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Tiralongo F, Toscano S, Mosconi C, Iezzi R, Giurazza F, Castiglione DG, Falsaperla D, Vacirca F, Ini' C, Corvino F, Lavalle S, Venturini M, Foti PV, Palmucci S, Basile A. Spontaneous retroperitoneal hematoma treated with transarterial embolization: a systematic review and metanalysis. CVIR Endovasc 2024; 7:50. [PMID: 38789727 PMCID: PMC11126549 DOI: 10.1186/s42155-024-00462-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to evaluate the safety, technical, and clinical effectiveness of percutaneous Transarterial Embolization (TAE) in treating spontaneous retroperitoneal hematomas as well as assess treatment outcomes in patients who underwent target or empirical embolization. MATERIALS AND METHODS Through the PubMed, Embase, and Google Scholar databases, an extensive search was performed in the fields of spontaneous retroperitoneal hematomas treated with transcatheter arterial embolization. We collected pooled data on 141 patients from 6 separate articles selected according to the inclusion and exclusion criteria. RESULTS Technical success rate was 100% in all six studies, for both targeted and empirical embolization. The clinical success rate varied from 56.3 to 89.5%. The total number of complications related to the embolization procedure was 10 events out of 116 procedures analyzed. Empirical or empirical embolization was performed in three studies, where the source of active bleeding was not evident during DSA. A meta-analysis compared the rebleeding rates between targeted and empirical embolization groups. The odds ratio from pooled data from the three assessed studies (72 patients) showed no significant difference in rebleeding rates after empirical TAE compared with targeted TAE. CONCLUSIONS TAE is a safe, effective, and potentially life-saving procedure for the treatment of life-threatening spontaneous retroperitoneal hematomas. Empirical and targeted TAE procedures demonstrate a relatively low risk of complications, compared to the high technical and relatively high clinical success rates.
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Affiliation(s)
- Francesco Tiralongo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy.
| | - Stefano Toscano
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria Di Bologna, via Albertoni 15, Bologna, 40138, Italy
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia-Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, l.go A gemelli 8, Rome, 00168, Italy
- Istituto di Radiodiagnostica, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital of Naples, Naples, 80131, Italy
| | - Davide Giuseppe Castiglione
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
| | - Daniele Falsaperla
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
| | - Francesco Vacirca
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
| | - Corrado Ini'
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
| | - Fabio Corvino
- Interventional Radiology Department, Cardarelli Hospital of Naples, Naples, 80131, Italy
| | - Salvatore Lavalle
- Faculty of Medicine and Surgery, University of Enna Kore, Enna, 94100, Italy
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, Varese, 21100, Italy
| | - Pietro Valerio Foti
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", UOSD I.P.T.R.A, University of Catania, University Hospital Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, Catania, 95123, Italy
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Comby PO, Guillen K, Chevallier O, Couloumy E, Dencausse A, Robert P, Catoen S, Salsac AV, Aho-Glele SL, Loffroy R. Blocked-flow vs. free-flow cyanoacrylate glue embolization: Histological differences in an in vivo rabbit renal artery model. Diagn Interv Imaging 2024; 105:137-143. [PMID: 38284342 DOI: 10.1016/j.diii.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE The purpose of this in vivo animal study was to compare the acute histological effects on the arterial vessel wall of free-flow vs. blocked-flow embolization with metacryloxysulfolane-n‑butyl cyanoacrylate (MS-NBCA) in several concentrations. MATERIALS AND METHODS A total of 42 rabbit renal arteries were embolized using MS-NBCA mixed with ethiodized oil. The MS-NBCA concentration was 12.5%, 25%, or 50%. All mixtures were injected under both free-flow and blocked-flow conditions. The rabbits were euthanised 30 min after arterial embolization. Arterial-lumen distension, intimal inflammation and necrosis, peri‑arterial edema, and distality of MS-NBCA penetration were assessed histologically. Multivariable regression analyses were performed using a manual backward procedure, with linear, ordinal and logistic regression to search for factors associated with these outcomes RESULTS: Marked or severe dilatation was observed in 36 out of 42 arteries (86%) and marked or transmural intimal arteritis in all 42 arteries (42/42; 100%). Lumen dilatation caused focal vessel-wall flattening, which resulted in intimal necrosis. Multifocal necrosis extending from the intima to the media occurred in 23 out of 42 kidneys (55%) and peri‑arterial edema with multifocal vascular leakage in 19 out of 42 kidneys (45%). At multivariable analysis, blocked-flow MS-NBCA injection was associated with greater severity of vessel-wall lesions, including intimal arteritis (P = 0.003) and intimal necrosis (P = 0.014), compared to free-flow injection. Blocked-flow injection was also associated with peri‑arterial edema (P = 0.008) and greater distality of MS-NBCA penetration (P = 0.001). CONCLUSION Blocked-flow MS-NBCA injection during renal artery embolization is significantly associated with more acute arterial-wall damage and greater distality of glue penetration compared to free-flow injection in a rabbit model. These preliminary findings may have clinical implications, as blocked-flow injection is routinely used to treat specific vascular diseases or malformations in human.
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Affiliation(s)
- Pierre-Olivier Comby
- Department of Neuroradiology and Emergency Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 21079 Dijon, France; ICMUB Laboratory, UMR CNRS 6302, Université de Bourgogne, 21000 Dijon, France
| | - Kévin Guillen
- ICMUB Laboratory, UMR CNRS 6302, Université de Bourgogne, 21000 Dijon, France; Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Olivier Chevallier
- ICMUB Laboratory, UMR CNRS 6302, Université de Bourgogne, 21000 Dijon, France; Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Emilie Couloumy
- R&D, Guerbet Research, 95943 Roissy Charles-de-Gaulle, France
| | - Anne Dencausse
- R&D, Guerbet Research, 95943 Roissy Charles-de-Gaulle, France
| | - Philippe Robert
- R&D, Guerbet Research, 95943 Roissy Charles-de-Gaulle, France
| | - Sarah Catoen
- R&D, Guerbet Research, 95943 Roissy Charles-de-Gaulle, France
| | - Anne-Virginie Salsac
- Biomechanics and Bioengineering Laboratory, UMR CNRS 7338, Université de Technologie de Compiègne, 60203 Compiègne, France
| | - Serge Ludwig Aho-Glele
- Department of Epidemiology, Statistics and Clinical Research, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Romaric Loffroy
- ICMUB Laboratory, UMR CNRS 6302, Université de Bourgogne, 21000 Dijon, France; Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 21079 Dijon, France.
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Guillen K, Comby PO, Oudot A, Salsac AV, Falvo N, Virely T, Poupardin O, Guillemin M, Chevallier O, Loffroy R. Iodixanol as a New Contrast Agent for Cyanoacrylate Embolization: A Preliminary In Vivo Swine Study. Biomedicines 2023; 11:3177. [PMID: 38137399 PMCID: PMC10740480 DOI: 10.3390/biomedicines11123177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
N-butyl cyanoacrylate (NBCA) is a lipophilic, permanent embolic glue that must be opacified for fluoroscopic guidance. Empirically, lipophilic Lipiodol Ultra Fluid® (LUF) has been added to produce a single-phase physically stable mixture. Varying the dilution ratio allows control of glue polymerization kinetics. LUF is far more costly than water-soluble iodinated contrast agents (ICAs). Our purpose was to evaluate whether a water-soluble nonionic iso-osmolar ICA could be used instead. We embolized both renal arteries of six swine using 1:3 NBCA-LUF or NBCA-iodixanol in 1:1, 1:3, and 1:7 ratios. We used both micro-computed tomography to assess the distality of glue penetration and indexed cast ratio and histology to assess distality, arterial obliteration, vessel-wall damage, and renal-parenchyma necrosis. Glue-LUF produced significantly greater indexed cast ratio and renal-artery ROI values and a significantly shorter cast-to-capsule distance. The injected volume was significantly greater with 1:7 iodixanol than with the other mixtures. No significant differences were found for histological evidence of artery obliteration, vessel-wall damage, or renal-parenchyma necrosis. This is the first study dealing with ICA alone as a contrast agent for cyanoacrylate embolization, compared to LUF. More research is needed to determine whether water-soluble nonionic iodinated agents can be used for human NBCA embolization given the good safety profile, availability, and low cost of ICA.
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Affiliation(s)
- Kévin Guillen
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, 21079 Dijon, France (N.F.); (O.C.)
- ICMUB Laboratory, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, 21000 Dijon, France;
| | - Pierre-Olivier Comby
- ICMUB Laboratory, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, 21000 Dijon, France;
| | - Alexandra Oudot
- Imaging and Preclinical Radiotherapy Platform, Georges-François Leclerc Cancer Center, 1 Rue Professeur Marion, 21079 Dijon, France; (A.O.); (M.G.)
| | - Anne-Virginie Salsac
- Biomechanics and Bioengineering Laboratory, UMR CNRS 7338, Technology University of Compiègne, 60203 Compiègne, France;
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, 21079 Dijon, France (N.F.); (O.C.)
- ICMUB Laboratory, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, 21000 Dijon, France;
| | - Thierry Virely
- Biossan, Pôle Agricole Auxois Sud, 21320 Créancey, France; (T.V.); (O.P.)
| | - Olivia Poupardin
- Biossan, Pôle Agricole Auxois Sud, 21320 Créancey, France; (T.V.); (O.P.)
| | - Mélanie Guillemin
- Imaging and Preclinical Radiotherapy Platform, Georges-François Leclerc Cancer Center, 1 Rue Professeur Marion, 21079 Dijon, France; (A.O.); (M.G.)
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, 21079 Dijon, France (N.F.); (O.C.)
- ICMUB Laboratory, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, 21000 Dijon, France;
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, 21079 Dijon, France (N.F.); (O.C.)
- ICMUB Laboratory, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, 21000 Dijon, France;
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Tanaka R, Sonomura T, Koike M, Sato H, Shimono R, Kumamoto A, Fukuda K, Higashino N, Ikoma A, Murata SI, Minamiguchi H. Comparison of Renal Damage Following Renal Artery Embolization with Three Different Embolic Mixtures in Swine. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:154-160. [PMID: 38020457 PMCID: PMC10681758 DOI: 10.22575/interventionalradiology.2021-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/13/2023] [Indexed: 12/01/2023]
Abstract
Purpose Renal artery embolization is a minimally invasive and effective procedure for renal ablation, a complete necrosis of the renal parenchyma. This study aims to compare the extent of renal damage in swine following renal artery embolization with ethanol and N-butyl-2-cyanoacrylate, commonly used as embolic materials in renal ablation. Material and Methods Three different embolic mixtures were prepared for renal artery embolization in swine: 33% ethanol-Lipiodol mixture (ethanol:Lipiodol = 1:2; Group A), 67% ethanol-Lipiodol mixture (ethanol:Lipiodol = 2:1; Group B), and 10% N-butyl-2-cyanoacrylate-Lipiodol mixture (N-butyl-2-cyanoacrylate:Lipiodol = 1:9; Group C). Three swine were assigned to each group and underwent embolization of the unilateral renal artery. Renal arteriography was performed before, immediately after, and two days after renal artery embolization. After two days, the kidneys were removed to determine the macroscopic necrosis rate and for histologic examination. Dark tissue regions were considered necrotic. Results The macroscopic necrosis rate of the kidneys was 50.3%±7.4%, 100%±0%, and 100%±0% in Groups A, B, and C, respectively. The necrosis rates were higher in Groups B and C than in Group A. Histologically, the renal tubules were damaged in the necrotic areas. In addition, the glomeruli were damaged in Groups A and B but were preserved in Group C. Conclusions Sixty-seven percent ethanol-Lipiodol mixture and 10% N-butyl-2-cyanoacrylate-Lipiodol mixture are effective embolic materials in renal artery embolization for renal ablation in swine. Also, ethanol caused partial glomerular necrosis, whereas N-butyl-2-cyanoacrylate preserved the glomeruli. Therefore, ethanol should be used for renal ablation.
