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Moudgal RA, Zare-Shahabadi A, Mowla A, Grossman AW, Prestigiacomo CJ, Shirani P. Massive Orofacial Hemorrhage Treated with the Micro Vascular Plug System. World Neurosurg 2020; 143:79-82. [PMID: 32589981 DOI: 10.1016/j.wneu.2020.06.120] [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: 02/12/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This case series describes the use of the Medtronic Micro Vascular Plug (MVP) system in the treatment of acute massive orofacial hemorrhages in patients with cancer and trauma, resulting in successful hemostasis in these emergent cases. CASE DESCRIPTION The first case describes a patient who presented with life-threatening oropharyngeal hemorrhage after a motor vehicle accident. In the second case, a patient with oropharyngeal cancer presented with life-threatening bleeding from an ulcerated tumor. Patients were successfully treated with a combination of MVP and coils. Immediate postprocedural imaging confirmed that homeostasis was achieved. CONCLUSIONS These cases demonstrate that the MVP as an embolic device is a valuable transarterial embolic treatment option in cases of acute orofacial bleeding where rapid, effective hemostasis is required.
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Affiliation(s)
- Rohitha A Moudgal
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ameneh Zare-Shahabadi
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ashkan Mowla
- Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA
| | - Aaron W Grossman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Charles J Prestigiacomo
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Peyman Shirani
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Reyre A, Michel J, Santini L, Dessi P, Vidal V, Bartoli JM, Moulin G, Varoquaux A. Epistaxis: The role of arterial embolization. Diagn Interv Imaging 2015; 96:757-73. [DOI: 10.1016/j.diii.2015.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
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Kaminski G, Jaroszuk A, Zybek A, Brzozowski K, Piasecki P, Ziecina P, Ruchala M. The calcium-phosphate balance, modulation of thyroid autoimmune processes and other adverse effects connected with thyroid arterial embolization. Endocrine 2014; 46:292-9. [PMID: 24146411 PMCID: PMC4040001 DOI: 10.1007/s12020-013-0072-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/24/2013] [Indexed: 11/25/2022]
Abstract
In search of new treatment options for thyroid diseases, when conventional procedures are ineffective, contraindicated or associated with serious side effects, safety of thyroid arteries embolization in the treatment of particular thyroid diseases was evaluated. The study included eight subjects with retrosternal toxic goiter, six patients affected by Graves' disease, five cases of retrosternal non-toxic goiter, two subjects with post-amiodarone hyperthyroidism, and one patient with severe thyroid-related orbitopathy, who underwent selective embolization of thyroid arteries. The study assessed and compared calcium-phosphate balance, modulation of thyroid autoimmunity and the presence of different side effects in patients who underwent the procedure. In addition, the serum concentrations of thyroid hormones, anti-thyroid autoantibodies and thyroid volume have been measured. Five of all enrolled subjects (22.7 %) experienced transient, not clinically relevant hypocalcaemia with no need for calcium supplementation. There were no significant changes in serum calcium levels in patients after embolization of both inferior thyroid arteries. The transient side effects associated with the treatment were neck pain and a slight increase in body temperature. Noted high concentration of free thyroid hormones immediately after the procedure was not accompanied by worsening of symptoms or signs of thyrotoxicosis. In patients with Graves' disease, a significant decrease in thyrotropin receptor antibodies level was observed. Thyroid arterial embolization does not disturb permanently calcium-phosphate balance, modulates positively thyroid autoimmune processes and is associated with no serious post-procedure side effects. Hence, it may be considered as a safe and effective treatment modality for selected thyroid disorders.
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Affiliation(s)
- Grzegorz Kaminski
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Szaserów Street 128, 04-141 Warsaw, Poland
| | - Andrzej Jaroszuk
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Szaserów Street 128, 04-141 Warsaw, Poland
| | - Ariadna Zybek
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-355 Poznan, Poland
| | - Krzysztof Brzozowski
- Department of Interventional Radiology, Military Institute of Medicine, Szaserów Street 128, 04-141 Warsaw, Poland
| | - Piotr Piasecki
- Department of Interventional Radiology, Military Institute of Medicine, Szaserów Street 128, 04-141 Warsaw, Poland
| | - Piotr Ziecina
- Department of Interventional Radiology, Military Institute of Medicine, Szaserów Street 128, 04-141 Warsaw, Poland
| | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-355 Poznan, Poland
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Abstract
OBJECTIVE To provide an update on the ever-increasing role that embolisation plays in the practice of otolaryngology. METHOD A literature search was performed during November 2008. The Medline, Embase, PubMed and Cochrane databases were searched. This resulted in 285 papers relevant for review. CONCLUSION The role of embolisation has expanded greatly to include the management of refractory epistaxis, pre-operative preparation of vascular tumours, vascular injuries and as an adjunct in skull base surgery.
