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PubMed1985

Hemorrhagic pancreatitis: a complication of transcatheter embolization treated successfully by total pancreatectomy.

Since pancreatitis can be produced experimentally in dogs by embolization of microspheres into the pancreatic arterial circulation, there has been speculation that intentional or inadvertent embolization of the pancreas in human subjects could also produce pancreatitis. Although such therapeutic embolization has increased, no pathologically documented case of this complication has been recorded. We have reported the first such case occurring in a patient with a large, highly vascular, nonfunctioning islet cell carcinoma of the tail of the pancreas preoperatively embolized with Gianturco coils and Gelfoam particles suspended in sodium tetradecylsulfate solution to facilitate distal pancreatectomy. The resultant hemorrhagic pancreatitis and duodenal necrosis required a total pancreatectomy. We conclude that, by itself, occlusion of the origin of the splenic and gastroduodenal arteries with coils would have been effective and without complication; however, the addition of Gelfoam particles in a sclerosing solution reduced the microscopic pancreatic circulation to a critical point and resulted in hemorrhagic pancreatitis.

Adenoma, Islet Cell↗
PubMed2000

Controlled clinical trial of a novel hemostatic agent in cardiac surgery. The Fusion Matrix Study Group.

BACKGROUND: We performed a prospective randomized trial to compare FloSeal Matrix (Fusion Medical Technologies, Inc, Mountain View, CA), a gelatin-based hemostatic sealant, with Gelfoam-Thrombin (Gelfoam, Pharmacia and Upjohn, Kalamazoo, MI; Thrombin, Gentrac Inc, Middeton, WI) (control group) to control perioperative bleeding. METHODS: A total of 93 patients undergoing cardiac operations were randomized into the FloSeal or control group after standard surgical means to control bleeding had failed. The bleeding site was evaluated at 1, 2, 3, 6, and 10 minutes after applying the hemostatic agent. If bleeding stopped within 10 minutes, the application was considered to be successful. In the case of a failure, the surgeon could use any means preferred (except FloSeal) to achieve hemostasis. All bleeding sites in a patient were treated with the hemostatic agent to which the patient was randomized. Follow-up evaluation was performed at 12 to 36 hours and 6 to 8 weeks after operation. RESULTS: FloSeal stopped bleeding in 94% of the patients (first bleeding site only) within 10 minutes, compared to 60% in the control group (p = 0.001). At 3 minutes, successful hemostasis was achieved in 72% of the FloSeal group compared with 23% in the control group (p = 0.0001). There was no difference in the adverse event profile between the two groups. CONCLUSIONS: FloSeal Matrix demonstrated efficacy superior to that of Gelfoam-Thrombin and had a safety profile similar to that of Gelfoam-Thrombin when used as a topical hemostatic agent during cardiac surgery procedures.

Blood Loss, Surgical↗
PubMed2003

A pig model of chronic heart failure by intracoronary embolization with gelatin sponge.

BACKGROUND: We produced a large-animal model of left ventricular (LV) failure induced by transcatheter embolization of the left coronary artery using a gelatin sponge. METHODS: Fourteen male pigs underwent transcatheter embolization of the left anterior descending artery (LAD) using gelatin sponge to produce anteroapical myocardial infarction. Coronary angiography was performed 1 week after the coronary embolization. The animals were followed up with echocardiography and LV pressure-volume study for the subsequent 8 weeks, and the data were compared with those of the control group (n = 13). RESULTS: The procedure mortality was 2 of 14 (14%). Coronary angiography revealed the occluded LAD was recanalized with poor run-off. The LV end-diastolic dimension progressively increased (control versus myocardial infarction: 39 +/- 2 mm versus 49 +/- 4 mm, p < 0.001 at week 4; and 40 +/- 2 mm versus 57 +/- 6 mm, p < 0.001 at week 8). Fractional area change decreased over 8 weeks (77% +/- 10% versus 43% +/- 6%, p < 0.001 at week 4; and 77% +/- 10% versus 40% +/- 8%, p < 0.001 at week 8). End-systolic elastance progressively decreased over 8 weeks (3.04 +/- 0.73 mm Hg/mL versus 1.54 +/- 0.51 mm Hg/mL, p < 0.0001 at week 4; and 2.88 +/- 0.44 mm Hg/mL versus 1.05 +/- 0.21 mm Hg/mL, p < 0.001 at week 8). The plasma levels of brain natriuretic peptide were significantly higher in the study group (543 +/- 131 pg/mL versus 1,321 +/- 364 pg/mL, p < 0.001 at week 4; and 610 +/- 152 pg/mL versus 1,523 +/- 232 pg/mL, p < 0.001 at week 8). CONCLUSIONS: This pig model of chronic heart failure is reliable, reproducible, and amenable to investigate other surgical procedures.