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Affiliation(s)
- Ryota Tanaka
- Department of Radiology, Wakayama Medical University, Japan
| | | | - Masataka Koike
- Department of Radiology, Wakayama Medical University, Japan
| | - Hirotatsu Sato
- Department of Radiology, Wakayama Medical University, Japan
| | - Ryuki Shimono
- Department of Radiology, Wakayama Medical University, Japan
| | | | - Kodai Fukuda
- Department of Radiology, Wakayama Medical University, Japan
| | | | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, Japan
| | - Shin-Ichi Murata
- Department of Human Pathology, Wakayama Medical University, Japan
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Becker LS, Stöhr F, Maus V, Dewald CLA, Meyer BC, Wacker FK, Kloeckner R, Hinrichs JB. Intraarterial embolizations in life-threatening spontaneous retroperitoneal and rectus sheath hemorrhage (SRRSH): a three-center experience. Emerg Radiol 2023:10.1007/s10140-023-02137-6. [PMID: 37120665 PMCID: PMC10390605 DOI: 10.1007/s10140-023-02137-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE To retrospectively evaluate the technical and clinical success of interventional treatments employed in three University medical centers and to develop work-flow recommendations for intra-arterial embolizations in patients with life-threatening spontaneous retroperitoneal and rectus sheath hemorrhage (SRRSH). MATERIALS AND METHODS Retrospective evaluation of all patients with contrast-enhanced CT and digital subtraction angiography (DSA) for SRRSH from 01/2018 to 12/2022, amounted to 91 interventions in 83 patients (45f, 38m) with a mean age of 68.1 ± 13.2 years. Analysis of the amount of bleeding and embolized vessels, choice of embolization material, technical success, and 30-day mortality was performed. RESULTS Pre-interventional contrast-enhanced CT demonstrated active contrast extravasation in 79 cases (87%). DSA identified a mean of 1.4 ± 0.88 active bleeds in all but two interventions (98%), consisting of 60 cases with a singular and 39 cases of >1 bleeding artery, which were consecutively embolized. The majority of patients underwent embolization with either n-butyl-2-cyanoacrylate (NBCA; n=38), coils (n=21), or a combination of embolic agents (n=23). While the technical success rate was documented at 97.8%, 25 patients (30%) died within 30 days after the initial procedure, with mortality rates ranging from 25 to 86% between the centers, each following different diagnostic algorithms. CONCLUSION Embolotherapy is a safe therapy option with high technical success rates in patients with life-threatening SRRSH. To maximize clinical success and survival rates, we propose a standardized approach to angiography as well as a low threshold for re-angiography.
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Affiliation(s)
- Lena S Becker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Fabian Stöhr
- Institute of Diagnostic and Interventional Radiology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Volker Maus
- Institute of Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Cornelia L A Dewald
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Bernhard C Meyer
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frank K Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Roman Kloeckner
- Institute of Diagnostic and Interventional Radiology, Johannes Gutenberg University Mainz, Mainz, Germany
- Institute for Interventional Radiology, University Clinic Schleswig-Holstein - Campus Lübeck, Lübeck, Germany
| | - Jan B Hinrichs
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Guillen K, Comby PO, Salsac AV, Falvo N, Lenfant M, Oudot A, Sikner H, Dencausse A, Laveissiere E, Aho-Glele SL, Loffroy R. X-ray Microtomography to Assess Determinants of In Vivo N-Butyl Cyanoacrylate Glubran ®2 Polymerization: A Rabbit-Model Study. Biomedicines 2022; 10:2625. [PMID: 36289887 PMCID: PMC9599502 DOI: 10.3390/biomedicines10102625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 08/30/2023] Open
Abstract
Although introduced decades ago, few cyanoacrylate glues have been approved for endovascular use, despite evidence of their usefulness, notably for complex procedures suchas hemostatic embolization. Indications include massive bleeding requiring emergent hemostasis and prevention of severe bleeding during scheduled surgery to remove a hypervascular tumor. Adding radiopaque Lipiodol Ultra Fluid® (LUF) modulates glue polymerization and allows fluoroscopic guidance, but few comparative in vivo studies have assessed the impact of the resulting change in glue concentration or of other factors such as target-vessel blood flow. In a rabbit model, we used ex vivo X-ray microtomography to assess the results of in vivo renal-artery embolization by various mixtures of N-butyl cyanoacrylate (NBCA), metacryloxysulfolane, and LUF. Overall, penetration to the superficial interlobular arteries was achieved in about two-thirds of cases and into the capillaries in nearly half the cases, while cast fragmentation was seen in slightly more than half the cases. Greater NBCA dilution and the blocked-blood-flow technique were independently associated with greater distality of penetration. Blocked-blood-flow injection was independently associated with absence of fragmentation, capillary penetration, a shorter cast-to-capsule distance, and higher cast attenuation. A larger mixture volume was independently associated with higher indexed cast ratio and deeper penetration. Finally, microtomography is an adapted tool to assess ex vivo distribution of glue cast.
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Affiliation(s)
- Kévin Guillen
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
| | - Pierre-Olivier Comby
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Anne-Virginie Salsac
- Biomechanics and Bioengineering Laboratory, UMR CNRS 7338, Université de Technologie de Compiègne, 60203 Compiègne, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
| | - Marc Lenfant
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Alexandra Oudot
- Department of Nuclear Medicine, Plateforme d’Imagerie et de Radiothérapie Préclinique, Georges-François Leclerc Center, 1 Rue Professeur Marion, BP 77980, CEDEX, 21079 Dijon, France
| | - Hugo Sikner
- Department of Nuclear Medicine, Plateforme d’Imagerie et de Radiothérapie Préclinique, Georges-François Leclerc Center, 1 Rue Professeur Marion, BP 77980, CEDEX, 21079 Dijon, France
| | - Anne Dencausse
- R&D, Guerbet Research, CEDEX, 95943 Roissy Charles-de-Gaulle, France
| | | | - Serge Ludwig Aho-Glele
- Department of Epidemiology, Statistics and Clinical Research, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
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Ko G, Choi JW, Lee N, Kim D, Hyeon T, Kim HC. Recent progress in liquid embolic agents. Biomaterials 2022; 287:121634. [PMID: 35716628 DOI: 10.1016/j.biomaterials.2022.121634] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/21/2022]
Abstract
Vascular embolization is a non-surgical procedure used to treat diseases or morbid conditions related to blood vessels, such as bleeding, arteriovenous malformation, aneurysm, and hypervascular tumors, through the intentional occlusion of blood vessels. Among various types of embolic agents that have been applied, liquid embolic agents are gaining an increasing amount of attention owing to their advantages in distal infiltration into regions where solid embolic agents cannot reach, enabling more extensive embolization. Meanwhile, recent advances in biomaterials and technologies have also contributed to the development of novel liquid embolic agents that can resolve the challenges faced while using the existing embolic materials. In this review, we briefly summarize the clinically used embolic agents and their applications, and then present selected research results that overcome the limitations of the embolic agents in use. Through this review, we suggest the required properties of liquid embolic agents that ensure efficacy, which can replace the existing agents, providing directions for the future development in this field.
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Affiliation(s)
- Giho Ko
- Center for Nanoparticle Research, Institute for Basic Spegcience (IBS), Seoul 08826, Republic of Korea; School of Chemical and Biological Engineering, and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Nohyun Lee
- School of Advanced Materials Engineering, Kookmin University, Seoul 02707, Republic of Korea
| | - Dokyoon Kim
- Department of Bionano Engineering and Bionanotechnology, Hanyang University, Ansan 15588, Republic of Korea.
| | - Taeghwan Hyeon
- Center for Nanoparticle Research, Institute for Basic Spegcience (IBS), Seoul 08826, Republic of Korea; School of Chemical and Biological Engineering, and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea.
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
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In Vitro Evaluation of Acrylic Adhesives in Lymphatic Fluids-Influence of Glue Type and Procedural Parameters. Biomedicines 2022; 10:biomedicines10051195. [PMID: 35625930 PMCID: PMC9138217 DOI: 10.3390/biomedicines10051195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/02/2022] [Accepted: 05/13/2022] [Indexed: 01/25/2023] Open
Abstract
To evaluate the embolic properties of different acrylic adhesive/iodized oil mixtures for lymphatic interventions. Polymerization of histoacryl (HA) (Bayer Healthcare) and glubran 2 (GL) (GEM) mixed with iodized oil (ratios 1:0–1:7) were investigated in lymphatic fluids with low and high triglyceride (low TG & high TG) contents. Static polymerization time and dynamic polymerization experiments with different volumes of glucose flush (1, 2 and 5 mL) were performed to simulate thoracic duct embolization. For both glues, static polymerization times were longer when the iodized oil content was increased and when performed in high TG lymphatic fluid. In the dynamic experiments, the prolongation of polymerization due to the oil content and TG levels was less pronounced for both glue types. Increased lymphatic flow rates decreased embolization times for low glue/oil ratios while preventing embolization for high glue/oil ratios. Higher glucose flush volumes increased occlusion times. Polymerization times of acrylic glue in a lymphatic fluid are prolonged by increasing the iodized oil concentration and triglyceride concentration as well as by using larger volumes of glucose flush. Increased lymphatic flow rates decrease embolization times for low glue/oil ratios and may prevent embolization for high glue/oil ratios.
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Shi Y, Chen L, Zhao B, Huang H, Lu Z, Su H. Transcatheter arterial embolization for massive hemobilia with N-butyl cyanoacrylate (NBCA) Glubran 2. Acta Radiol 2022; 63:360-367. [PMID: 33562997 DOI: 10.1177/0284185121992971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Massive hemobilia is a life-threatening condition and therapeutic challenge. Few studies have demonstrated the use of N-butyl cyanoacrylate (NBCA) for massive hemobilia. PURPOSE To investigate the efficacy and safety of transcatheter arterial embolization (TAE) using NBCA Glubran 2 for massive hemobilia. MATERIAL AND METHODS Between January 2012 and December 2019, the data of 26 patients (mean age 63.4 ± 12.6 years) with massive hemobilia were retrospectively evaluated for TAE using NBCA. The patients' baseline characteristics, severities of hemobilia, and imaging findings were collected. Emergent TAE was performed using 1:2-1:4 mixtures of NBCA and ethiodized oil. Technical success, clinical success, procedure-related complications, and follow-up outcomes were assessed. RESULTS Pre-procedure arteriography demonstrated injuries to the right hepatic artery (n = 24) and cystic artery (n = 2). Initial coil embolization distal to the lesions was required in 5 (19.2%) patients to control high blood flow and prevent end-organ damage. After a mean treatment time of 11.2 ± 5.3 min, technical success was achieved in 100% of the patients without non-target embolization and catheter adhesion. Clinical success was achieved in 25 (96.2%) patients. Major complications were noted in 1 (3.8%) patient with gallbladder necrosis. During a median follow-up time of 16.5 months (range 3-24 months), two patients died due to carcinomas, whereas none of the patients experienced recurrent hemobilia, embolic material migration, or post-embolization complications. CONCLUSION NBCA embolization for massive hemobilia is associated with rapid and effective hemostasis, as well as few major complications. This treatment modality may be a promising alternative to coil embolization.
