Experimental study of the effects of absorbable gelatin sponge and non­absorbable polyvinyl alcohol particle material used in transcatheter arterial embolization on liver tissues.

Hepatic trauma is a leading cause of death in major abdominal trauma, and transcatheter arterial embolization has been widely used to treat it. However, there is limited research on whether absorbable gelatin sponge (AGS) and non-absorbable polyvinyl alcohol particles (PVA) have different effects on liver tissue, making it an important area of exploration. The present study investigated this issue using animal experiments by performing transhepatic arterial embolization with AGS and PVA. The effects on normal liver tissue in rabbits were examined by detecting liver function and inflammatory indexes, conducting histopathological examination, and using western blotting to detect apoptotic proteins. There were significant differences between the AGS and PVA groups after embolization. The AGS group exhibited a trend of improvement at ~1 week after embolization, and all indicators were statistically different until day 21 compared with the PVA group. The AGS group exhibited improved repair of hepatocytes and the biliary system based on H&E staining, while the PVA group exhibited more severe necrosis of the hepatocytes and biliary system around the embolization site. The western blotting results indicated that the Bcl-2/Bax ratio decreased on day 1 and day 3, and then rebounded in the AGS group on days 7 and 21, demonstrating gradual repair of hepatocytes compared with the PVA group.

Comparison of polyvinyl alcohol particles and tris-acryl gelatin microspheres embolic agents used in uterine artery embolization: A systematic review and meta-analysis.

Objective: To identify the preferred agent by comparing the therapeutic efficacy, degree of infarction, and side effects of polyvinyl alcohol particles (PVA) and tris-acryl gelatin embolization (TAGM) agents in uterine artery embolization. Materials and Methods: We included available articles comparing PVA with TAGM embolization agents in the management of fibroids. The primary outcomes included the decrease in uterine volume (%), decrease in dominant tumor volume (%), fibroid infarction rate, complete infarction fibroid, complications, pain score after 24 h, procedure time (minutes), duration of hospital stay, fluoroscopy time (minutes), and the change in symptom severity score. Results: Eight articles that met our inclusion criteria were included in this study. Our analysis yielded an overall superiority of PVA compared to TAGM regarding complete fibroid infarction rate at the first 24 h. However, TAGM was better than PVA concerning <90% infarction rate outcome. While both embolization techniques showed similar effects regarding the change in symptom severity score, the percentage of decrease in uterine volume, percentage of decrease of dominant tumor volume, 90-99% infarction rate, complete infarction rate when assessed after the first 24 h, pain score after the first 24 h, procedure time, fluoroscopy time, minor, and major complications. Conclusion: Both PVA and TAGM embolization agents are effective and safe modalities in treating patients with fibroids, with no significant variation of both agents in most outcomes.

Hepatic Artery Embolization for Palliation of Symptomatic Hypoglycemia in Patients With Hepatic Insulinoma Metastases.

