[New embolic material for therapeutic embolization of malignant tumor--gelatin sponge containing carbazilquinone (author's transl)].
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Results for “Embolization, Therapeutic”
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Therapeutic embolization of juvenile angiofibroma.
Therapeutic embolization of juvenile angiofibromas was performed in 15 boys, aged 12--18 years, 11 of whom subsequently underwent surgery. Intraoperative blood loss was reduced from an average of 2,400 ml in nonembolized patients to 800 ml after embolization. Angiography is of value to confirm the diagnosis prior to excision and to delineate the extent of the tumor. Embolization may be performed at the same sitting as a presurgical adjunct or possibly as a definitive or palliative therapeutic method. The embolization procedure is discussed in detail, emphasizing techniques and potential hazards of such procedures.
Adolescent↗
Unexpected complications following therapeutic embolization.
Unexpected complications may follow therapeutic embolization, even though no apparent technical errors have occurred. This report includes four cases of facial palsy following middle meningeal artery embolization, one case of aspiration pneumonia following glomus tumor embolization, and a case of pulmonary embolization following embolization of a spinal arteriovenous malformation.
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[Pulmonary embolism as a result of therapeutic embolization].
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Embolization, Therapeutic↗
Appearance of gas in renal tissue after therapeutic embolization.
We present a case of therapeutic embolization in a patient with adenocarcinoma who demonstrated the presence of gas in the renal infarcted tissue on the second day. The pattern of air distribution was intravascular. There was no sign of abscess clinically or radiographically. To the syndrome of postembolization we add a new sign--the presence of postembolization air.
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Therapeutic embolization for acute haemorrhage in the abdomen and pelvis.
Therapeutic embolization for acute haemorrhage is increasingly being utilized. An audit of 34 patients undergoing therapeutic embolization for acute abdominal or pelvic haemorrhage was undertaken, in an attempt to assess the importance of the following variables in determining a successful outcome: coagulation status, transfusion status, time to procedure after onset of circulatory instability, duration of procedure, and the effect of the embolization technique employed. Overall success was 79%, with definitive control of haemorrhage achieved by embolization; 21% required surgical management for rebleeding 4-24 h post embolization. The duration of the procedure and transfusion status of the patient were the most important factors associated with a successful outcome.
Abdomen↗
[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.
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Therapeutic embolization of aneurysmal bone cyst.
Results of therapeutic embolization of aneurysmal bone cysts in five patients are described. Transcatheter arterial embolization was performed with Ivalon and Gelfoam particles and Gianturco coils. The postembolization period was characterized by complete relief of pain and decrease in size of the aneurysmal bone cyst in all patients. In patients whose follow-up was longer than 12 months, sclerosis and recalcification of bone were present. There were no complications.
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Treatment of pulmonary arteriovenous malformations by therapeutic embolization. Rest and exercise physiology in eight patients.
Pulmonary arteriovenous malformations (AVM) lead to chronic hypoxemia and systemic emboli. These lesions can now be treated by catheter embolization. In order to examine physiologic abnormalities during exercise in AVM patients, and to evaluate functional improvement after therapeutic embolization, eight patients underwent detailed physiologic studies at rest and during exercise before and after therapeutic embolization. Before treatment, six patients noted dyspnea on exertion and three had symptoms suggesting paradoxical embolism. Resting studies showed hypoxemia, abnormally increased shunt fractions, chronic alveolar hyperventilation, mild decreases in diffusing capacity, and abnormal wasted ventilation (VD). During exercise, oxygenation changed little from the resting values but VD increased markedly. Functional impairment was observed in most patients, and was correlated with shunt fraction. Obliteration of the AVM was accomplished by therapeutic embolization with placement of coils or balloons in the feeder vessels. This treatment resulted in immediate relief of dyspnea and improvement in resting PaO2 and shunt fraction. Exercise studies after embolization showed improvement in exercise capacity and gas exchange. However, chronic alveolar hyperventilation and reduced diffusing capacity remained unchanged. In summary, therapeutic embolization effectively reduces the degree of shunting, with improvement in respiratory symptoms, exercise capacity, and gas exchange at rest and during exercise. The abnormally decreased diffusing capacity and increased VD suggest the presence of a diffuse pulmonary vascular abnormality, of which further study is warranted.