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Affiliation(s)
- Yadong Shi
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Liang Chen
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Boxiang Zhao
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Hao Huang
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Zhaoxuan Lu
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
| | - Haobo Su
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China
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Patidar Y, Srinivasan SV, Singh J, Patel RK, Chandel K, Mukund A, Sharma MK, Sarin SK. Clinical Outcomes of Transcatheter Arterial Embolization Using N-butyl-2-cyanoacrylate (NBCA) in Cirrhotic Patients. J Clin Exp Hepatol 2022; 12:353-361. [PMID: 35535058 PMCID: PMC9077175 DOI: 10.1016/j.jceh.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To evaluate the clinical outcomes of transcatheter arterial embolization (TAE) with n-butyl-2-cyanoacrylate (NBCA) for treatment of bleeding in cirrhotic patients. Materials and methods A total of 35 cirrhotic patients (26 men, 9 women; mean age, 48.4 ± 11.1) who underwent TAE with NBCA for bleeding from January 2011 to December 2020 were retrospectively analysed. Only cirrhotic patients with active arterial bleeding confirmed on computed tomography (CT) were included. Fifteen patients were hemodynamically unstable before embolization procedure, and coagulopathy was observed in 32 patients. The mean MELD score and Child Pugh score were 24 ± 9.9 and 9.9 ± 2.2, respectively. The mean haemoglobin level and mean number of RBC units transfused before embolization were 7.4 ± 1.4 g/dL and 10.2 ± 4, respectively. The technical, clinical success rate and 30-day mortality rate were evaluated. Results Technical success and clinical success rates were achieved in 100% and 82.8% of patients, respectively. Overall 30-day mortality rate was 48%. No major complications related to the embolization procedure was seen. Only the greater number of RBC units transfused before the embolization procedure (OR = 1.81, 95% CI = 1.17-2.80, P = 0.007) was significantly associated with clinical failure. Greater number of RBC units transfused (OR = 1.53, 95% CI: 1.00-2.34, P = 0.004) and higher Child Pugh score (OR 2.44, 95% CI 1.26-4.71, P = 0.008) were significantly associated with higher 30-day mortality rate. Conclusion Transcatheter arterial embolization using NBCA can be used as the effective treatment option for bleeding in cirrhotic patients which has a high technical and clinical success despite the grave prognosis associated with cirrhosis.
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Key Words
- CT, computed tomography
- INR, international normalized ratio
- IQR, Interquartile range
- MELD, model for end-stage liver disease
- NASH, non-alcoholic steatohepatitis
- NBCA
- NBCA, N-butyl-2-cyanoacrylate
- OR, Odds ratio
- PVA, polyvinyl alcohol
- RBC, red blood cell
- TAE, transarterial embolization
- acute arterial bleeding
- cirrhotic patients
- coagulopathy
- transcatheter arterial embolization
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Affiliation(s)
- Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Shyam V. Srinivasan
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Jitender Singh
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Ranjan K. Patel
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Karamvir Chandel
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Manoj K. Sharma
- Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
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Fukuda K, Higashino N, Sonomura T, Okuhira R, Koike M, Ikoma A, Kawai N, Minamiguchi H. Determination of the Optimal Ratio and the Relationship Between Viscosity and Adhesion of n-Butyl Cyanoacrylate–Lipiodol–Iopamidol for Balloon-Assisted Embolization of Wide-Neck Aneurysms in Swine. Cardiovasc Intervent Radiol 2022; 45:357-364. [DOI: 10.1007/s00270-021-03055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022]
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Ischemic Lumbar Plexopathy After Transarterial Embolization of Type II Endoleak Using N-Butyl-2-cyanoacrylate. Cardiovasc Intervent Radiol 2022; 45:536-538. [PMID: 34977969 DOI: 10.1007/s00270-021-03019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/04/2021] [Indexed: 11/02/2022]
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Kolu M, Yıldırım İO. Treatment of a patient with carotid blowout syndrome with a new deconstructive embolization technique. Radiol Case Rep 2021; 17:310-313. [PMID: 34876956 PMCID: PMC8633831 DOI: 10.1016/j.radcr.2021.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/24/2021] [Indexed: 11/07/2022] Open
Abstract
Carotid blowout syndrome is a rare clinical conditions with a high mortality rate, especially in patients with head and neck tumors who have received radiotherapy and chemotherapy. We present our patient who had hemangioendothelioma of the neck for 5 years and therefore received radiotherapy, fistulized to the skin on the neck and active bleeding out of the fistula area. In the radiological imaging of the patient, vessel wall irregularities in the common carotid artery (CCA) and accompanying pseudoaneurysm with a diameter of 3 cm were detected, and endovascular treatment was performed. After the patient passed the balloon occlusion test, first the proximal internal carotid artery was closed with coils. Then, the balloon was inflated proximal to the CCA and a 10% diluted glue-lipiodol mixture was injected into the entire diseased CCA bed. Closure of the distal with coil and proximal with balloon prevented the risk of off-target embolization of the glue.
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Affiliation(s)
- Mehmet Kolu
- Dicle University, Faculty of Medicine, Department of Radiology, Diyarbakır, Turkey
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Li Y, Xiao L, Wang Z, Chen K, Xue C, Yu M, Wang Y, Kong F, Liu K, Qin K. Raman Spectroscopic Characterization of Polymerization Kinetics of Cyanoacrylate Embolic Glues for Vascular Embolization. Polymers (Basel) 2021; 13:polym13193362. [PMID: 34641176 PMCID: PMC8512224 DOI: 10.3390/polym13193362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022] Open
Abstract
Endovascular glue embolization is a minimally invasive technique used to selectively reduce or block the blood supply to specific targeted vessels. Cyanoacrylate glues, mixed with radiopaque iodized oil, have been widely used for vascular embolization owing to their rapid polymerization rate, good penetration ability and low tissue toxicity. Nevertheless, in clinical practice, the selection of the glue–oil proportion and the manual injection process of mixtures are mostly based on empirical knowledge of operators, as the crucial physicochemical effect of polymerization kinetics has rarely been quantitatively investigated. In this study, the Raman spectroscopy is used for studying the polymerization kinetics of n-butyl-cyanoacrylate-based glues mixed with an iodized oil. To simulate the polymerization process during embolization, glue–oil mixtures upon contact with a protein ionic solution mimicking blood plasma are manually constructed and their polymerization kinetics are systematically characterized by Raman spectroscopy. The results demonstrate the feasibility of Raman spectroscopy in the characterization of polymerization kinetics of cyanoacrylate-based embolic glues. The polymerization process of cyanoacrylate-based mixtures consists of a fast polymerization phase followed by a slow phase. The propagation velocity and polymerization time primarily depend on the glue concentrations. The commonly used 50% mixture polymerizes 1 mm over ∼21.8 s, while it takes ∼51 min to extend to 5 mm. The results provide essential information for interventional radiologists to help them understand the polymerization kinetics of embolic glues and thus regulate the polymerization rate for effective embolization.
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Affiliation(s)
- Yongjiang Li
- School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology, Dalian 116024, China; (Y.L.); (L.X.); (Z.W.); (K.C.); (C.X.); (Y.W.); (F.K.)
| | - Lei Xiao
- School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology, Dalian 116024, China; (Y.L.); (L.X.); (Z.W.); (K.C.); (C.X.); (Y.W.); (F.K.)
| | - Zian Wang
- School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology, Dalian 116024, China; (Y.L.); (L.X.); (Z.W.); (K.C.); (C.X.); (Y.W.); (F.K.)
| | - Kejie Chen
- School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology, Dalian 116024, China; (Y.L.); (L.X.); (Z.W.); (K.C.); (C.X.); (Y.W.); (F.K.)
| | - Chundong Xue
- School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology, Dalian 116024, China; (Y.L.); (L.X.); (Z.W.); (K.C.); (C.X.); (Y.W.); (F.K.)
| | - Miao Yu
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China;
| | - Yu Wang
- School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology, Dalian 116024, China; (Y.L.); (L.X.); (Z.W.); (K.C.); (C.X.); (Y.W.); (F.K.)
| | - Fanyi Kong
- School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology, Dalian 116024, China; (Y.L.); (L.X.); (Z.W.); (K.C.); (C.X.); (Y.W.); (F.K.)
| | - Kun Liu
- School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology, Dalian 116024, China; (Y.L.); (L.X.); (Z.W.); (K.C.); (C.X.); (Y.W.); (F.K.)
- Correspondence: (K.L.); (K.Q.); Tel.: +86-0411-8470-9690 (K.Q.)
| | - Kairong Qin
- School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology, Dalian 116024, China; (Y.L.); (L.X.); (Z.W.); (K.C.); (C.X.); (Y.W.); (F.K.)
- Correspondence: (K.L.); (K.Q.); Tel.: +86-0411-8470-9690 (K.Q.)
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Guillen K, Comby PO, Chevallier O, Salsac AV, Loffroy R. In Vivo Experimental Endovascular Uses of Cyanoacrylate in Non-Modified Arteries: A Systematic Review. Biomedicines 2021; 9:biomedicines9091282. [PMID: 34572467 PMCID: PMC8472126 DOI: 10.3390/biomedicines9091282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/06/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022] Open
Abstract
Cyanoacrylates were first used for medical purposes during World War II to close skin wounds. Over time, medical applications were developed, specifically in the vascular field. Uses now range from extravascular instillation in vascular grafting to intravascular injection for embolization. These applications were made possible by the conduct of numerous preclinical studies involving a variety of tests and outcome measures, including angiographic and histological criteria. Cyanoacrylates were first harshly criticized by vascular surgeons, chiefly due to their fast and irreversible polymerization. Over the past five years, however, cyanoacrylates have earned an established place in endovascular interventional radiology. Given the irreversible effects of cyanoacrylates, studies in animal models are ethically acceptable only if supported by reliable preliminary data. Many animal studies of cyanoacrylates involved the experimental creation of aneurysms or arteriovenous fistulas, whose treatment by endovascular embolization was then assessed. In clinical practice, however, injection into non-modified arteries may be desirable, for instance, to deprive a tumor of its vascular supply. To help investigators in this field select the animal models and procedures that are most appropriate for their objectives, we have reviewed all published in vivo animal studies that involved the injection of cyanoacrylates into non-modified arteries to discuss their main characteristics and endpoints.
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Affiliation(s)
- Kévin Guillen
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (K.G.); (O.C.)
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France;
| | - Pierre-Olivier Comby
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France;
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (K.G.); (O.C.)
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France;
| | - Anne-Virginie Salsac
- Biomechanics and Bioengineering Laboratory, UMR CNRS 7338, Université de Technologie de Compiègne, 60203 Compiègne, France;
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (K.G.); (O.C.)