CONTEXT: Insulinoma is a pancreatic neuroendocrine tumor that causes hyperinsulinemic hypoglycemia. Symptomatic hypoglycemia related to hepatic insulinoma metastases may be addressed with liver-directed therapies such as hepatic artery embolization. OBJECTIVE: This work aimed to determine the safety and effectiveness of bland hepatic artery embolization (HAE) for palliation of symptomatic hypoglycemia in patients with hepatic insulinoma metastases refractory to medical management. METHODS: An institutional review board-approved retrospective review was undertaken of all patients with a tissue (n = 18) or imaging (n = 2) diagnosis of hepatic insulinoma metastases and symptomatic hyperinsulinemic hypoglycemia refractory to medical management who underwent bland HAE at a single center between January 1, 1998 and November 1, 2020. Twenty patients (10 women, 10 men; mean age, 56 years; range, 18-84 years) were identified who individually underwent 1 (n = 7), 2 (n = 5), 3 (n = 5), 4 (n = 2), or 5 (n = 1) HAEs, for an overall total of 45 HAEs. Post-HAE hypoglycemia recurrence was defined as onset of adrenergic symptoms (eg, sweating, weakness, tremor), neuroglycopenic symptoms (eg, confusion, loss of consciousness), and/or documented serum glucose of less than 50 mg/dL, in the absence of an alternative explanation. Median time to first hypoglycemia recurrence, hypoglycemia-free survival (HFS), and overall survival (OS) were calculated using Kaplan-Meier method. RESULTS: Before HAE, all patients experienced adrenergic or neuroglycopenic symptoms alleviated by glucose intake, and 60% (n = 12) of patients had documented serum glucose of less than 50 mg/dL within 1 week of the first treatment. Median post-HAE follow-up was 9.4 months (mean, 26 months; range, 0.1-190 months). Postprocedural hypoglycemic symptom relief after the first HAE was reported in 100% (n = 20) of patients before discharge or at follow-up. Post-HAE hypoglycemia recurrence occurred in 60% (n = 12) of patients with a median time to first hypoglycemia recurrence of 2 months (mean, 14 months; range, 0.2-60 months). After the first HAE, median HFS was 14.5 months, and median OS was 16 months. One patient experienced labile postprocedure blood glucose levels requiring intensive care unit admission for intravenous dextrose. Otherwise, no major procedure-related complications occurred. CONCLUSION: Bland HAE is a safe, effective, and repeatable procedure for palliation of symptomatic hypoglycemia in patients with hepatic insulinoma metastases refractory to medical management.

Bronchial artery embolization. What further we can offer?

INTRODUCTION: Massive hemoptysis is the most feared of all respiratory emergencies, with many underlying causes. In 90% of cases, the source of hemoptysis is the bronchial circulation. Despite high recurrence rates, bronchial artery embolization (BAE) remains the first-line treatment in management of hemoptysis. AIM: To establish pre-procedure and procedural protocols for BAE. MATERIAL AND METHODS: The study included a total of 50 patients referred to the Department of Radiology for complaints of hemoptysis. Pre-procedure computed tomography (CT) angiography for determination of responsible circulation was performed as a regular protocol except in cases presenting with life-threatening hemoptysis. Polyvinyl alcohol (PVA size, 300-500 µm and 500-700 µm) particles combined with gel foam embolization was performed. Successful catheterization and embolization of the targeted vessel was considered technical success and the cessation of hemoptysis to minimal levels was labeled clinical success. RESULTS: Thirty-two (64%) male and 18 (36%) female subjects comprised the study group. Forty (80%) patients had moderate to severe hemoptysis. Tuberculosis (80%) was the most common etiology. Five patients had severe AV shunting and were embolized with decremental particle size (500-700 µm followed by 300-500 µm) to occlude the bed and then embolize the artery. Technical success was achieved in all the patients, but clinical success was achieved in 40 (80%) patients. CONCLUSIONS: Bronchial artery embolization is a minimally invasive procedure recognized for primary management of hemoptysis. Preprocedure evaluation with CT angiography can add incremental value in management. Usage of decremental particle size is helpful to embolize large AV shunts.

Superselective embolization for high-flow priapism refractory to medical and surgical treatments.

BACKGROUND: This study aimed to report long-term outcome of superselective embolization in patients with high-flow priapism refractory to medical and surgical treatments. METHODS: From August 2011 until July 2016, 14 patients with high-flow priapism refractory to local treatments were treated and their charts were retrospective reviewed. Clinical evaluation, color Doppler ultrasonography, arteriography and selective embolization were performed. Follow up was performed in all patients. Fourteen men (18-63 years old) were enrolled, with priapism duration of 14 h to 28 days. Internal pudendal arteries or glutaea inferior arteriae were successfully embolized with gelatin sponge particles, polyvinyl alcohol particles or microcoils. RESULTS: Pseudoaneurysm in right femoral artery was found in one case after intervention. The follow-up 1 week later showed that 13 patients were in good condition, the priapism diminished 1-7 days (mean 3.2 ± 0.5 days) after intervention, and 1 patient received second intervention. Mean follow-up was (range 10.8-69.6) months. One patient had recurrent priapism months after embolization and had his penis surgically removed for severe necrosis. CONCLUSIONS: Superselective embolization is safe and effective in high-flow priapism refractory local treatments, with a good long-term prognosis.

