients, the size of the tumour was 2-4 cm, in 10 (29%) 5-10 cm, and in 4 more than 10 cm. Ultrasonography, computerized tomography, celiacography, scintigraphy with blood pool and ultrasound guided liver biopsy were used to diagnose haemangiomas. Polyvinyl-alcohol (Ivalon) was used for embolization. Through femoral catheter truncus coeliacus was reached, a. hepatica was catheterized, contrast was injected, and then microembolization of peripheral branches was performed. In 10 patients, because of the size of haemangioma, symptoms or localization, and a high risk of bleeding, embolization was performed. Biochumoral parameters were analyzed on the first, the second and the seventh day after the intervention. Within the period of five years, control ultrasound examinations were performed in all patients, and results were compared. In 9 patients control liver scintigraphy with blood pool was carried out. RESULTS: Embolization was performed with polyvinyl-alcohol. During angiography which followed, avascular zones were seen. There was no statistically significant difference between biochumoral parameters before and after embolization. Five years after the embolization, a reduced size of haemangioma was found in 8 patients. The echosonographic appearance of the tumour was changed in almost all patients. All clinical symptoms disappeared. There was no bleeding. In 8 of 9 patients liver scintigraphy with blood pool was performed, and there were no "warm fields." DISCUSSION: Due to modern diagnostic procedures, haemangiomas are now more often detected. However, ultrasonography is not always specific in discovering haemangiomas. Liver scintigraphy does not always reveal the typical shape of these tumours. Every procedure has its advantages and disadvantages. Once haemangioma is detected, it is the question how to treat it. Experience of most hepatologists suggests that interventions should be performed only in case of symptomatic haemangiomas, progressively growing haemangiomas, and in case of the high risk of bleeding. Embolization of the hepatic artery, previously used only as the first part of surgical procedures is now used as the only procedure in the treatment of these tumours. Some authors reported pain and fever after this intervention, which were also noticed in our patients. The reported agranulomatous arteritis with eosinophilic infiltration was not found in our patients. There were no significant changes in biochumoral analysis; this finding confirmed that there was no necrosis around embolized haemangioma. On the basis of the follow-up of our patients we came to the conclusion that embolization of haemangioma, performed by an experienced radiologist, is a very useful procedure in the therapy of symptomatic haemangiomas and haemangiomas with a high risk of bleeding.

Embolization, Therapeutic↗
PubMed1991

Intraarterial sodium amytal administration to guide preoperative embolization of cerebral arteriovenous malformations.

In preoperative embolization of cerebral arteriovenous malformation (AVM), one difficulty frequently encountered is assessment of the risk of ischemic deficit, posed by proceeding with embolization. One technique to assist prediction of tolerance of devascularization involves superselective injection of sodium amytal into cerebral arteries, prior to and during embolization. Since September, 1985, we have performed 119 embolization procedures in 77 patients with cerebral AVM. Of these, 89 procedures in 60 patients involved superselective intracerebral catheterization and embolization with either polyvinyl alcohol (PVA) alone or in combination with platinum microcoils, surgical silk, or a mixture of ethanol and microfibrillar collagen. In 50 of these procedures, we superselectively administered sodium amytal intraarterially immediately prior to embolization, for purposes of functional testing. Groups of patients undergoing testing were compared to groups not tested prior to embolization, for development of transient or permanent neurologic deficits or cerebral hemorrhage, subsequent to embolization. Significantly better results, both in absolute numbers and severity of complications, were found when testing was employed. No complications of amytal administration were seen. In four cases, embolization was altered or discontinued based on development of a deficit at the time of amytal administration. We conclude that the brief anesthetic effect of intraarterial testing with sodium amytal is a safe and important adjunct during preoperative embolization of cerebral AVMs.

Journal Article↗
PubMed1996

Lung water is increased in regions of higher neutrophil retention after acute bead embolization.