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France;
- Correspondence: ; Tel.: +33-380-293-677
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Hwang JH, Kim JH, Park S, Lee KH, Park SH. Feasibility and outcomes of bronchial artery embolization in patients with non-massive hemoptysis. Respir Res 2021; 22:221. [PMID: 34362373 PMCID: PMC8344225 DOI: 10.1186/s12931-021-01820-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/02/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the safety, efficacy, and long-term outcome of bronchial artery embolization (BAE) in the treatment of non-massive hemoptysis and the prognostic factors associated with recurrent bleeding. Materials and methods From March 2005 to September 2014, BAE was performed in 233 patients with non-massive hemoptysis. All patients had a history of persistent or recurrent hemoptysis despite conservative medical treatment. We assessed the technical and clinical success, recurrence, prognostic factors related to recurrent bleeding, recurrence-free survival rate, additional treatment, and major complications in all the patients. Results Technical success was achieved in 224 patients (96.1%), and clinical success was obtained in 219 (94.0%) of the 233 patients. In addition, 64 patients (27.5%) presented hemoptysis recurrence with median time of 197 days after embolization. Tuberculosis sequelae and presence of aberrant bronchial artery or non-bronchial systemic collaterals were significantly related to recurrent bleeding (p < 0.05). The use of Histoacryl-based embolic materials significantly reduced the recurrent bleeding rate (p < 0.05). Patient who had a tuberculosis sequelae showed a significantly lower recurrence-free survival rate (p = 0.013). Presence of aberrant bronchial artery or non-bronchial systemic collaterals showed a statistically significant correlation with recurrence-free survival rate (p = 0.021). No patients had major complications during follow-up. Conclusions BAE is a safe and effective treatment to manage non-massive hemoptysis. The procedure may offer a better long-term control of recurrent hemoptysis and quality of life than conservative therapy alone.
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Affiliation(s)
- Jung Han Hwang
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Jeong Ho Kim
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
| | - Suyoung Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Ki Hyun Lee
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
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Borghese O, Ganimede MP, Briatico Vangosa A, Pisani A, Vidali S, Di Stasi C, Burdi N, Semeraro V. The Minimally Invasive Treatment of Visceral Artery Pseudoaneurysms: A Retrospective Observational Single Centre Cohort Study on Glue Embolization. Vasc Endovascular Surg 2021; 55:831-837. [PMID: 34261391 DOI: 10.1177/15385744211028730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The objective is to report a single centre experience in the embolization of visceral artery pseudoaneurysms with N-butyl-cyanoacrylate-methacryloxy sulfolane (NBCA-MS). METHODS A retrospective observational cohort study was conducted on data about all consecutive patients treated for visceral artery pseudoaneurysms in the Interventional Radiology Unit of SS Annunziata Hospital, in Taranto (Italy) between January 2016 and July 2020. Only patients treated with NBCA-MS embolization were included. Clinical and technical outcomes were evaluated during in-hospital stay and at 3-month follow-up by computed angiotomography (CTA). RESULTS Among 89 patients undergoing treatment for visceral artery pseudoaneurysm, a total of 58 (65.2%) patients (n = 32, 55.2% men; median age 45.8 years, range: 35-81) treated with NBCA-MS only were enrolled. Pseudoaneurysms were located in the renal artery (n = 18 cases, 31%), in the splenic artery (n = 27, 46.6%), in the intra-parenchymal hepatic artery (n = 3, 5.2%), in the common hepatic artery (n = 4, 6.9%) or in the pancreatic artery (n = 6, 10.3%). N-butyl-cyanoacrylate was diluted 1:1 with Lipiodol ultra-fluid, and mean volume injected was 0.6 ± 0.3 mL (range: 0.2-2.8 mL). Embolization was technically and clinically successful in all patients (n = 58, 100%) with an immediate total thrombosis of the pseudoaneurysm at the completion angiography. No systemic complications were noted in all cases. Five cases (8.6%) of non-target vessel embolization occurred without any clinical complication. No pseudoaneurysm recurrence was detected at the CTA control 1 day postoperatively. In one case (1.7%), a recurrence was detected 4 days after the initial treatment and successfully managed by a repeated NBCA-MS embolization. During the hospital stay, 56 patients recovered well but 2 (3.4%) died from multi-organ failure not related to the embolization. No recurrences were detected at the 3-month postoperative CTA in the remaining patients. CONCLUSIONS In properly selected patients affected with visceral artery pseudoaneurysms, NBCA-MS represents a definitive and safe embolization agent.
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Affiliation(s)
- Ottavia Borghese
- Department of Vascular and Endovascular Surgery, 55183Nord Laennec Hospital, Saint-Herblain, France.,9311University Sapienza of Rome, Rome, Italy
| | | | | | - Angelo Pisani
- Department of Cardiothoracic Surgery, 47165Pinata Grande Hospital, Castel Volturno, Italy
| | | | - Carmine Di Stasi
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
| | - Nicola Burdi
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
| | - Vittorio Semeraro
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
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El Naamani K, Carrasco J, Ramesh S, Milman T, Abbas R, Sweid A, Zhou S, El Hajjar R, Tjoumakaris SI, Gooch MR, Rosenwasser RH, Jabbour PM. Preoperative Ultrasound-Guided Percutaneous Embolization of Orbital Lymphaticovenous Malformations Using Onyx. World Neurosurg 2021; 154:13-20. [PMID: 34245882 DOI: 10.1016/j.wneu.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022]
Abstract
The treatment of orbital lymphaticovenous malformations (OLVMs) has evolved from simple surgical resection to a multimodal approach consisting of sclerosing agents, embolization, and resection depending on the specific components that compose the lesion. Here we present a representative case series of 5 nonconsecutive patients who underwent percutaneous embolization of OLVMs with the Onyx Liquid Embolic System (Medtronic, Dublin, Ireland) before surgical resection between 2019 and 2021. OLVMs are rare, benign, congenital lesions that grow with age and can become symptomatic and disabling. Treatment can be conservative or invasive; depending on the clinical presentation and characteristics of the lesions, treatment modalities can vary. Preoperative percutaneous embolization of OLVMs with the Onyx system is a promising technique, as demonstrated in this case series.
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Affiliation(s)
- Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Jacqueline Carrasco
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | | | - Tatyana Milman
- Occular Pathology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Rawad Abbas
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Ahmad Sweid
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Siwei Zhou
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Rayan El Hajjar
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stavropoula I Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Michael R Gooch
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Pascal M Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
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Seo JW, Park H, Kim D, Lee S, Koh YG, Kim JY, Park I, Lee W. In Vivo Animal Study of a Highly Viscous N-butyl Cyanoacrylate Medical Adhesive for Intravenous Embolization. MATERIALS 2021; 14:ma14133527. [PMID: 34202769 PMCID: PMC8269526 DOI: 10.3390/ma14133527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022]
Abstract
N-butyl cyanoacrylate (NBCA) is a liquid monomer that undergoes an exothermic polymerization reaction to form a solid upon initiation with hydroxyl anions. Recently, EGpresto, a highly viscous NBCA-based adhesive, has been developed for vascular-occlusion purposes. In this study, we investigated the heat of polymerization of EGpresto and compared the results with those of a low-viscosity NBCA glue. Results show that EGpresto exhibited a lower heat of polymerization (64 ± 7 °C vs. 34 ± 1 °C). This was due to its high viscosity, which resulted in a delayed polymerization time. To investigate the efficacy and safety of EGpresto for intravenous embolization, a 14 d in vivo animal test was conducted using three pigs. Five cc of EGpresto was injected into the epigastric vein of each animal. Complete postoperative vein occlusion was confirmed at 7 and 14 d by ultrasonographic visualization. After the animals were sacrificed, the operated and unoperated veins were exposed, and the injected adhesive was found without migration. During the histology, the injected adhesive was not found in the inner or outer vein walls, and the immune reactions seemed to be the only foreign-body reaction, showing that EGpresto is a non-toxic and safe intravascular embolic agent.
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Affiliation(s)
- Jae-Won Seo
- ENGAIN Co. Ltd., 700, Daewangpangyo-ro, Bundang-gu, Seongnam 13488, Gyeonggi-do, Korea; (J.-W.S.); (H.P.); (D.K.); (S.L.); (Y.G.K.)
| | - Habeen Park
- ENGAIN Co. Ltd., 700, Daewangpangyo-ro, Bundang-gu, Seongnam 13488, Gyeonggi-do, Korea; (J.-W.S.); (H.P.); (D.K.); (S.L.); (Y.G.K.)
- Department of Chemistry, Sejong University, 209, Neungdong-ro, Gwangjin-gu, Seoul 05006, Korea
| | - Dogeun Kim
- ENGAIN Co. Ltd., 700, Daewangpangyo-ro, Bundang-gu, Seongnam 13488, Gyeonggi-do, Korea; (J.-W.S.); (H.P.); (D.K.); (S.L.); (Y.G.K.)
| | - Seoyun Lee
- ENGAIN Co. Ltd., 700, Daewangpangyo-ro, Bundang-gu, Seongnam 13488, Gyeonggi-do, Korea; (J.-W.S.); (H.P.); (D.K.); (S.L.); (Y.G.K.)
| | - Young Gook Koh
- ENGAIN Co. Ltd., 700, Daewangpangyo-ro, Bundang-gu, Seongnam 13488, Gyeonggi-do, Korea; (J.-W.S.); (H.P.); (D.K.); (S.L.); (Y.G.K.)
| | - Jang Yong Kim
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Insoo Park
- Charm Vascular Clinic, 1814 Nambu-sunhwan-ro, Gwanak-gu, Seoul 08787, Korea;
| | - Wonmok Lee
- ENGAIN Co. Ltd., 700, Daewangpangyo-ro, Bundang-gu, Seongnam 13488, Gyeonggi-do, Korea; (J.-W.S.); (H.P.); (D.K.); (S.L.); (Y.G.K.)
- Department of Chemistry, Sejong University, 209, Neungdong-ro, Gwangjin-gu, Seoul 05006, Korea
- Correspondence: ; Tel.: +82-10-4914-3598
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Mine T, Yasui D, Saito H, Ueda T, Yokoyama T, Ikeda S, Mizushima S, Happoh S, Kumita SI. Effects of temperature alteration on viscosity, polymerization, and in-vivo arterial distribution of N-butyl cyanoacrylate-iodized oil mixtures. Jpn J Radiol 2021; 39:1111-1118. [PMID: 34106382 PMCID: PMC8568870 DOI: 10.1007/s11604-021-01143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/20/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Temperature alteration can modify the polymerization of n-butyl cyanoacrylate (NBCA)-iodized oil mixtures during vascular embolization; its effects on viscosity, polymerization time, and intra-arterial distribution of the NBCA-iodized oil mixture were investigated. MATERIALS AND METHODS In vitro, the viscosities of NBCA, iodized oil, and NBCA-iodized oil mixtures (ratio, 1:1-8) were measured at 4-60 ºC using a rotational rheometer. The polymerization times (from contact with blood plasma to stasis) were recorded at 0-60 ºC using a high-speed video camera. In vivo, the 1:2 mixture was injected into rabbit renal arteries at 0, 20, and 60 ºC; intra-arterial distribution of the mixture was pathologically evaluated. RESULTS The mixtures' viscosities decreased as temperature increased; those at 60 ºC were almost four to five times lower than those at 4 ºC. The polymerization time of NBCA and the 1:1-4 mixtures increased as temperature decreased in the 0-30 ºC range; the degree of time prolongation increased as the percentage of iodized oil decreased. The 0 ºC group demonstrated distributions of the mixture within more peripheral arterial branches than the 20 and 60 ºC groups. CONCLUSION Warming reduces the mixture's viscosity; cooling prolongs polymerization. Both can be potential factors to improve the handling of NBCA-iodized oil mixtures for lesions requiring peripheral delivery. Temperature alteration influences the polymerization time, viscosity, and intra-arterial distribution of NBCA-iodized oil mixtures. Warming reduces the viscosity of the mixture, while cooling prolongs polymerization.