Role of Interventional Radiology in the Management of Peripheral Vascular Malformations: A Tertiary Care Center Experience.

Peripheral vascular malformations (PVMs) represent a wide spectrum of vascular abnormalities occurring due to anomalous connections between arteries, veins, capillaries, and lymphatic channels at the microscopic level, in different combinations. They are rare and challenging to treat. Different operators may have different approaches based on their experience and expertise. Sclerotherapy either alone or in combination with embolization has been used as an independent method for the treatment of PVMs. Purpose The aim of this study is to assess the safety and efficacy of sclerotherapy and embolization, with or without surgery, for the treatment of peripheral vascular malformations, based on our approach. Materials and methods A retrospective review of all patients with PVMs treated in our interventional radiology department from 2011 to 2017 was carried out. Medical records, imaging, and follow-up notes were reviewed to evaluate the response to treatment and post-procedure complications. Results Thirty-four sessions were performed in 15 patients (eight male, seven female) with PVMs. Low-flow lesions were identified in 10, intermediate flow in one, and high flow in four patients. Sodium tetradecyl sulfate (STS) was used as the sclerotherapeutic agent in 10 (66.67%), glue with lipoidal in three (20.0%), and bleomycin in one patient (6.67%). Coils with PVA and a covered stent were used in one and a combination of coil, PVA, and gel foam was used in one patient. A marked response was seen in 11 and a partial response in four patients. One patient developed foot gangrene. Stent thrombosis was noted in one patient with no clinical consequences. Recurrence was seen in two patients, who were lost to follow up. Conclusion PVMs are complex lesions. Sclerotherapy with or without embolization is a safe and effective treatment modality, with clinical response approaching 100%.

Preoperative Embolization of Skull Base Meningiomas: Outcomes in the Onyx Era.

OBJECTIVE: Preoperative embolization may facilitate skull base meningioma resection, but its safety and efficacy in the Onyx era have not been investigated. In this retrospective cohort study, we evaluated the outcomes of preoperative embolization of skull base meningiomas using Onyx as the primary embolysate. METHODS: We queried an endovascular database for patients with skull base meningiomas who underwent preoperative embolization at our institution in 2007-2017. Patient, tumor, procedure, and outcome data were analyzed. RESULTS: Twenty-eight patients (28 meningiomas) underwent successful preoperative meningioma embolization. The mean patient age ± SD was 56 ± 13 years, and 18 patients (64%) were women. The mean tumor size was 49 cm3. There were 1, 2, or 3 arterial pedicles embolized in 21 cases (75%), 6 cases (21%), and 1 case (4%), respectively. The embolized pedicles included branches of the middle meningeal artery in 19 cases (68%), the internal maxillary artery in 8 cases (29%), the ascending pharyngeal artery in 2 cases (7%), and the posterior auricular, ophthalmic, occipital, and anterior cerebral arteries in 1 case each (4%). The embolysates used were Onyx alone in 20 cases (71%), n-butyl cyanoacrylate alone in 3 cases (11%), coils/particles and Onyx/n-butyl cyanoacrylate in 2 cases each (7%), and Onyx and coils in 1 case (4%). The median degree of tumor devascularization was 60%. Significant neurologic morbidity occurred in 1 patient (4%) who developed symptomatic peritumoral edema after Onyx embolization. CONCLUSIONS: For appropriately selected skull base meningiomas supplied by dura mater-based arterial pedicles without distal cranial nerve supply, preoperative embolization with current embolysate technology affords substantial tumor devascularization with a low complication rate.

High-flow priapism treated with superselective transcatheter embolization using polyvinyl alcohol particles.

