Superselective arterial embolization for the treatment of lower gastrointestinal hemorrhage.

PURPOSE: To evaluate the technical feasibility, efficacy of hemostasis, recurrent bleeding, and ischemia resulting from superselective embolization of acute lower gastrointestinal (GI) hemorrhage. MATERIALS AND METHODS: Fifty-two superselective mesenteric artery catheterization procedures were undertaken in 48 patients with angiographic evidence of lower GI bleeding. Embolization was performed only if the arterial recta leading to the bleed could be successfully catheterized (n = 39). The lesions treated were located in the colon (n = 33) and jejunum (n = 6). In 28 of 39 procedures, embolization was achieved by delivering polyvinyl alcohol (PVA) particles (150-500 microm) through a microcatheter. Microcoils were used as the sole embolic agent in four procedures and a combination of microcoils and PVA particles were used in another four. Gelfoam particles were used in three of our earliest procedures. Of the 35 patients who underwent embolization, 25 were evaluated for objective evidence of ischemia by endoscopy (n = 16) and/or histologic evaluation of the surgical specimen (n = 9); the remaining 10 patients were followed clinically. RESULTS: Embolization was successful in 39 procedures involving 35 patients. Immediate hemostasis was achieved after embolization in all but two patients. Recurrent bleeding occurred in 12 other patients, eight patients underwent surgery, three were managed medically, and one underwent successful repeat embolization. Of the 25 patients evaluated for ischemia, mucosal ischemia was demonstrated in six (24%), but they remained asymptomatic and developed no sequelae as a result of ischemic changes on long-term follow-up. There was no incidence of clinically significant intestinal ischemia. Embolization alone was the definitive treatment in 44% patients (21 of 48). Reasons for unsuccessful superselective catheterization (27%) were small vessel spasm, cessation of bleeding, and vessel tortuosity. CONCLUSION: Superselective embolization is a feasible, safe, and effective technique for treating acute lower GI hemorrhage.

Embolization of intracranial aneurysms with Guglielmi detachable coils augmented by microballoons.

We describe two cases in which balloons were used to aid in the occlusion of intracranial aneurysms with Guglielmi detachable coils. In both patients, initial attempts to place coils within the aneurysmal sac failed, as the loops of the coil repeatedly protruded through a wide aneurysmal neck into the parent vessel. Temporary balloons placed across the neck of these small, wide-necked aneurysms, the bridging balloon technique, effectively narrowed the necks, providing support for the formation of a proper coil basket, which was not possible without the balloon. Follow-up studies at 1 year showed good results in both patients.

Outcome of 350 implanted chest ports placed by interventional radiologists.

PURPOSE: To determine the outcome of implanted chest ports placed by interventional radiologists. MATERIALS AND METHODS: Between June 1993 and July 1996, a single institution placed 350 implanted chest ports in 346 patients by means of the subclavian vein approach. The medical records of these patients were reviewed to determine the outcome of the ports. Ports were implanted for chemotherapy (n = 341), blood transfusion (n = 7), or antibiotics (n = 2). RESULTS: Immediate complications were seven (2%) pneumothoraces and one (0.3%) hematoma. Four (1.1%) of the pneumothoraces necessitated hospital admission and treatment with a chest tube. The remaining three were managed on an outpatient basis. One was successfully treated in the interventional suite by catheter suction. Two pneumothoraces were observed and resolved spontaneously. Mean time of patient follow-up was 260 days (range, 22-929 days). Total time of follow-up was 91,000 catheter days. Delayed complications were 10 cases of thrombosis (2.9% or 0.11 per 1,000 catheter days) of the subclavian vein, four infections (1.1% or 0.04 per 1,000 catheter days), four catheter coiling or tip malpositions (1.1% or 0.04 per 1,000 catheter days), three catheter occlusions (0.9% or 0.03 per 1,000 catheter days), and one catheter leak (0.3% or 0.01 per 1,000 catheter days). Six (1.7%) ports had to be removed as a result of a delayed complication. CONCLUSION: Chest port implantation by interventional radiologists within the radiology department is a successful and safe procedure with complication rates equivalent to, or lower than, those reported in surgical placement series.

Acute lower gastrointestinal hemorrhage: treatment by superselective embolization with polyvinyl alcohol particles.

OBJECTIVE: The major risk of transcatheter embolotherapy for acute hemorrhage in the lower gastrointestinal tract is irreversible intestinal ischemia. The authors studied the efficacy and safety of superselective transcatheter embolization with polyvinyl alcohol particles in arresting acute hemorrhage in the lower gastrointestinal tract. SUBJECTS AND METHODS: All patients with clinical or scintigraphic evidence of acute hemorrhage in the lower gastrointestinal tract were considered for superselective embolization. The nine patients with angiograms that showed active hemorrhage in the lower gastrointestinal tract underwent the procedure. Superselective embolization was done through a 3-French catheter and was accomplished by using 100- to 590-microns polyvinyl alcohol particles. The segments of the intestinal tracts involved in the embolizations were examined for the presence of ischemia by endoscopy (n = 7) or histologic evaluation of a surgical specimen (n = 2) 2-44 days (mean, 11 days) after embolization or by clinical evaluation (n = 1). RESULTS: The lesions treated by this method were located in the colon (n = 8) and jejunum (n = 1). Immediate hemostasis was achieved in every case. Three patients had recurrent lower gastrointestinal hemorrhage 1-24 days (mean, 9 days) after initial embolization. Two of these patients had surgery, while one had a successful second embolization. Two asymptomatic patients were found endoscopically to have small areas of ischemia involving only the mucosa. Only one patient was shown to have severe mucosal ischemia; this involved the colon in a distribution that suggested it was not caused by the embolization. CONCLUSION: Ten superselective embolization procedures that used polyvinyl alcohol particles successfully controlled hemorrhage in the lower gastrointestinal tract in nine patients. In no case was intestinal infarction induced by the procedure, and only two endoscopically proved cases of asymptomatic mucosal ischemia occurred.

Separation of a ruptured angioplasty balloon with successful percutaneous retrieval--a case report.

A case of ruptured angioplasty balloon with complete separation from the catheter is presented. Successful percutaneous retrieval of the balloon with endoscopic biopsy forceps was performed.

Successful embolization of multiple AV foot lesions--a case history.

A 39-year-old white female with multiple arteriovenous malformations of the left foot had had surgical ligation on her left dorsalis pedis artery at age 12 with no clinical improvement. She was placed into a leotard at age 16 and was able to function but would tire very easily and her left foot was twice the size of her right one. In May 1988, she had four large feeder vessels off the posterior tibial artery and two off the anterior tibial artery embolized by use of 1,000 microns PVA particles, occlusive spring coils, and detachable balloons. Her foot shrunk and is now smaller than her normal right foot; she does not tire, and she now wears a knee length stocking to help prevent other channels from opening.