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Affiliation(s)
- Takahiko Mine
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
| | - Daisuke Yasui
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hidemasa Saito
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Taro Yokoyama
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Shinpei Ikeda
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Shohei Mizushima
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Seigoh Happoh
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Shin-Ichiro Kumita
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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21
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Mine T, Ueda T, Yasui D, Mizushima S, Kumita SI. Embolization using warmed glue via the triaxial microballoon occlusion system for various vascular disorders. ACTA ACUST UNITED AC 2021; 26:241-244. [PMID: 32071032 DOI: 10.5152/dir.2019.19285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE We aimed to illustrate the benefits of using warmed glue for viscosity reduction via the triaxial microballoon system for the treatment of various vascular disorders. METHODS Seven patients who underwent 10 treatment sessions for hemoptysis, type II endoleak, post-pancreatic surgical bleeding, spontaneous retroperitoneal bleeding, or ovarian tumor bleeding were evaluated based on technical and clinical outcomes. In the procedure, the triaxial system, consisting of a 4.5-Fr guiding catheter, a 2.8-Fr microballoon catheter, and a 1.9-Fr no-taper microcatheter, was advanced into the target lesion. Glue (33% n-butyl cyanoacrylate mixed with Lipiodol) warmed to 40°C was injected under balloon occlusion. RESULTS The common hepatic, right bronchial, intercostals, internal mammary, costocervical, lateral thoracic, superior thoracic, thoracoacromial, inferior thyroid, iliolumbar, lumbar, internal pudendal arteries, and branch of the inferior mesenteric artery were successfully embolized; 100% technical success and 100% clinical success were obtained after each session. CONCLUSION Our modified balloon-occluded glue embolization may lead to better handling with more distal glue penetration capability.
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Affiliation(s)
- Takahiko Mine
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Daisuke Yasui
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Shohei Mizushima
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
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Newly Developed N-butyl Cyanoacrylate (EG glue) for Arterial Embolization: A Preclinical Study in Rabbit Renal Artery. Macromol Res 2021. [DOI: 10.1007/s13233-021-9022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Klausenitz C, Kuehn JP, Noeckler K, Radosa CG, Hoffmann RT, Teichgraeber U, Mensel B. Efficacy of transarterial embolisation in patients with life-threatening spontaneous retroperitoneal haematoma. Clin Radiol 2020; 76:157.e11-157.e18. [PMID: 33138981 DOI: 10.1016/j.crad.2020.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/08/2020] [Indexed: 01/25/2023]
Abstract
AIM To evaluate the technical and clinical success of embolisation in patients with life-threatening spontaneous retroperitoneal haematoma (SRH) and to assess predictors of clinical outcome. MATERIALS AND METHODS Thirty patients (mean age: 71.9±9.8 years) with SRH underwent digital subtraction angiography (DSA). All patients received anticoagulant or antiplatelet medication or a combination of both at the time the SRH occurred. RESULTS Pre-interventional computed tomography angiography (CTA) revealed active retroperitoneal bleeding in 28 of 30 (93.3%) patients. DSA identified active haemorrhage in 22 of 30 patients (73.3%). Twenty-nine of 30 (96.7%) patients underwent embolisation. n-Butyl-2-cyanoacrylate (NBCA) was used in 15 patients (51.7%), coils were used in 10 patients (34.5%), and both embolic agents were used in four patients (13.8%). The technical success rate was 100%. Pre-interventional haemoglobin levels increased significantly after embolotherapy from 70.9±16.1 g/l to 87±11.3 g/l (p<0.001), whereas partial thromboplastin time decreased from 58±38 to 30±9 seconds (p<0.001) after embolotherapy. The need for transfusion of concentrated red cells decreased from 3±2.2 to 1±1.1 units (p<0.001) after the intervention. Clinical success was achieved in 19 of 29 (65.5%) patients. No major procedure-related complications occurred. Seven patients (24.1%) died within 30 days after the procedure. CONCLUSION Embolotherapy in patients with life-threatening SRH leads to a high technical success rate and is a safe therapeutic option. The clinical success rate was acceptable and influenced by pre-interventional coagulation status and by the amount of transfused concentrated red cells.
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Affiliation(s)
- C Klausenitz
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - J-P Kuehn
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - K Noeckler
- Department of Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany
| | - C G Radosa
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - R-T Hoffmann
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - U Teichgraeber
- Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - B Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany; Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
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Yen HH, Lin YT, Wu JM, Liu KL, Lin MT. Percutaneous embolization for a subacute gastric fistula following laparoscopic sleeve gastrectomy: a case report and literature review. BMC Surg 2020; 20:231. [PMID: 33032556 PMCID: PMC7545859 DOI: 10.1186/s12893-020-00896-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background The management for subacute or chronic fistula after bariatric surgery is very complicated and with no standard protocol yet. It is also an Achilles’ heel of all bariatric surgery. The aim of this case report is to describe our experience in managing this complication by percutaneous embolization, a less commonly used method. Case presentation A 23-year-old woman with a body mass index of 35.7 kg/m2 presented with delayed gastric leak 7 days after laparoscopic sleeve gastrectomy (LSG) for weight reduction. Persistent leak was still noted under the status of nil per os, nasogastric decompression, and parenteral nutrition for 1 month; therefore, endoscopic glue injection was performed. The fistula tract did not seal off, and the size of pseudocavity enlarged after gas inflation during endoscopic intervention. Subsequently, we successfully managed this subacute gastric fistula via percutaneous fistula tract embolization (PFTE) with removal of the external drain 2 months after LSG. Conclusions PFTE can serve as one of the non-invasive methods to treat subacute gastric fistula after LSG. The usage of fluoroscopy-visible glue for embolization can seal the fistula tract precisely and avoid the negative impact from gas inflation during endoscopic intervention.
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Affiliation(s)
- Hung-Hsuan Yen
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Biomedical Park Branch, Hsinchu County, Taiwan.,Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ting Lin
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Ming Wu
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Biomedical Park Branch, Hsinchu County, Taiwan.,Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Cancer Center, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Tsan Lin
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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25
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Harada T, Fujita A, Sakata J, Kohta M, Kohmura E. Endovascular Internal Trapping by Low-Concentration N-butyl-2-Cyanoacrylate for a Ruptured Giant Common Carotid Artery Pseudoaneurysm. Vasc Endovascular Surg 2020; 55:81-85. [PMID: 32873222 DOI: 10.1177/1538574420953942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Treating carotid blowout syndrome following rupture of giant pseudoaneurysms is difficult because the destroyed parent artery precludes conventional treatment. We present a patient with a ruptured giant pseudoaneurysm that we occluded using a modified internal trapping technique with low-concentration N-butyl-2-cyanoacrylate (NBCA) and a minimum number of coils. An 80-year-old man with a history of chemoradiation therapy for oropharyngeal cancer presented with several episodes of active bleeding from the subsequent tracheostomy site. Radiological examination revealed a giant right common carotid artery (CCA) pseudoaneurysm. Endovascular internal trapping was performed using both NBCA and coils under proximal flow control. We slowly injected 9 ml of low-concentration NBCA, which subsequently filled the entire pseudoaneurysm. We then injected an additional 2 ml of NBCA into the proximal CCA to achieve complete obliteration. No re-bleeding was observed during the 6-month follow-up. Endovascular internal trapping using low-concentration NBCA was feasible to treat a giant CCA pseudoaneurysm. The injected low-concentration NBCA filled the entire pseudoaneurysm without the risk of catheter entrapment.
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Affiliation(s)
- Tomoaki Harada
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Fujita
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junichi Sakata
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaaki Kohta
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Kobe, Japan
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Hayashi N, Takeuchi Y, Miura H, Arima Y, Toda M, Okamoto T, Asai S, Sakai K, Hirota T, Yamada K. Reply to the letter: N-Butyl Cyanoacrylate–Lipiodol Mixture for Endovascular Purpose: Polymerization Kinetics Differences Between In Vitro and In Vivo Experiments. Cardiovasc Intervent Radiol 2020; 43:1411-1412. [DOI: 10.1007/s00270-020-02599-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
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Effectiveness of bronchial arterial embolization using N-butyl-2-cyanoacrylate for local control of pulmonary hilar or mediastinal tumors that are refractory to chemotherapy. Eur J Radiol 2020; 131:109160. [PMID: 32858493 DOI: 10.1016/j.ejrad.2020.109160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/22/2020] [Accepted: 06/30/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate local control and survival after bronchial artery embolization (BAE) using N-butyl-2-cyanoacrylate (NBCA) for pulmonary hilar or mediastinal tumors that are refractory to chemotherapy or chemoradiotherapy. METHOD This is a single center retrospective study involving 42 patients treated between 2015 and 2018 for pulmonary hilar or mediastinal tumors (primary tumors in 5 and metastatic ones in 37). Tumor histology was sarcoma in 22 and carcinoma in 20 patients. All patients had shown tumor progression regardless of previous chemotherapy (n = 37) or chemoradiotherapy (n = 5). Thirty-seven patients (88 %) had respiratory symptoms, such as cough, dyspnea, and hemoptysis. BAE was performed using NBCA to shrink tumors for extending life expectancy. Target tumors were followed with computed tomography at 1,3, and 6 months after BAE. Endpoints included the best tumor response within 6 months as well as overall survivals in patients with and without tumor responses. RESULTS Best local responses within 6 months were complete response (CR) in 1 patient, partial response (PR) in 16, stable disease (SD) in 24, and progressive disease (PD) in 1; the CR/PR rate was 40 % (17/42). Median follow-up period was 13 months (range:1-43). Overall survival in patients with CR/PR was significantly better than in those with SD/PD (p = 0.006); with 3-year survival rates of 45 % (8/17) and 0% (0/25), respectively. CONCLUSIONS BAE using NBCA has potential promise for shrinking hilar and/or mediastinal tumors that are refractory to chemotherapy or chemoradiotherapy, and may also improve overall survival in patients who respond.
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Westbroek EM, Pennington Z, Ahmed AK, Xia Y, Boone C, Gailloud P, Sciubba DM. Comparison of complete and near-complete endovascular embolization of hypervascular spine tumors with partial embolization. J Neurosurg Spine 2020; 33:245-251. [PMID: 32244203 DOI: 10.3171/2020.1.spine191337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Preoperative endovascular embolization of hypervascular spine tumors can reduce intraoperative blood loss. The extent to which subtotal embolization reduces blood loss has not been clearly established. This study aimed to elucidate a relationship between the extent of preoperative embolization and intraoperative blood loss. METHODS Sixty-six patients undergoing preoperative endovascular embolization and subsequent resection of hypervascular spine tumors were retrospectively reviewed. Patients were divided into 3 groups: complete embolization (n = 22), near-complete embolization (≥ 90% but < 100%; n = 22), and partial embolization (< 90%; n = 22). Intraoperative blood loss was compared between groups using one-way ANOVA with post hoc comparisons between groups. RESULTS The average blood loss in the complete embolization group was 1625 mL. The near-complete embolization group had an average blood loss of 2021 mL in surgery. Partial embolization was associated with a mean blood loss of 4009 mL. On one-way ANOVA, significant differences were seen across groups (F-ratio = 6.81, p = 0.002). Significant differences in intraoperative blood loss were also seen between patients undergoing complete and partial embolization (p = 0.001) and those undergoing near-complete and partial embolization (p = 0.006). Pairwise testing showed no significant difference between complete and near-complete embolization (p = 0.57). Analysis of a combined group of complete and near-complete embolization also showed a significantly decreased blood loss compared with partial embolization (p < 0.001). Patient age, tumor size, preoperative coagulation parameters, and preoperative platelet count were not significantly associated with blood loss. CONCLUSIONS Preoperative endovascular embolization is associated with decreased intraoperative blood loss. In this series, blood loss was significantly less in surgeries for tumors in which preoperative complete or near-complete embolization was achieved than in tumors in which preoperative embolization resulted in less than 90% reduction of tumor vascular blush. These findings suggest that there may be a critical threshold of efficacy that should be the goal of preoperative embolization.