Animals↗
PubMed1992

Renal artery embolization with ethanol and gelfoam for the treatment of ureteric fistulae with one year follow-up.

Two patients with ureteric fistulae who were unfit for reconstructive surgery were treated by renal ablation using intra-arterial ethanol, gelfoam fragments and in one case coils. In both cases the fistulae dried-up on the same day and both patients are well and normotensive a year later. Our conclusion is that renal ablation by arterial embolization with ethanol can be a valuable alternative to surgery to treat ureteric fistulae in patients who are poor surgical risks.

Embolization, Therapeutic↗
PubMed1993

Treatment of inoperable hepatocellular carcinoma by transcatheter arterial chemoembolization using an emulsion of cisplatin in iodized oil and gelfoam.

Eighty patients with inoperable hepatocellular carcinoma (HCC) were treated by transcatheter arterial chemoembolization using an emulsion of Lipiodol and Cisplatin. In 59 patients, gelfoam embolization was also given. The tumour size ranged from 0.5 cm to 33 cm in maximum diameter with the median diameter being 8 cm. The chemoembolization sessions were repeated every 1 1/2 to 3 months. The number of sessions the patients underwent varied from 1 to 11, with the mean number of sessions being 3.7. The HCC either disappeared completely or decreased in size in 44 patients (55%). In patients having an HCC of 12 cm or less in size, 31 out of 41 (75.6%) who had the addition of gelfoam demonstrated decrease in tumour size, while seven out of 11 (63.6%) without the addition of gelfoam demonstrated decrease in tumour size. In patients having an HCC of more than 12 cm in size, only six out of 18 (33.3%) who had the addition of gelfoam demonstrated reduction in tumour size and none of the 10 patients without the addition of gelfoam responded. Thus, HCCs of 12 cm or less in size responded better than larger ones to chemoembolization (P < 0.0001) while the addition of gelfoam enhanced the response (P = 0.039). The 1 year survival rate for the 80 patients was 53% and the 2 years survival rate was 38%. The median survival was 13 months. For patients having an HCC of 12 cm or less in size, the 1 year and 2 year survival rates were 69% and 47% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1980

Per catheter control of haemorrhage from the superior and inferior mesenteric arteries.

The relevant findings in 11 cases of per catheter control of haemorrhage from different sites in the large and small bowel are presented together with a description of the techniques and some of the possible complications of vasopressin infusion and gelfoam embolisation. In six of these cases vasopressin infusion was sus achieved by embolisation, three following the failure of vasopressin therapy. In one case embolisation of the ileo-colic artery produced a caecal infarct. Important differences in the vascular supply to the large and small bowel and their practical significance in embolisation are discussed.

Adult↗
PubMed1981

Superior gluteal artery haemorrhage following pelvic features controlled by embolisation.

Successful embolisation of active bleeding from the superior gluteal artery seen in two patients within the last 12 months is described. Both patients had extensive abdominal and pelvic injuries. One patient eventually died from renal failure and a perforated colon. The other patient is mobile and has been periodically seen in the out-patient department over the past nine months. In both instances, haemorrhage was at the sacrosciatic notch. Early angiography, in patients with extensive pelvic trauma and major blood requirements, with intent to embolise any identifiable bleeding source would appear to be the best initial manoeuvre to prevent exsanguination.

