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PubMed1979

Transcatheter occlusion of the gastroduodenal artery.

The gastroduodenal arteries of 7 patients were occluded for treatment of duodenal bleeding in 4, hepatic devascularization in 2, and redistribution of blood flow for intra-arterial chemotherapy in one patient. In 6 patients, occlusion was performed with Gianturco coils, and with Gelfoam in one. No major complication was encountered. This approach was successful in the control of bleeding from peptic ulcers, arteriovenous malformation and invasion of duodenum by retroperitoneal metastatic lymph nodes from carcinoma of the testicle. Occlusion of the gastroduodenal artery was utilized for further dearterialization of hepatic neoplasms. Redistribution of hepatic blood flow was accomplished by the occlusion of the gastroduodenal and replaced right hepatic arteries allowing infusion of chemotherapeutic agents into the entire liver through the left hepatic artery.

Adenoma, Bile Duct↗
PubMed1979

Vessel occlusion with transcatheter electrocoagulation: initial clinical experience.

Transcatheter electrocoagulation (TCEC) was used for vessel occlusion in combination with embolization by Gelfoam and/or Ivalon in six patients in whom other interventional or surgical techniques were considered dangerous or unfeasible. The technique was effective in decreasing or obliterating the blood supply to variously located lesions in all cases. The only complications were small skin burns in one patient and a small ulceration of the upper lip in another.

Adult↗
PubMed1980

Transcatheter embolization of intrahepatic arterial aneurysms.

Four patients with intrahepatic arterial aneurysms were treated with transcatheter embolization. Two patients had multiple aneurysms, and two had single aneurysms; in two the aneurysms were post-traumatic, and in the other two they were mycotic. Either Gelfoam or isobutyl-2-cyanocrylate was used to occlude the hepatic artery branches. It is concluded that transcatheter embolization is a safe and effective method for the management of these aneurysms and can be used as an alternative to surgery.

Adult↗
PubMed1980

Hepatic arterial redistribution for intraarterial infusion of hepatic neoplasms.

An aberrant hepatic artery occurs in approximately half of the population. With increased use of selective intraarterial chemotheraphy for hepatic neoplasms, an aberrant artery becomes a significant obstacle. Occlusion of the artery was attempted to redistribute the entire hepatic arterial flow from multiple arteries to a single artery to facilitate the effect of infusion. There were six hepatic artery variations found in the ten patients evaluated for this study. The aberrant left hepatic artery was embolized in five patients, and a replaced right hepatic artery was embolized in six; one patient had embolization of two hepatic arteries. The standard embolization method used Gelfoam and a coil to achieve proximal occlusion of the hepatic artery. Redistribution of hepatic flow through intrahepatic collaterals was achieved in all cases.

Antineoplastic Agents↗
PubMed1981

Therapeutic embolization of the renal artery with Gianturco coils: limitations and technical pitfalls.

The Gianturco coil, with or without Gelfoam, is particularly popular and effective in occluding renal arteries to control bleeding, devascularize tumors, close arteriovenous fistulas, and infarct kidneys in end-stage renal disease. However, without special precautions, successful embolization can suddenly be transformed into catastrophe. Representative reports of complications from medical centers across North America are used to illustrate the initial technical pitfalls of coil placement, as well as the more delayed complications that produce deviations from the usual postinfarction syndrome.

Abscess↗
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↗
PubMed1981

Systemic embolization as a complication of transhepatic venography.

Many patients with cirrhosis and portal hypertension demonstrate a right-to-left shunt, caused by development of anastomoses connecting the high-pressure periesophageal veins with the low-pressure bronchial and/or pulmonary veins at the level of the pulmonary hili. These anastomoses from the pathway by which small Gelfoam particles injected into the coronary or short gastric veins may embolize the systemic arterial circulation. Such embolization could have serious consequences, but reports of such complications have not been found by the authors.

Adult↗
PubMed1982

The coil baffle in the experimental occlusion of large vascular structures.

A new method to occlude large vascular systems using a combination of a coil baffle and conventional coil was evaluated in the abdominal aortas of seven dogs. Three types of coil baffles were introduced into the canine abdominal aorta, followed by four to eight coils. Balloon catheters were applied to control the length of the embolus complex in two dogs. All seven dogs had complete aortic occlusion immediately. Six dogs were observed for six weeks; of these four required additional Gelfoam embolization at two weeks. At autopsy, all six dogs had 100% aortic occlusion. The combined use of coil baffle and coil allows occlusion of large vascular systems not feasible for occlusion with the conventional coil alone.

Animals↗
PubMed1982

Diagnostic and interventional angiography in acute gastrointestinal hemorrhage.

The use of vasopressin infusion or arterial embolization in the treatment of 87 patients with gastrointestinal hemorrhage is reviewed. A bleeding point was identified angiographically in 46 patients (53%), with a higher success rate in those with upper gastrointestinal hemorrhage (63%) than in those with lower (39%) gastrointestinal hemorrhage. Vasopressin infusion in 33 patients completely stopped hemorrhage in 14 and slowed hemorrhage pending surgery in another 5. Gelfoam embolization was successful as definitive therapy in 12 of 15 patients. Mortality as a result of hemorrhage or its sequelae was 40% in patients with upper gastrointestinal hemorrhage and 21% in those with lower gastrointestinal hemorrhage.

Acute Disease↗
PubMed1982

Experimental canine hepatic artery embolization with polyvinyl alcohol foam particles.