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Affiliation(s)
| | | | | | | | - Christine Boone
- 2Department of Interventional Radiology, University of California, San Diego School of Medicine, San Diego, California
| | - Philippe Gailloud
- 3Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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N-Butyl Cyanoacrylate-Lipiodol Mixture for Endovascular Purpose: Polymerization Kinetics Differences Between In Vitro and In Vivo Experiments. Cardiovasc Intervent Radiol 2020; 43:1409-1410. [PMID: 32494834 DOI: 10.1007/s00270-020-02540-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/25/2020] [Indexed: 11/27/2022]
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30
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Sun LC, Su Y, Ding XC, Xu DS, Li CM, Wang L, Li WL, Sun XD, Yu JM, Meng X. In vitro and in vivo evaluation of the safety and efficacy of a novel liquid fiducial marker for image-guided radiotherapy. Oncol Lett 2020; 20:569-580. [PMID: 32565982 PMCID: PMC7286123 DOI: 10.3892/ol.2020.11591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 03/26/2020] [Indexed: 12/30/2022] Open
Abstract
The true extent of a tumor is difficult to visualize, during radiotherapy, using current modalities. In the present study, the safety and feasibility of a mixture of N-butyl cyanoacrylate and lipiodol (NBCA/Lip) was evaluated in order to investigate the optimal combination for application as a fiducial marker for radiotherapy. Four combinations of NBCA/Lip injection (1:1–0.1, 1:1–0.15, 1:3–0.1 and 1:3–0.15 ml) were injected into the subcutaneous tissue of BALB/c mice. The changes in gross histopathology, body weight, skin score, marker volume, neutrophil and macrophage counts were observed to analyze the effects of the different mixing ratios and injection volumes, in order to identify the best combination. Evaluation according to the International Organization for Standardization criteria was further conducted in order to test the biocompatibility of the mixture, including an acute systematic assay with mice, cytotoxicity with L929 fibroblasts and delayed-type hypersensitivity tests with guinea pigs and an intradermal test with rabbits. The results revealed that at the seventh week, 42 markers (42/48; 87.5%) were still visible using computed tomography (CT) imaging. No serious adverse effects were observed throughout the study period; however, the combination of 1:1–0.1 ml had the lowest body weight and worst skin score. A review of the histopathological reaction to NBCA/Lip revealed a combination of acute inflammation, chronic inflammation, granulation tissue, foreign-body reaction and fibrous capsule formation. The 1:1 NBCA combination ratio resulted in the most intense tissue repair reaction and a slower degradation rate of markers. In general, the combination of 1:3–0.15 ml had a better fusion with local tissue, maintained a stable imaging nodule on CT images for 7 weeks and the final biocompatibility test demonstrated its safety. Overall, the findings of the present study demonstrated NBCA/Lip as a safe and feasible fiducial marker, when using the 1:3–0.15 ml combination.
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Affiliation(s)
- Liang-Chao Sun
- Department of Radiation Oncology and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, Shandong 300060, P.R. China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Yi Su
- Department of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University Institution, Yantai, Shandong 264001, P.R. China
| | - Xing-Chen Ding
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Dong-Shui Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Cheng-Ming Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Lu Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Wan-Long Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Xin-Dong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Jin-Ming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
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Is the Cessation of Blood Flow Faster than the Polymerization of an n-Butyl Cyanoacrylate-Lipiodol Mixture? An In Vitro Phantom Study. Cardiovasc Intervent Radiol 2019; 43:630-635. [PMID: 31832724 DOI: 10.1007/s00270-019-02393-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/05/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE To compare the polymerization time of n-butyl cyanoacrylate (NBCA) and lipiodol mixture in a static model and a pulsating flow model simulating embolization procedure of small caliber arteries. MATERIALS AND METHODS The polymerization time of NBCA-lipiodol mixture was measured by the morphological changes of a glue droplet in a petri dish. For the flow model, we used a 2-mm-inner-diameter polyvinyl alcohol tube connected to a pulsation pump. Bovine serum was supplied from the pump and circulated into the system at 30 ml/min and 60 bpm. A 0.64-mm-inner-diameter silicon microcatheter was inserted into this system, and then, 0.5 ml of glue was injected into the tube. The flow cessation time was defined as the time it took to stop the serum draining from the end of the tube. Six samples of 100, 66, 50, 40, 33, and 20 vol% NBCA were assessed. RESULTS The median polymerization times for each concentration were 0.12, 3.72, 12.30, 27.41, 57.68, and 63.67 s, respectively. The median flow cessation times were 0.28, 0.78, 1.43, 3.75, 4.50, and 9.29 s, respectively. The flow cessation time was significantly shorter than the polymerization time for all samples except for 100 vol% cyanoacrylate (p < 0.05). CONCLUSION The flow cessation time of cyanoacrylate glue was significantly shorter than the polymerization time in an in vitro experiment. The injected glue possibly stops the blood flow before the completion of polymerization in the vascular system.
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Park KY, Kim JW, Kim BM, Kim DJ, Chung J, Jang CK, Kim JH. Coil-Protected Technique for Liquid Embolization in Neurovascular Malformations. Korean J Radiol 2019; 20:1285-1292. [PMID: 31339016 PMCID: PMC6658879 DOI: 10.3348/kjr.2019.0127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/09/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of the coil-protected technique for liquid embolization in neurovascular malformations. MATERIALS AND METHODS Twenty-two patients who underwent coil-protected liquid embolization for symptomatic cranial (n = 13) and spinal (n = 9) arteriovenous fistula (AVF) or arteriovenous malformations (AVMs) were identified. A total of 36 target feeder vessels were embolized with N-butyl cyanoacrylate and/or Onyx (Medtronic). This technique was used to promote delivery of a sufficient amount of liquid embolic agent into the target shunt or nidus in cases where tortuous feeding arteries preclude a microcatheter wedging techniqu and/or to prevent reflux of the liquid embolic agent in cases with a short safety margin. The procedure was considered technically successful if the target lesion was sufficiently filled with liquid embolic agent without unintentional reflux. Angiographic and clinical outcomes were retrospectively evaluated. RESULTS Technical success was achieved for all 36 target feeders. Post-embolization angiographies revealed complete occlusion in 16 patients and near-complete and partial occlusion in three patients each. There were no treatment-related complications. Of the six patients who showed near-complete or partial occlusion, five received additional treatments: two received stereotactic radiosurgery for cerebral AVM, two underwent surgical removal of cerebral AVM, and one underwent additional embolization by direct puncture for a mandibular AVM. Finally, all patients showed complete (n = 19) or near-complete (n = 3) occlusion of the target AVF or AVM on follow-up angiographies. The presenting neurological symptoms improved completely in 15 patients (68.2%) and partially in seven patients (31.8%). CONCLUSION The coil-protected technique is a safe and effective method for liquid embolization, especially in patients with various neurovascular shunts or malformations who could not be successfully treated with conventional techniques.
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Affiliation(s)
- Keun Young Park
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woo Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Byung Moon Kim
- Division of Interventional Neuroradiology and Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Dong Joon Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Ki Jang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Hwee Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Rafeedheen R, Agarwal SK, Meek JC, Uretsky BF. Use of “super‐glue” to seal a perforation during chronic total occlusion coronary intervention and the potential to “unglue” it. Catheter Cardiovasc Interv 2019; 95:1136-1140. [DOI: 10.1002/ccd.28399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/23/2019] [Accepted: 07/04/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Rahil Rafeedheen
- Division of CardiologyUniversity of Arkansas for Medical Sciences Little Rock Arkansas
| | - Shiv K. Agarwal
- Division of CardiologyUniversity of Arkansas for Medical Sciences Little Rock Arkansas
- Division of CardiologyCentral Arkansas Veterans Health Care System Little Rock Arkansas
| | - James C. Meek
- Department of RadiologyUniversity of Arkansas for Medical Sciences Little Rock Arkansas
| | - Barry F. Uretsky
- Division of CardiologyUniversity of Arkansas for Medical Sciences Little Rock Arkansas
- Division of CardiologyCentral Arkansas Veterans Health Care System Little Rock Arkansas
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Kuetting D, Schild HH, Pieper CC. In Vitro Evaluation of the Polymerization Properties of N-Butyl Cyanoacrylate/Iodized Oil Mixtures for Lymphatic Interventions. J Vasc Interv Radiol 2018; 30:110-117. [PMID: 30527658 DOI: 10.1016/j.jvir.2018.07.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/26/2018] [Accepted: 07/28/2018] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate polymerization of N-butyl cyanoacrylate (NBCA)/iodized oil mixtures for lymphatic interventions in vitro. MATERIALS AND METHODS Polymerization times of different NBCA/iodized oil mixtures (ratios of 1:0-1:7) were investigated in a static and dynamic experimental setup (performed in a lymph flow model in a silicone tube). Eight lymphatic samples with different triglyceride (TG) concentrations (low TGs, < 50 mg/dL; medium TGs, approximately 100-400 mg/dL; high TGs, > 700 mg/dL) were investigated. Morphologic changes during NBCA polymerization were monitored and recorded by video. Statistical analysis was performed with intergroup comparisons (Kruskal-Wallis test) and multiple regression analysis. RESULTS Static experiments showed increasing polymerization times with increasing concentrations of iodized oil as well as increasing concentrations of TGs. In the low-TG group, polymerization time increased from 14 s at a 1:1 ratio of NBCA to iodized oil to 1,336 s at a 1:7 ratio; times in the medium-TG group increased from 21 s (1:1) to 2,546 s (1:7), and those in the high TG group increased from 168 s (1:1) to 16,530 s (1:7). In dynamic experiments, prolongation of polymerization time was less pronounced. For low- and medium-TG groups, total occlusion of the silicon tube was observed in all cases during the embolization procedure at between 26 seconds (1:1 ratio) and 52 seconds (1:7). In the high-TG group, polymerization took considerably longer (between 43 s [1:1] and 467 s [1:7]) or failed completely. CONCLUSIONS Polymerization time of NBCA/iodized oil in lymph seems to be prolonged by increasing iodized oil and TG concentrations.