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Therapeutic embolization of the hepatic artery.
We have performed therapeutic embolization of the hepatic artery and its branches in 15 patients, 14 with metastatic neoplasm and one with postoperative hepatobiliary hemorrhage. In the latter patient, bleeding ceased on embolization of the right hepatic artery and did not recur. The median survival time of the 14 patients who had hepatic embolization was six months. The mean survival time in our three patients with metastatic gastric leiomyosarcoma was 24 months, whereas our five patients with metastases from carcinoma of the colon had a mean survival time of only five months. On the basis of this experience we conclude that hepatic artery embolization is advisable in patients with hormonal effects of metastatic disease and in patients with massive hepatomegaly related to metastases from gastric leiomyosarcomas, and may be indicated in patients with hepatic artery hemorrhage.
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[Therapeutic embolization in ORL pathology. Indications and results].
The progress of therapeutical embolization in otolaryngology was made possible by the arrival of new techniques which allowed the embolization of the different ramifications of the arteria carotis externa. The embolization technique is based on two principles: 1. The embolus is to be injected in a super-selective way, after catheterization of the pathological blood vessels. 2. The mass of the embolus has to be big enough to be able to obstruct the pathological vessel. Therefore the femoral way is mostly used. The aim of embolization is to create a spontaneous thrombosis around the used particles. The thrombosis thus succeeds in completing the embolization. The principal counter-indications against embolization are due to facts of a technical and a geographical order. Incidents and accidents are often related either to the catheterization, or to the contrast-media, or also to the anastomoses which become functional after the embolization. The major complications are hemiplegiae, aphasiae and eyesight troubles, all problems brought about by ischaemia are: --the indications for isolated embolization, amongst which have to be pointed out the surgical counter-indications, severe epistaxis, vessel malformations, important cranio-facial angiomatosis, the telangiectasical family angiomatosis of Rendu-Osler, and the antalgic effect of embolization, in particular in cancer treatment; -- an excellent indication for embolization is the prevention of massive hemorrhages and the simplification of the surgical act, in particular in hypervascularized ORL tumours, either benign or malignant, for instance the naso-pharyngeal fibrome and the whole of the malignant tumours and of the metastases of the ORL sphere. To conclude, we may say, that, within skilled hands and when taking the usual precautions, accidents in embolization are exceptional, and that embolization remains a therapeutical process with great prospects.
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Therapeutic embolization in the treatment of intractable epistaxis.
OBJECTIVE: To determine the effectiveness of therapeutic embolization in the treatment of intractable epistaxis. DESIGN: Cohort. SETTING: Tertiary care hospital. PATIENTS: Consecutive referred sample of 57 patients with intractable epistaxis. INTERVENTION: Percutaneous transfemoral catheterization and angiography of the internal maxillary arteries. Embolization of the most distal branches with 0.1- to 0.9- cm3 medium-sized polyvinyl alcohol particles on the suspected side of bleeding. OUTCOME: Outcome was successful if no further interventional treatment was required for epistaxis. RESULTS: Anatomical abnormalities precluded embolization in three patients. Three of the remaining 54 patients required supplementry embolization. Including these three patients, 52 (96%) of 54 patients had successful control epistaxis. The major neurologic complication rate was 6% (three of 54 patients), with no permanent deficits. CONCLUSIONS: Therapeutic embolization is an effective and safe technique and should be considered as the primary treatment modality in severe epistaxis.
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Therapeutic embolization for vascular trauma of the head and neck.
Therapeutic embolization is an effective and relatively safe method for managing many cases of head and neck trauma. In the last 5 years, 78 traumatic vascular lesions--10 arterial transections and 68 arteriovenous fistula--were treated by intravascular embolization at four medical centers. Selection of embolic materials is discussed and different types of lesions are illustrated. Treatment was successful in every instance. Complications were limited to one case of cerebral infarction and two cases of temporary oculomotor weakness. The indications for embolization have widened beyond life-threatening hemorrhage alone, and continued improvement in techniques and embolic agents should see an increased use of this form of treatment.
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CT evaluation of therapeutic embolization of hepatic hemangiomas.