OBJECTIVES: Priapism is a persistent erection of the penis not associated with sexual stimulation. High-flow priapism is caused by unregulated arterial inflow, usually preceded by perineal or penile blunt trauma and formation of an arterial-lacunar fistula. We present a case of high-flow priapism in a 13-year-old patient managed with polyvinyl alcohol particles. METHODS: After obtaining informed consent of the parents of the minor, diagnosis was made with penile Color Doppler Ultrasound and confirmed with flush angiography. Selective arterial embolization was performed with the use of polyvinyl alcohol particles. RESULTS: Complete detumescence was achieved without compromising the patient's erectile function. CONCLUSIONS: The use of permanent occlusive agents like polyvinyl alcohol particles for embolization shows good occlusion rates compared to temporary agents. More studies are needed to find the safer and better agent for the treatment of high flow priapism without compromising erectile function.

Preoperative embolization of meningiomas with polyvinyl alcohol particles: The benefits are not outweighed by risks.

PURPOSE: The purpose of this study was to define the feasibility, the efficacy and the safety of preoperative embolization (POE) of meningiomas using polyvinyl alcohol (PVA) particles. MATERIALS AND METHODS: Between January 2006 and June 2014, 191 consecutive patients were referred to our institution for the treatment of meningiomas; of these 57 patients were excluded from the study. A total of 64 patients (22 men and 42 women) with a mean age of 58.4±10.8 [SD] years (range: 14-82years) who underwent POE with PVA particles, achieving extensive (>90%) devascularization were ultimately included and compared to 70 patients who had surgery without POE. Surgical time and intraoperative blood loss were compared between the two groups. The duration of procedures and complications related to POE were analyzed. RESULTS: No differences were found between the two groups with respect to intraoperative blood loss. A significant reduction in surgical time was observed for the group who had POE (207.4±79.5 [SD] min vs. 226.9±117.6 [SD] min; P=0.028). In a subgroup analysis, the size and location of meningiomas did not influence these results. The duration of procedures was 41.4±10.5 [SD] min. Minor complications related to POE occurred in 3 out of 64 patients (4.7%). CONCLUSION: POE of meningiomas using PVA particles is effective in reducing surgical time, when extensive tumor devascularization is achieved. However, radiation exposure, the duration of procedures and complications related to POE with PVA particles do not justify this technique in most patients.

A comparative study on the fertility of uterine artery embolization and myomectomy for leiomyoma / Монголын Анагаах Ухаан

Objective@#To compare the nature of pregnancy and deliveryin women with leiomyoma who were treated with uterine artery embolization to the outcomes in women who were treated with abdominal myomectomy. @*Material and Methods@#A prospective, clinical study was conducted in 2010-2013 at “Urguu” Maternity Hospital, Ulaanbaatar. 94 women meeting the criteria were selected for the study. Post-treatment, the patients were reviewed for a period of two years. Uterine artery embolization was performed using polyvinyl alcohol particles (300-500 µm in diameter).@*Results@#The percentage of conception in UAE group was 25.5% and 31.9% in myomectomy group (p=0.494); complication of pregnancy was 50.0% and 57.1% respectively (p=0.729); complication of delivery was 33.3% and 0.0% respectively (p=0.047). 88.9% and 90.0% (p=0.596) had Caesarean delivery. 16 (84.2%) women had uncomplicated and 3 (15.8%) women had complicated delivery due to placenta praevia, placenta acreta and uterine hypotonia. These cases all belonged to UAE group. @*Conclusion@#Pregnancy rates in women with leiomyoma who were treated by uterine artery embolization, compared with pregnancies after abdominal myomectomy, were similar.(p=0.494) In this study, there was the rate of Cesarean delivery above 80 percent in both group. There were no differences in newborn weights and Apgar scores.

Comparison of microcoils and polyvinyl alcohol particles in selective microcatheter angioembolization of non variceal acute gastrointestinal hemorrhage.