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Affiliation(s)
- Daniel Kuetting
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Hans H Schild
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Claus C Pieper
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
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Uller W, El-sobky S, Alomari AI, Fishman SJ, Spencer SA, Taghinia AH, Chaudry G. Preoperative Embolization of Venous Malformations Using n-Butyl Cyanoacrylate. Vasc Endovascular Surg 2018; 52:269-274. [DOI: 10.1177/1538574418762192] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: The purpose of this study was to evaluate the safety and efficacy of preoperative percutaneous n-butyl cyanoacrylate (nBCA) embolization of venous malformations in children. Material and Methods: Clinical data were retrospectively reviewed in children who underwent embolization using nBCA followed by resection of venous malformations. Results: A total of 17 embolizations were performed in 14 patients (9 females, mean age: 5.5 years; median age: 3 years; range 0.1-16 years). The venous malformations involved the lower extremity and the knee joint (n = 7), the trunk (n = 4), head and neck (n = 2), and hand (n = 1). n-Butyl cyanoacrylate was diluted with iodized oil at a ratio of 1:3 to 1:5. The mean and median volume of nBCA per procedure were 2.1 and 2 mL, respectively (range: 0.5-8 mL). There were no complications associated with the procedures. The mean and median time between final embolization and resection were 3.6 and 2 days, respectively. All children underwent successful resection of the symptomatic lesions. The estimated mean and median blood loss were 75 and 50 mL, respectively (range: 5-350 mL). The postprocedure course was uneventful, the days to discharge ranged between 1 and 6 days (mean 3 days). Conclusion: Initial results suggest that preoperative percutaneous n-butyl cyanoacrylate embolization of venous malformations is safe and effective in children, with the potential for minimizing blood loss and inpatient stay.
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Affiliation(s)
- Wibke Uller
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Vascular and Interventional Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sherif El-sobky
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Vascular and Interventional Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Ahmad I. Alomari
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Vascular and Interventional Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Steven J. Fishman
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Samantha A. Spencer
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Orthopaedics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Amir H. Taghinia
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Plastic Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Gulraiz Chaudry
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Vascular and Interventional Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
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Koç O, Acar K, Özbek O, Güler İ, Sarıtaş K, Erdem TB, Solak Y, Toy H, Küçükapan A, Özbek S, Gaipov A, Haznedaroğlu İC. Splenic artery embolization with Ankaferd blood stopper in a sheep model. Diagn Interv Radiol 2017; 22:354-7. [PMID: 27306661 DOI: 10.5152/dir.2015.15382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Splenic artery embolization is a minimally invasive therapeutic procedure utilized in a number of disorders. Ankaferd blood stopper (ABS) is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We aimed to investigate the safety and efficiency of ABS for splenic artery embolization in a sheep model. METHODS Seven adult female sheep were included in the study. Selective celiac angiography was performed using a 5F diagnostic catheter and then a 2.7F hydrophilic coating microcatheter was advanced coaxially to the distal part of the main splenic artery. Under fluoroscopic guidance, 6 mL mixture composed of half-and-half ABS and contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration and stagnation of the flow. Control celiac angiograms were obtained immediately after the embolization. After the procedure, the animals were observed for one day and then sacrificed with intravenous sodium thiopental. RESULTS Technical success rate was 100%. None of the animals died or experienced a major systemic adverse event during the procedure. All of the spleens appeared dark on macroscopic examination due to excessive thrombosis. Microscopically, the majority of the splenic sinusoids (90%-95%) were necrotic. CONCLUSION In our study, splenic artery embolization by ABS was found to be safe and effective in the short-term. Further studies are needed to better understand the embolizing potential of this novel hemostatic agent.
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Affiliation(s)
- Osman Koç
- Department of Radiology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey.
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Li YJ, Barthès-Biesel D, Salsac AV. Polymerization kinetics of a mixture of Lipiodol and Glubran 2 cyanoacrylate glue upon contact with a proteinaceous solution. J Mech Behav Biomed Mater 2017; 74:84-92. [PMID: 28554038 DOI: 10.1016/j.jmbbm.2017.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/13/2017] [Accepted: 05/16/2017] [Indexed: 02/03/2023]
Abstract
The Glubran 2 cyanoacrylate glue is a liquid embolic agent used to block blood vessels endovascularly. Typically mixed with an iodized oil (Lipiodol) for visualization under X-ray, it polymerizes when in contact with blood and tissues owing to the presence of ions and proteins. The objective of the study is to determine the influence of plasma proteins in the polymerization reaction. A triggering solution containing bovine serum albumin (BSA) and the main blood ions is used as a model of plasma. The polymerization kinetics of Glubran 2-Lipiodol mixtures is measured upon aspiration in a capillary tube and contact with the proteinaceous solution. Having varied the glue and protein concentrations, we show that glue-Lipiodol mixtures with concentrations larger or equal to 25% polymerize when put in contact with an ionic solution containing at least 4% of BSA. The reaction is decomposed into two phases: a fast zwitterionic polymerization induced by the BSA molecules followed by a slower polymerization phase. The reaction speed and extent of the solidification region mostly depend on the glue concentration. The time for the glue solution to polymerize over a 1mm thickness varies from 5s for pure glue to about 1min for a 50% glue concentration, and 10min for a 25% glue mixture. It is the first time that the kinetics of the two polymerization reactions is quantified for Glubran 2, which will provide the information needed by interventional radiologists to optimize the planning of endovascular glue injection.
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Affiliation(s)
- Y J Li
- Biomechanics and Bioengineering Laboratory (UMR CNRS 7338), Université de Technologie de Compiègne - CNRS, Sorbonne Universités, CS 60319, 60203 Compiègne, France
| | - D Barthès-Biesel
- Biomechanics and Bioengineering Laboratory (UMR CNRS 7338), Université de Technologie de Compiègne - CNRS, Sorbonne Universités, CS 60319, 60203 Compiègne, France
| | - A-V Salsac
- Biomechanics and Bioengineering Laboratory (UMR CNRS 7338), Université de Technologie de Compiègne - CNRS, Sorbonne Universités, CS 60319, 60203 Compiègne, France.
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Yadav RR, Boruah DK, Bhattacharyya V, Prasad R, Kumar S, Saraswat VA, Kapoor VK, Saxena R. Percutaneous Direct Needle Puncture and Transcatheter N-butyl Cyanoacrylate Injection Techniques for the Embolization of Pseudoaneurysms and Aneurysms of Arteries Supplying the Hepato-pancreato-biliary System and Gastrointestinal Tract. J Clin Imaging Sci 2017; 6:48. [PMID: 28123838 PMCID: PMC5209862 DOI: 10.4103/2156-7514.196278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 10/30/2016] [Indexed: 11/30/2022] Open
Abstract
Aims: The aim of this study was to evaluate the safety and clinical efficacy of percutaneous direct needle puncture and transcatheter N-butyl cyanoacrylate (NBCA) injection techniques for the embolization of pseudoaneurysms and aneurysms of arteries supplying the hepato-pancreato-biliary (HPB) system and gastrointestinal (GI) tract. Subjects and Methods: A hospital-based cross-sectional retrospective study was conducted, where the study group comprised 11 patients with pseudoaneurysms/aneurysms of arteries supplying the HPB system and GI tract presenting to a tertiary care center from January 2015 to June 2016. Four patients (36.4%) underwent percutaneous direct needle puncture of pseudoaneurysms with NBCA injection, 3 patients (27.3%) underwent transcatheter embolization with NBCA as sole embolic agent, and in 4 patients (36.4%), transcatheter NBCA injection was done along with coil embolization. Results: This retrospective study comprised 11 patients (8 males and 3 females) with mean age of 35.8 years ± 1.6 (standard deviation [SD]). The mean volume of NBCA: ethiodized oil (lipiodol) mixture injected by percutaneous direct needle puncture was 0.62 ml ± 0.25 (SD) (range = 0.5–1 ml), and by transcatheter injection, it was 0.62 ml ± 0.37 (SD) (range = 0.3–1.4 ml). Embolization with NBCA was technically and clinically successful in all patients (100%). No recurrence of bleeding or recurrence of pseudoaneurysm/aneurysm was noted in our study. Conclusions: Percutaneous direct needle puncture of visceral artery pseudoaneurysms and NBCA glue injection and transcatheter NBCA injection for embolization of visceral artery pseudoaneurysms and aneurysms are cost-effective techniques that can be used when coil embolization is not feasible or has failed.
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Affiliation(s)
- Rajanikant R Yadav
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Deb K Boruah
- Department of Radiodiagnosis, Assam Medical College, Dibrugarh, Assam, India
| | - Vishwaroop Bhattacharyya
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Raghunandan Prasad
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sheo Kumar
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - V A Saraswat
- Department of Medical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - V K Kapoor
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajan Saxena
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Li YJ, Barthès-Biesel D, Salsac AV. Polymerization kinetics of n-butyl cyanoacrylate glues used for vascular embolization. J Mech Behav Biomed Mater 2017; 69:307-317. [PMID: 28131066 DOI: 10.1016/j.jmbbm.2017.01.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/31/2016] [Accepted: 01/02/2017] [Indexed: 12/15/2022]
Abstract
Vascular embolization is a minimally invasive treatment used for the management of vascular malformations and tumors. It is carried out under X-ray by navigating a microcatheter into the targeted blood vessel, through which embolic agents are delivered to occlude the vessels. Cyanoacrylate liquid glues have been widely used for vascular embolization owing to their low viscosity, rapid polymerization/solidification rate, good penetration ability and low tissue toxicity. The objective of this study is to quantitatively investigate the physical properties of two n-butyl cyanoacrylate (nBCA) glues (Glubran 2 and Histoacryl) mixed with an iodized oil (Lipiodol) at various concentrations. We show that an homogeneous solution results from the mixing of the glue and Lipiodol, and that the viscosity, density and interfacial tension of the mixture increase with the proportion in Lipiodol. We have designed a new experimental setup to systemically characterize the polymerization kinetics of a glue mixture upon contact with an ionic solution. We observe that the whole polymerization process includes two phases: an interfacial polymerization that takes place at the interface as soon as the two liquids are in contact with a characteristic time scale of the order of the minute; a volumetric polymerization during which a reaction front propagates within the mixture bulk with a characteristic time scale of the order of tens of minutes. The polymerization rate, front propagation speed and volume reduction increase with the glue concentrations. It is the first time that such comprehensive results are obtained on liquid embolic agents.
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Affiliation(s)
- Y J Li
- Biomechanics and Bioengineering Laboratory (UMR CNRS 7338), Université de technologie de Compiègne - CNRS, Sorbonne universités, CS 60319, 60203 Compiègne, France
| | - D Barthès-Biesel
- Biomechanics and Bioengineering Laboratory (UMR CNRS 7338), Université de technologie de Compiègne - CNRS, Sorbonne universités, CS 60319, 60203 Compiègne, France
| | - A-V Salsac
- Biomechanics and Bioengineering Laboratory (UMR CNRS 7338), Université de technologie de Compiègne - CNRS, Sorbonne universités, CS 60319, 60203 Compiègne, France.
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Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery. Cardiovasc Intervent Radiol 2016; 40:55-60. [DOI: 10.1007/s00270-016-1472-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
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Gonzalez-Aguirre AJ, Durack JC. Managing Complications Following Nephron-Sparing Procedures for Renal Masses. Tech Vasc Interv Radiol 2016; 19:194-202. [PMID: 27641453 DOI: 10.1053/j.tvir.2016.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Small renal malignancies are commonly treated with nephron-sparing procedures including partial nephrectomy and percutaneous ablation. Although these procedures offer faster patient recovery and preserve renal function, a variety of complications can occur. Here, we review vascular and nonvascular complications associated with nephron-sparing renal mass treatments and discuss options for minimally invasive image-guided management.
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Affiliation(s)
- Adrian J Gonzalez-Aguirre
- Department of Radiology, Interventional Radiology Section, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeremy C Durack
- Department of Radiology, Interventional Radiology Section, Memorial Sloan Kettering Cancer Center, New York, NY.