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Chou WC, Lu CH, Lin G, Hong YS, Chen PT, Hsu HC, Chen JS, Yeh KY, Wang HM, Liaw CC. Transcutaneous arterial embolization to control massive tumor bleeding in head and neck cancer: 63 patients’ experiences from a single medical center. Support Care Cancer 2007; 15:1185-90. [PMID: 17356807 DOI: 10.1007/s00520-007-0234-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Accepted: 01/30/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Massive tumor bleeding is a life-threatening complication in patients with head and neck cancer (HNC). Tumor hemorrhage is usually hard to localize, and medical management is often ineffective. Arterial angiography is used to visualize the source of bleeding, and concurrent transcutaneous arterial embolization (TAE) can be done to stop bleeding in some patients. We analyzed the outcome of TAE in HNC patients with massive bleeding at our institution. METHOD We retrospectively reviewed 93 angiographic procedures in 63 HNC patients. Factors potentially related to post-hemorrhagic survival were evaluated, including tumor stage (T, N, M), tumor type, previous curative-intent surgery, previous chemotherapy, previous radiotherapy, angiographic findings, the presence of embolization, and the embolization methods. RESULT A total 56 TAEs were done in 93 angiographic procedures in 63 HNC patients. The overall median post-hemorrhagic survival after angiography was 16 days (range 0-644 days). Median post-hemorrhagic survival for patients receiving TAE was 26 days (range 0-644 days), while patients who received angiography alone survived 8 days (range 0-144 days; p = 0.008). No factors other than TAE predicted post-hemorrhagic survival, and there were no major adverse events after TAE. CONCLUSION In our hands, TAE was associated with a low incidence of toxicities commonly attributable to the procedure such as stroke. Patients who were able to undergo TAE lived longer than those who were not candidates for the procedure.
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Affiliation(s)
- Wen-Chi Chou
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Kakizawa H, Toyota N, Naito A, Ito K. Endovascular Therapy for Management of Oral Hemorrhage in Malignant Head and Neck Tumors. Cardiovasc Intervent Radiol 2005; 28:722-9. [PMID: 16132394 DOI: 10.1007/s00270-004-0130-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of endovascular therapy in oral hemorrhage from malignant head and neck tumors. METHODS Ten patients (mean age 56 years) with oral hemorrhage caused by malignant head and neck tumors underwent a total of 13 emergency embolization procedures using gelatin sponge particles, steel and/or platinum coils, or a combination of these embolic materials. Angiographic abnormalities, technical success rate, clinical success rate, recurrence rate, complications, hemostatic period, hospital days, survival days, and patient outcome were all analyzed. RESULTS Angiographic abnormalities were identified during 85% of procedures (11/13). The technical success rate was 100% (13/13 procedures). The primary and secondary clinical success rates were 77% (10/13 procedures) and 67% (2/3 procedures), respectively. The overall clinical success rate was 92%, and the recurrence rate was 22% (2/9 procedures) in patients whom we were able to observe during the 1-month period after embolization. No major complications occurred. Several patients in whom gelatin sponge particles had been used complained of transient local pain after the procedure. The median hemostatic period was 71 days (range 0-518 days). Median hospital and survival days were 59 days (range 3-209 days) and 141 days (range 4-518 days), respectively. Three patients survived and 7 patients died during the observation period. Only 1 of these 7 patients died from hemorrhage. CONCLUSION In conclusion, our findings suggest that endovascular therapy is an effective, safe, and repeatable treatment for oral hemorrhage caused by malignant head and neck tumors.
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Affiliation(s)
- Hideaki Kakizawa
- Department of Radiology, Division of Medical Intelligence and Informatics Programs for Applied Biomedicine, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, 734-8551, Japan.
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Sittel C, Gossmann A, Jungehülsing M, Zähringer M. Superselective embolization as palliative treatment of recurrent hemorrhage in advanced carcinoma of the head and neck. Ann Otol Rhinol Laryngol 2001; 110:1126-8. [PMID: 11768702 DOI: 10.1177/000348940111001208] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of recurrent major hemorrhage in a patient with advanced head and neck squamous cell carcinoma. Before and between the bleeding episodes, the functional level of the patient was remarkably high. Therefore, an attempt at bleeding control with superselective embolization with Ethibloc was made. Because of its specific characteristics, this substance is almost ideal for the purpose of palliative embolization. The material used and the technique of application are described in detail. After the procedure, no hemorrhage occurred for more than 4 months. We recommend superselective embolization, preferably with Ethibloc, for minimally invasive control of recurrent bleeding as palliative treatment in selected patients with advanced head and neck carcinoma, since significant benefit in terms of the quality of life may result.
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Affiliation(s)
- C Sittel
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Cologne, Germany
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Imai S, Kajihara Y, Kamei T, Komaki K, Tamada T, Shirai H, Gyoten M, Handa T, Akisada T, Orita Y. Arterial embolization for control of bleeding in advanced head and neck malignancy. Int J Clin Oncol 1998. [DOI: 10.1007/bf02489838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Transcatheter arterial embolization (TCAE) is a well recognized radiological technique that has been used for over 25 years. It is a method of diminishing blood flow through selected vessels by inserting haemostatic material under angiographic control. The procedure is performed under local anaesthetic through a femoral or, occasionally, an axillary approach. We present our experience of the use of TCAE in the management of pain and haemorrhage in three hospice inpatients in whom other options had been exhausted. The use of TCAE as a technique for the palliation of these symptoms in the hospice setting is discussed.
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Affiliation(s)
- K E Broadley
- Edenhall Marie Curie Centre, Hampstead, London, UK
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