Previous reports have shown that neutrophils are retained in the lung after acute embolization and that these neutrophils play an important role in the subsequent formation of permeability pulmonary edema. The present study was designed to test the hypothesis that acute embolic injury results in microvascular damage in lung regions with the greater retention of neutrophils. Seventeen pigs (20 +/- 2 kg) were embolized by injecting polystyrene beads (250 microns; labeled with 131I) into the right atrium over 5 min. Five pigs, which received no embolic beads, served as controls. Neutrophils (89 +/- 5% pure), isolated on Ficoll-Histopaque gradient, were radiolabeled with 111In-oxine. Twenty minutes after embolization, the radiolabeled neutrophils were injected into the right atrium along with 85Sr-labeled microspheres to mark the initial neutrophil distribution within the lung as well as the regional pulmonary blood flow at the time of their delivery. The animals were killed 50 min after embolization, and the lungs were removed, frozen over liquid nitrogen, and cut into 60 samples. The data show that after embolization regional neutrophil retention was inversely related to the regional blood flow but was not affected by the embolic load in the same region. Regional extravascular lung water was increased in regions of higher neutrophil retention, but the regions with increased edema did not receive a greater embolic load. These results show that microvascular injury occurs in the lung regions with the greatest neutrophil retention and that this increased retention of neutrophils is unrelated to the extent of embolization.

Animals↗
PubMed1999

Diagnostic value of gas exchange tests in patients with clinical suspicion of pulmonary embolism.

OBJECTIVE: To assess the value of parameters derived from arterial blood gas tests in the diagnosis of pulmonary embolism. METHOD: We measured alveolar-arterial partial pressure of oxygen [P(A-a)O2] gradient, PaO2 and arterial partial pressure of carbon diaxide (PaCO2) in 773 consecutive patients with suspected pulmonary embolism who were enrolled in the Prospective Investigative Study of Acute Pulmonary Embolism. DIAGNOSIS: The study design required pulmonary angiography in all patients with abnormal perfusion scans. RESULTS: Of 773 scans, 270 were classified as normal/near-normal and 503 as abnormal. Pulmonary embolism was diagnosed by pulmonary angiography in 312 of 503 patients with abnormal scans. Of 312 patients with pulmonary embolism, 12, 14 and 35% had normal P(A-a)O2, PaO2 and PaCO2, respectively. Of 191 patients with abnormal scans and negative angiograms, 11, 13 and 55% had normal P(A-a)O2, PaO2 and PaCO2, respectively. The proportions of patients with normal/near-normal scans who had normal P(A-a)O2, PaO2 and PaCO2 were 20, 25 and 37%, respectively. No differences were observed in the mean values of arterial blood gas data between patients with pulmonary embolism and those who had abnormal scans and negative angiograms. Among the 773 patients with suspected pulmonary embolism, 364 (47%) had prior cardiopulmonary disease. Pulmonary embolism was diagnosed in 151 (41%) of 364 patients with prior cardiopulmonary disease, and in 161 (39%) of 409 patients without prior cardiopulmonary disease. Among patients with pulmonary embolism, there was no difference in arterial blood gas data between patients with and those without prior CPD. CONCLUSION: These data indicate that arterial blood gas tests are of limited value in the diagnostic work-up of pulmonary embolism if they are not interpreted in conjunction with clinical and other laboratory tests.

Journal Article↗
PubMed1995

[Examination of cardiac myxomas complicated with embolism].

Cardiac myxomas complicated with embolism were examined. Of 51 patients who underwent surgical excision of myxomas during the last 19 years, 10 patients (6 patients originated from left atrium, 4 patients originated from right atrium) had complications by embolisms. The embolism occurred in cerebral arteries (5 cases), a coronary artery (1 case), a retinal artery (1 case), and pulmonary arteries (4 cases). Patients were divided into an embolism group and a non-embolism group to investigate risk factors of embolism. Arrhythmia, diameter, narrow peducle, and tumor friability were thought to be major risk factors. Gelatinous and rough surface type tumor tended to cause embolism. Hypervascular tumors did not cause embolism. Among 10 patients, 2 patients had already had new embolism and another 2 patients had aggravated their symptoms before making diagnosis of myxoma. Myxomas should always be considered as a source of embolization, which need meticulous investigation and prompt indication of surgical resection.

Adolescent↗