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Adrianto Y, Yang KH, Koo HW, Park W, Jung SC, Park JE, Kim KK, Jeon SR, Suh DC. Concomitant origin of the anterior or posterior spinal artery with the feeder of a spinal dural arteriovenous fistula (SDAVF). J Neurointerv Surg 2016; 9:405-410. [DOI: 10.1136/neurintsurg-2016-012267] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/19/2016] [Accepted: 03/23/2016] [Indexed: 11/04/2022]
Abstract
Background/objectiveThe concomitant origin of the anterior spinal artery (ASA) or the posterior spinal artery (PSA) from the feeder of a spinal dural arteriovenous fistula (SDAVF) is rare and the exact incidence is not known. We present our experience with the management of SDAVFs in such cases.MethodsIn 63 patients with SDAVF between 1993 and 2015, the feeder origin of the SDAVF was evaluated to determine whether it was concomitant with the origin of the ASA or PSA. Embolization was attempted when the patient did not want open surgery and an endovascular approach was regarded as safe and possible. The outcome of the procedure was evaluated as complete, partial, or no obliteration. The clinical outcome was evaluated by Aminoff–Logue (ALS) gait and micturition scale scores.ResultsNine patients (14%) had a concomitant origin of the ASA or PSA with the feeder. There were two cervical, five thoracic, and two lumbar level SDAVFs. A concomitant origin of the feeder was identified with the ASA (n=7) and PSA (n=2). Embolization was performed in four patients and open surgery was performed in five. Embolization resulted in complete obliteration in three patients and partial obliteration in one. Using the ALS gait and micturition scale, the final outcome improved in six while three cases remained in an unchanged condition over 2–148 months.ConclusionsThe concomitant origin of the ASA or PSA with the feeder occurs occasionally. Complete obliteration of the fistula can be achieved either by embolization or open surgery. Embolization can be carefully performed in selected patients who are in a poor condition and do not want to undergo open surgery.
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Aoki M, Tokue H, Koyama Y, Tsushima Y, Oshima K. Transcatheter arterial embolization with N-butyl cyanoacrylate for arterial esophageal bleeding in esophageal cancer patients. World J Surg Oncol 2016; 14:54. [PMID: 26912065 PMCID: PMC4766665 DOI: 10.1186/s12957-016-0803-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/17/2016] [Indexed: 01/01/2023] Open
Abstract
Background The aim of this study is to evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for the treatment of arterial esophageal bleeding in esophageal cancer patients. Methods Between November 2008 and December 2014, five esophageal cancer patients underwent TAE with NBCA for the treatment of arterial esophageal bleeding. We retrospectively evaluated the technical and clinical success, recurrent bleeding, and procedure-related complications. Results All of the patients had bleeding from the esophageal artery and were in shock at the beginning of TAE. Four patients had a coagulopathy at the time of TAE; however, the TAE could successfully arrest bleeding in all five patients. After TAE, they immediately recovered from the shock state. Two patients were discharged without event, one patient is currently hospitalized for another complication, and the other two patients died due to multiorgan failure. In addition, no procedure-related complications such as esophageal infarction and recurrence of arterial esophageal bleeding were observed during this study. Conclusions TAE with NBCA can arrest bleeding in esophageal cancer patients with active arterial esophageal bleeding, even in those with a pre-existing coagulopathy.
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Affiliation(s)
- Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan. .,Department of Diagnostic and Interventional Radiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
| | - Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoshinori Koyama
- Department of Diagnostic and Interventional Radiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoshito Tsushima
- Department of Diagnostic and Interventional Radiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Madhusudhan KS, Gamanagatti S, Garg P, Shalimar, Dash NR, Pal S, Peush S, Gupta AK. Endovascular Embolization of Visceral Artery Pseudoaneurysms Using Modified Injection Technique with N-Butyl Cyanoacrylate Glue. J Vasc Interv Radiol 2015; 26:1718-25. [DOI: 10.1016/j.jvir.2015.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 01/13/2023] Open
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Uchikawa Y, Mori K, Shiigai M, Konishi T, Hoshiai S, Ishigro T, Hiyama T, Nakai Y, Minami M. Double Coaxial Microcatheter Technique for Glue Embolization of Renal Arteriovenous Malformations. Cardiovasc Intervent Radiol 2015; 38:1277-83. [PMID: 26253779 DOI: 10.1007/s00270-015-1188-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 07/04/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To demonstrate the technical benefit of the double coaxial microcatheter technique for embolization of renal arteriovenous malformations (AVMs) with n-butyl cyanoacrylate and iodized oil (glue). MATERIALS AND METHODS Six consecutive patients (1 man and 5 women; mean age 61 years; range 44-77 years) with renal AVMs were included. Five patients had hematuria, and one had a risk of heart failure due to a large intrarenal arteriovenous shunt. All patients underwent transarterial embolization using glue and the double coaxial microcatheter technique with outer 2.6F and inner 1.9F microcatheters. After glue injection, the inner microcatheter was retracted, while the outer microcatheter was retained. We assessed the complications and clinical outcomes of this technique. RESULTS Technical success was achieved in all patients. In 9 sessions, 34 feeding arteries were embolized with glue using the double coaxial microcatheter technique, 1 was embolized with glue using a single microcatheter, and 2 were embolized with coils. The double coaxial microcatheter technique was useful for selecting small tortuous feeding arteries, preventing glue reflux to the proximal arteries, and approaching multiple feeding arteries without complete retraction of the microcatheters. As a minor complication, glue migrated into the venous system in four patients without any sequelae. In all patients, favorable clinical outcomes, including hematuria cessation in five patients and improvement of the large intrarenal arteriovenous shunt in one patient, were obtained without deterioration of renal function. CONCLUSION Glue embolization with the double coaxial microcatheter technique was useful for treating renal AVMs with multiple tortuous feeding arteries.
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Affiliation(s)
- Yoko Uchikawa
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan. .,Department of Radiology, Hitachi General Hospital, 2-1-1 Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan.
| | - Kensaku Mori
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Masanari Shiigai
- Department of Radiology, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
| | - Takahiro Konishi
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Sodai Hoshiai
- Department of Radiology, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki, 309-1793, Japan.
| | - Toshitaka Ishigro
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Takashi Hiyama
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Yasunobu Nakai
- Department of Neurosurgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
| | - Manabu Minami
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
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Zander T, Medina S, Montes G, Nuñez-Atahualpa L, Valdes M, Maynar M. Endoluminal occlusion devices: technology update. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:425-36. [PMID: 25489252 PMCID: PMC4257107 DOI: 10.2147/mder.s49540] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Endoluminal occlusion has been performed since the early beginning of interventional radiology. Over recent decades, major technological advances have improved the techniques used and different devices have been developed for changing conditions. Most of these occlusion devices have been implemented in the vascular territory. Early embolization materials included glass particles, hot contrast, paraffin, fibrin, and tissue fragments such as muscle fibers and blood clots; today, occlusion materials include metallic devices, particles, and liquid materials, which can be indicated for proximal or distal occlusion, high-flow and low-flow situations, and in large-caliber and small-caliber vessels, based on need. Technological progress has led to a decreased size of delivery catheters, and an increase in safety due to release systems that permit the withdrawing and replacement of embolization material. Furthermore, bioactive embolization materials have been developed to increase the efficacy of embolization or the biological effect of medication. Finally, materials have been modified for changing indications. Intravascular stents were initially developed to keep an artery open; however, by adding a covering membrane, these stents can be used to occlude the wall of a vessel or other endoluminal structures. This article gives an overview of the devices most utilized for occlusion of endoluminal structures, as well as their major purpose in the endovascular territory.
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Affiliation(s)
- Tobias Zander
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain
| | - Samantha Medina
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain
| | - Guillermo Montes
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain
| | | | - Michel Valdes
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain
| | - Manuel Maynar
- Endoluminal/Vascular Department, Hospiten Hospital Group, Santa Cruz de Tenerife, Spain ; University of Las Palmas de Gran Canarias, Las Palmas, Canary Island, Spain
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Disastrous Portal Vein Embolization Turned into a Successful Intervention. Cardiovasc Intervent Radiol 2014; 38:1365-8. [PMID: 25212417 DOI: 10.1007/s00270-014-0985-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/07/2014] [Indexed: 01/05/2023]
Abstract
Portal vein embolization (PVE) may be performed before hemihepatectomy to increase the volume of future liver remnant (FLR) and to reduce the risk of postoperative liver insufficiency. We report the case of a 71-year-old patient with hilar cholangiocarcinoma undergoing PVE with access from the right portal vein using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil. During the procedure, nontarget embolization of the left portal vein occurred. An aspiration maneuver of the polymerized plug failed; however, the embolus obstructing portal venous flow in the FLR was successfully relocated into the right portal vein while carefully bypassing the plug with a balloon catheter, inflating the balloon, and pulling the plug into the main right portal vein.
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Transcatheter Embolotherapy with N-Butyl Cyanoacrylate for Ectopic Varices. Cardiovasc Intervent Radiol 2014; 38:344-51. [DOI: 10.1007/s00270-014-0943-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 05/20/2014] [Indexed: 12/29/2022]
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Alaraj A, Dashti R, Mehta NK, Goodin S, Charbel FT, Aletich VA. Augmentation of N-butyl cyanoacrylate embolization of cranial, head, and neck tumors by simultaneous infusion of 5% dextrose solution. J Neurointerv Surg 2014; 7:463-70. [DOI: 10.1136/neurintsurg-2013-011071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/10/2014] [Indexed: 11/03/2022]
Affiliation(s)
- Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Reza Dashti
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Nikhil K Mehta
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sean Goodin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Victor A Aletich
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Shin CI, Kim HC, Song YS, Cho HR, Lee KB, Lee W, Jae HJ, Chung JW. Rat model of hindlimb ischemia induced via embolization with polyvinyl alcohol and N-butyl cyanoacrylate. Korean J Radiol 2013; 14:923-30. [PMID: 24265568 PMCID: PMC3835640 DOI: 10.3348/kjr.2013.14.6.923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 08/04/2013] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the feasibility of a rat model on hindlimb ischemia induced by embolization from the administration of polyvinyl alcohol (PVA) particles or N-butyl cyanoacrylate (NBCA). Materials and Methods Unilateral hindlimb ischemia was induced by embolization with NBCA (n = 4), PVA (n = 4) or surgical excision (n = 4) in a total of 12 Sprague-Dawley rats. On days 0, 7 and 14, the time-of-flight magnetic resonance angiography (TOF-MRA) and enhanced MRI were obtained as scheduled by using a 3T-MR scanner. The clinical ischemic index, volume change and degree of muscle necrosis observed on the enhanced MRI in the ischemic hindlimb were being compared among three groups using the analysis of variance. Vascular patency on TOF-MRA was evaluated and correlated with angiographic findings when using an inter-rater agreement test. Results There was a technical success rate of 100% for both the embolization and surgery groups. The clinical ischemic index did not significantly differ. On day 7, the ratios of the muscular infarctions were 0.436, 0.173 and 0 at thigh levels and 0.503, 0.337 and 0 at calf levels for the NBCA, PVA and surgery groups, respectively. In addition, the embolization group presented increased volume and then decreased volume on days 7 and 14, respectively. The surgery group presented a gradual volume decrease. Good correlation was shown between the TOF-MRA and angiographic findings (kappa value of 0.795). Conclusion The examined hindlimb ischemia model using embolization with NBCA and PVA particles in rats is a feasible model for further research, and muscle necrosis was evident as compared with the surgical model.
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Affiliation(s)
- Cheong-Il Shin
- Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea
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