OBJECTIVES: To compare the efficacy of polyvinyl alcohol (PVA) particles with microcoils in angiembolisation of non variceal acute gastrointestinal haemorrhage. METHODS: This is a retrospective cross-sectional study of patients who underwent transcatheter angioembolization from January, 1995 to December, 2013 at Aga Khan University Hospital, Karachi. Patients were divided into two groups on basis of use of either microcoils or PVA particles and compared in terms of technical success, clinical success, re-bleeding and ischemic complication rates. Chi (χ(2)) square and Fisher's exact tests were applied and a P-value of less than 0.05 was considered statistically significant. RESULTS: Fifty seven patients underwent angioembolization. Microcoil and PVA particles embolization was performed in 63% (36/57) and 35% (20/57) cases respectively. Technical success was achieved in all cases (100%). Clinical success rate was higher in microcoils group (92%) than PVA particles group (75%) with statistically significant P value (p=0.048). Ischemic complication was seen in one case (3%) in the microcoil group, while no such complications were seen in the PVA particles group. CONCLUSION: In angioembolization of non variceal acute gastrointestinal haemorrhage microcoils are better than Polyvinyl alcohol particles with higher clinical success and lower re-bleed rates.

Transcatheter arterial chemoembolization using polyvinyl alcohol particles in patients with primary hepatic cancer / 中国医学影像技术

Objective To assess the clinical value of transcatheter arterial chemoembolization (TACE) with polyvinyl alcohol (PVA) particles as embolic material in patients with primary hepatic cancer (PHC). Methods Twenty patients with PHC underwent TACE. The mixed emulsion of chemotherapy agents and lipiodol was given to embolize the tumor vssTranscatheter arterial chemoembolization using polyvinyl alcohol feeding artery of tumors. The tumors size, response rate and Alpha-Fetoprotein (AFP) value were monitored respectively at the end of the first month, the third month, the sixth month and the first year after TACE. The changes of liver function, including serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and total bilirubin (TBILI), were recorded within 1 week and 1 month after TACE. The time to progression and the overall survival were recorded. Results Compared with pre-TACE, the tumor size decreased obviously at the end of the first month, the third month, the sixth month and the first year after TACE (P<0.05), the response rate reached 80.00%, 90.00%, 95.00% and 95.00%, respectively. The AFP value decreased obviously. Serum AST, ALT and TBILI significantly increased in the first week after TACE (P<0.05), but returned to preoperative level within 1 month. The average follow-up time was (19.8±7.0) months (range 12-32 months), the time to progression was (17.0±6.8) months, and the overall survival was (19.3±7.0) months. Conclusion PVA particles are optimal embolic material for TACE of PHC. Superselective embolization is necessary in TACE to achieve effective tumor devascularization and reduce liver damage.

Bilateral tri-arterial embolization for the treatment of epistaxis.

BACKGROUND: Intractable epistaxis is treated by ipsilateral trans-arterial embolization of the internal maxillary artery, but there is 13-26% recurrence of bleeding. Preemptive embolization of both internal maxillary arteries along with the ipsilateral facial artery could provide maximal protection against recurrent epistaxis. We report our experience with 8 patients treated with bilateral tri-arterial embolization. METHODS: We performed a retrospective review of the patients who were treated with bilateral internal maxillary artery and ipsilateral facial artery embolization from January 2005 to January 2007. All patients had bleeding that was refractory to nasal packing. RESULTS: Eight patients were treated with bilateral tri-arterial embolization. The median age was 65 years (range, 35-90 years). Risk factors included hypertension (n=4), smoking (n=2), alcohol (n=2), and use of anticoagulation (n=2). All but 2 of the patients were treated under local anesthesia. All patients had complete obliteration of bleeding during the procedure, with no residual vascular blush. No major peri- or post-procedural complications were noted. Patients stayed in the hospital for 2-4 days (average 2.6 days). One patient developed ipsilateral temporofacial pain which resolved during hospitalization. Another patient had minor recurrent epistaxis on post operative day 2 which resolved with temporary repacking and the patient was discharged the next day. CONCLUSION: In our experience with 8 cases, bilateral internal maxillary artery and/or ipsilateral facial artery embolization was achieved without complication and was associated with complete obliteration of vascular blush and no significant recurrent epistaxis.

Endovascular Treatment of a Traumatic Pseudo Aneurysm of the Middle Meningeal Artery.

We describe a case of traumatic pseudoaneurysm of middle meningeal artery in a patient after a head trauma. The aneurysm was associated with epidural hemorrhage and was treated successfully with coil embolization.