Adolescent↗
PubMed1984

Therapeutic arterial embolisation: report of five years' experience.

Therapeutic arterial embolisation was performed in 48 patients. Gelfoam, Oxycel, Bucrylate, Gianturco wire coils and lyophilised dura mater were used. Indications included control of acute haemorrhage, pre-operative vascular reduction, palliation of inoperable lesions, or to render such lesions operable, and elective definitive treatment. The technique was not considered to be of significant value as a pre-operative measure but was successful for the control of haemorrhage, the management of inoperable lesions and as an elective definitive treatment for various unusual lesions. One patient died and three had complications. The choice of occlusive material is discussed and depends upon the nature and vascularity of the lesion and whether short- or long-term occlusion is required.

Acute Disease↗
PubMed1997

Iatrogenic renal vascular injuries and their radiological management.

Twenty-nine patients with significant haematuria after a renal invasive procedure (27 of whom had undergone a percutaneous renal procedure and 2 surgical pyelolithotomy) were investigated with angiography. Out of the 21 patients with evidence of arterial injury, 19 were treated by transarterial embolization with gelfoam with or with hydrogel particles; (n = 11), steel coils with gelfoam (n = 4), hydrogel particles (n = 1), surgicel (n = 2), silk with gelfoam (n = 1). The efficacy and technique of the therapeutic embolization procedure is emphasized.

Aneurysm, False↗
PubMed1978

Prevention of peritoneal adhesions by the combined use of spongostan and 32% dextran 70: an experimental study in pigs.

Twenty female pigs underwent laparotomy during which transection of both uterine horns and wedge resection of both ovaries were performed with a standard technique. Following the injuries a mixture of Spongostan and 32% dextran 70 was applied only to the lesions on the right side. Three weeks after surgery another laparotomy was performed and the degree of adhesion formation was recorded. A marked reduction in degree and extent of adhesions was observed on the treated side as compared with the control side. The possible advantages of a compound that can be applied locally and has hemostatic properties as well are discussed.

Administration, Topical↗
PubMedDate not supplied

Bleeding following endoscopic sphincterotomy: angiographic management by transcatheter embolization.

Transcatheter embolization is a well-established and effective method for the control of bleeding from the upper gastrointestinal tract and often represents the preferred alternative to more invasive surgical management. The applications of this technique for the management of bleeding following endoscopic sphincterotomy have not been reported previously. Of five patients referred for arteriography with life-threatening postsphincterotomy bleeding, active bleeding from branches of the gastroduodenal artery was demonstrated in four. Embolization of this vessel with Gelfoam controlled the bleeding in all three patients in whom it was attempted. Arterial stenosis and spasm precluded such treatment in one patient. The fifth patient was not bleeding at the time of arteriography. There were no complications from these procedures. Our experience shows that postsphincterotomy bleeding can be safely and effectively controlled by transcatheter embolization, thereby avoiding surgery which is associated with significant morbidity and mortality in this setting.

Adult↗
PubMed1978

Preoperative angiographic embolization for large hemorrhagic Wilms' tumor.

Preoperative angiographic embolization of the renal artery is a surgical adjunct not necessary for the majority of Wilms' tumors. However, on the basis of early experience, we would recommend this technique for those large vascular tumors with preoperative hemorrhage in which the risk of embolization is likely to outweight the risk of intraoperative disruption and hemorrhage.

Child, Preschool↗
PubMed1979

Arteriographic embolization for control of recurrent severe gastric hemorrhage in a 10-yr-old boy.

Severe stress ulceration or stress gastritis may occasionally produce uncontrollable gastric hemorrhage in the pediatric age group. Modern arteriographic techniques utilizing selective embolization to occlude demonstrated bleeding arteries can successfully control such hemorrhage and avoid emergency destructive surgical resection. A 10-yr-old boy, in whom a previous 80% gastric resection failed to control life threatening hemorrhage, is presented, with roentgenographic demonstration of the procedure and the successful control of his gastric bleeding.

Angiography↗