Segmental and complete hepatic artery embolization with Ivalon (polyvinyl alcohol) particles (0.25 to 1 mm) was performed in 12 dogs to evaluate hepatic function alterations and histopathological changes. In dogs undergoing segmental embolization, liver function alterations were minimal and the liver was normal, both grossly and microscopically, at autopsy. In dogs undergoing complete hepatic embolization, only two had significant elevation of SGOT and alkaline phosphatase levels, which normalized in 2 and 4 weeks; one of these two dogs also had an elevated bilirubin level. A focal hepatic infarct was observed both grossly and microscopically in one dog and only microscopically in four dogs. Two dogs died of pancreatic abscess due to unintentional pancreatic embolization. The study suggested that segmental embolization with Ivalon particles was well tolerated by dogs, and complete hepatic embolization resulted in hepatic function changes and focal infarction comparable with Gelfoam embolization.

Alkaline Phosphatase↗
PubMed1983

Paresis following internal iliac artery embolization.

Extensive lower limb paresis developed in three patients with terminal cancer following internal iliac (hypogastric) artery embolization. This procedure was carried out for control of hemorrhage in two of the patients and for reduction of the bulk of metastatic tumor in another. The embolic materials used resulted in extensive obliteration of small and large vessels of the posterior and anterior divisions of the internal iliac artery. The paresis is attributed to the resulting ischemia of the sciatic and femoral nerves; previous radiotherapy may also have been a contributing factor. To reduce the incidence of paralysis, identification of the bleeding vessels and selective embolization are recommended. If this cannot be achieved, and the catheter lies in the main stem, it is recommended that the emboli should not be smaller than Gelfoam pledgets (1 X 1 X 10 mm) to preserve the peripheral circulation and lessen the risk of complication.

Adult↗
PubMed1983

Peripheral hepatic artery embolization for primary and secondary hepatic neoplasms.

Eighteen patients underwent peripheral arterial embolization with Gelfoam powder for treatment of primary or metastatic hepatic neoplasms. Except for two cases in which the patients could not undergo long-term arterial infusion, all cases were treatment failures from intravenous chemotherapy, intra-arterial chemotherapy, or, in some cases, intra-arterial chemotherapy plus radiation therapy. Fourteen patients had good symptomatic relief from the procedure. Four of these patients are alive at 3, 5, 6, and 18 months following the procedure. Four patients died within 2 weeks following embolization, three of progression of disease and one of aspiration pneumonia. Of the patients showing symptomatic relief, 10 died of progression of cancer 2 to 14 months following embolization, with a median survival of 5 months. Based on the results in this small group of patients, it would seem that transcatheter hepatic dearterialization is often successful palliative therapy in patients who are not responsive to traditional therapies. Because of the low procedural morbidity, transcatheter embolization is superior to surgical dearterialization.

Carcinoma, Hepatocellular↗
PubMed1983

Transcatheter embolization of hepatocellular carcinoma: assessment of efficacy in cases of resection following embolization.

In 8 cases of hepatocellular carcinoma, hepatectomy was performed after hepatic artery embolization with Gelfoam. Complete necrosis of the tumor was found in 4 of these cases. Compared with the tumors that showed incomplete necrosis, the tumor in the complete necrosis group were small, thickly encapsulated, and located at sites remote from collateral circulation. Angiography and computed tomography after embolization accurately demonstrated tumor necrosis or continued viability, as confirmed by examination of resected specimens.

Aged↗
PubMed1983

Digital subtraction angiography: limitations for the detection of pulmonary embolism.

Perfusion lung scanning, magnification pulmonary arteriography, and digital subtraction angiography (DSA) were performed prior to and following Gelfoam embolization of selected pulmonary arteries in eight canines. The sites of embolization were identified in 75% of perfusion lung scans, in 93% of magnification pulmonary arteriograms, in 75% of arterial phase DSA studies, and 100% of parenchymal phase DSA examinations. With technological advances, DSA has the potential to become the examination of choice for the evaluation of patients suspected of having pulmonary emboli.

Angiography↗
PubMed1985

Hepatocellular carcinoma detected by iodized oil. Use of anticancer agents.

Transcatheter arterial embolization (TAE) was performed in 97 patients with hepatocellular carcinoma. Ethiodol (iodized oil) containing an anticancer drug was infused via the hepatic artery followed by Gelfoam particles. The Ethiodol emulsion was selectively retained in the tumor vessels and also remained in the small daughter nodules that could not be detected by angiography or computed tomography (CT) prior to TAE. Ethiodol remained in the tumor for more than 1 year. Following TAE, main tumors and small daughter nodules appeared as areas of markedly high density on CT. In most patients there was a reduction in the tumor size following TAE, and serum alpha-fetoprotein levels were reduced in all patients whose initial levels had exceeded 400 ng/ml. This method is considered to be effective not only for treatment of hepatic tumor but also useful for evaluation of post-TAE changes in the tumor and diagnosis of small daughter nodules, due to the long-term accumulation of Ethiodol in tumor vessels.

Adult↗
PubMed1985

Absolute ethanol injection of the adrenal artery: hypertensive reaction.

Transcatheter injection of 0.4 ml of absolute ethanol into the adrenal artery was performed in three Rhesus monkeys. The injection produced a mean increase of 60 mmHg in systolic blood pressure and 50 mmHg in diastolic blood pressure within two minutes. Hypertension was accompanied by cardiac arrhythmias (two monkeys) and sinus tachycardia (one monkey). These changes were probably related to an acute catecholamine release. Embolization of the inferior phrenic artery with Gelfoam powder produced only a mild blood pressure elevation in three monkeys (6 mmHg systolic pressure and 10 mmHg diastolic pressure).

Adrenal Glands↗