Computed tomography (CT) was used to monitor the response to therapeutic embolization in two cases of giant cavernous hemangiomas of the liver. Base-line tumor volume and rat of enhancement were calculated. Therapeutic embolization with a detachable balloon or Ivalon microsphere plus a detachable balloon was then performed. CT was repeated to evaluate both change in tumor volume and in rate of enhancement ("fill-in") of the lesion. It was possible to document the response to embolization by changes in the size and the degree of enhancement of the lesions. Thus, CT can be used to document the success or failure of embolization of hepatic hemangiomas.
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Therapeutic embolization for unusual latrogenic complications related to coronary revascularization.
Percutaneous therapeutic embolization may be an effective strategy to manage distal coronary perforations or inadvertent iatrogenic coronary arteriovenous fistula complicating revascularization procedures. We present two cases in which embolization techniques were used to manage these patients and avoid the need for surgical intervention.
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Flow-controlled therapeutic embolization: a physiologic and safe technique.
A feared complication of therapeutic embolization is loss of control of one or more particles with resultant ischemic infarction of normal tissues. To avoid passage of emboli into normal arteries, the delivery catheter may be wedged tightly into the artery or the artery completely occluded with a balloon catheter during embolus injection. These techniques, termed occlusion control, were a valuable forward step and significantly enhanced patient safety. However, occluding the vessel completely may cause spasm, and allows the operator to introduce fluid and emboli under higher than normal perfusion pressures which can open extra- to intracranial shunts and cause disastrous intracranial embolization. A further refinement is suggested. First, the emboli are suspended in contrast agent; then the particles are introduced while arterial runoff of the contrast agent is watched so the acceptance rate of the artery is not exceeded. Normal perfusion pressures and flow then carry the embolus distally into the abnormality being treated. This technique is safe, easily learned, and gives the radiologist direct vision control over the embolization process. It has been used in39 patients with only one serious complication.
Catheterization↗
[Therapeutic embolization for traumatic renal haemorrhage. 11 cases (author's transl)].
Therapeutic embolization by means of autologous clots or fragments of gelatin sponge was carried out in 11 patients suffering from renal haemorrhage of traumatic origin (5 needle biopsies, 3 surgical operations, 2 external traumas, 1 penetrating wound). Arterio-venous fistulae were present in 6 cases and arterial lesions in 5. Performed with a fine catheter, embolization was highly selective for the segmental arteries involved. The clinical symptoms disappeared within less than 12 hours in three patients, within 2 to 4 days in five and within 15 days in one. In two patients haematuria was only temporarily arrested ; a second embolization could be performed in one of these, but nephrectomy was required in the other.
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Detection of microemboli distal to cerebral aneurysms before and after therapeutic embolization.
PURPOSE: Recently developed interventional radiologic techniques, such as embolization with platinum coils, may induce thrombus formation within an aneurysm. The aim of the present study was to investigate the frequency of microemboli distal to untreated and treated cerebral aneurysms. METHODS: Among a total of 110 patients treated with platinum coil embolization, 35 patients (27 women and eight men, aged 50+/-10 years) who were at high risk of ischemic complications underwent emboli detection with a transcranial Doppler sonographic monitoring system. All patients were studied before and after coil embolization. The aneurysms were located at the internal carotid artery (n=14), the basilar artery (n=10), the middle cerebral artery (n=7), or the vertebral artery (n=4). Twenty-nine (85%) of 35 patients were monitored within 6 hours of the completion of treatment. RESULTS: Microemboli distal to the aneurysm were not detected in any of the patients before treatment. Microemboli were detected in 11 patients (31%) after embolization (mean, 16+/-21 per hour; range, 1-74 per hour). Microemboli were detected in five (71%) of seven patients in whom ischemic complications occurred after treatment, but in only six (21%) of 28 asymptomatic patients. This difference was statistically significant. The rate of occurrence of emboli in patients with ischemic complications (23+/-30 emboli per hour) was higher than in asymptomatic patients (10+/-7 emboli per hour), but this difference was not statistically significant. CONCLUSION: Microemboli were detected significantly more often in patients who suffered from cerebral ischemia after coil embolization of an intracranial aneurysm. This observation supports the definition of a high-risk group of patients with incomplete embolization or with a large-diameter, broad-neck aneurysm. The early detection of microemboli after treatment may be an indicator for excessive intraaneurysmal thrombus formation and could influence the decision for prophylactic treatment with heparin or aspirin.
Aneurysm↗