Triaxial coil embolization using Guglielmi detachable coils with the voltage-dependent coil-detaching technique

Retreatment of a recanalized splenic artery aneurysm using a low-profile microembolization platform

Recanalization of a splenic artery aneurysm owing to incomplete transcatheter coil embolization is uncommon. In addition to the challenges of inherent vessel tortuosity, reintervention via catheterization of the main splenic artery presents unique difficulties in navigating across potentially obstructive preexisting coils. We describe here the application of a low-profile microembolization platform, most commonly used in neurovascular interventions, in the treatment of a tortuous, expanding splenic artery aneurysm that had previously undergone failed coil embolization.

Combination of the double-microcatheter technique and triaxial system in coil packing for visceral and renal artery aneurysms

Background

In coil packing for visceral artery aneurysms (VAAs), difficulties are sometimes associated with preserving the patency of the parent artery, particularly for wide-neck aneurysms. However, the double-microcatheter technique effectively prevents coil migration, while the triple-coaxial (triaxial) system is useful for reducing microcatheter kick-back.

Purpose

To assess the feasibility of combining these two techniques in coil packing for VAAs.

Material and Methods

Coil packing using the double-microcatheter technique and triaxial system was attempted for seven VAAs in six patients between August 2015 and January 2018. The technical success rate, packing density of aneurysms, complications related to the procedure, and occlusion status were evaluated. Technical success was defined as the completion of coil packing by immediate post-embolic angiography. The occlusion status was evaluated using time-resolved magnetic resonance angiography.

Results

There were three renal, three splenic, and one anterior superior pancreaticoduodenal aneurysms. The median size of VAAs was 13 mm (range = 8–21 mm), with five being classified as wide-neck aneurysms. The completion of coil packing was confirmed for all VAAs and the technical success rate was 100%. The median packing density was 28% (range = 22–40%). There were no complications related to the procedure. The median follow-up period was 14 months (range = 8–24 months). In six VAAs that were followed up, there were three complete occlusions, three neck remnants, and no body filling; re-treatment was not required in any patient.

Conclusion

The combination of the double-microcatheter technique and triaxial system is a feasible method of coil packing for VAAs.

Preoperative transcatheter arterial embolization using a gelatin sponge for head and neck tumors

Purpose: To evaluate the usefulness of preoperative transcatheter arterial embolization using a gelatin sponge for hypervascular head and neck tumors to reduce intraoperative blood loss (IBL).　　　　 Material and methods: Nineteen patients underwent preoperative transcatheter arterial embolization for hypervascular head and neck tumors using a gelatin sponge. The technical success rate, devascularization rate, IBL, and complications were evaluated. Angiography images obtained before and after preoperative embolization were compared in all patients, and the devascularization rate was assessed from the relative reduction rate of contrast agent volumes. Results: The technical success rate was 100%. The median devascularization rate was 95% (range, 75-100%). The median period between embolization and surgical resection was one day (range, 1-12 days). The median IBL was 122 ml (range, 0-3780 ml). Blood transfusions were required in three cases, and their IBL and devascularization rates were 850, 1959, and 3780 ml, and 75%, 90%, and 80%, respectively. There was a complication of cerebral embolism in one out of 19 cases (5%). Conclusions: Preoperative transcatheter arterial embolization using a gelatin sponge was feasible and may contribute to decreasing IBL.

Visualization of the Spinal Artery by CT During Embolization for Pulmonary Artery Pseudoaneurysm

BACKGROUND

Spinal artery ischemia is a rare but serious complication of embolization for treatment of hemoptysis. When the spinal artery is visualized at angiography, embolization should not be performed. However, it has been reported that spinal artery feeders are not visible on angiography in patients with developing spinal infarction.

CASE REPORT

A 70-year-old man with a history of pulmonary aspergillosis had hemoptysis and underwent contrast-enhanced CT, revealing a pulmonary artery pseudoaneurysm (PAP) in the left upper lobe. Systemic angiography from the fifth left intercostal artery showed the PAP at the distal site, but the access route to the PAP was very tortuous and long. Although the spinal branch could not be observed with that angiography, CT during angiography was performed, and it visualized the posterior spinal artery obviously. Thus, the artery distal and proximal to the PAP was then successfully coil-embolized from the pulmonary artery.

CONCLUSIONS

CT during angiography may be useful to confirm the presence of the spinal artery for treatment of hemoptysis by embolization.

Ultraselective embolization using a 1.7-Fr catheter and soft bare coil for small intestinal bleeding

OBJECTIVE

We aimed to evaluate the safety and efficacy of embolization using a 1.7-Fr catheter and soft bare coil to treat acute small intestinal bleeding.

MATERIAL AND METHODS

Subjects were five consecutive patients who experienced onset of melena with small intestinal bleeding and underwent transcatheter arterial embolization with 1.7-Fr catheters and 0.010-inch detachable bare coils (five procedures in total). Technical success, clinical success, relative post-procedural complications, arterial bleeding source and cause, and relationship between coagulopathy and embolization efficacy were examined by capsule endoscopy.

RESULTS

We achieved 100% technical and clinical success for the five transcatheter arterial embolizations. All catheterizations of the vasa recta of the bleeding artery (jejunal artery, n = 2; ileal artery, n = 3) were possible with a 1.7-Fr catheter. We achieved high embolization efficacy in two patients with coagulopathy. No rebleeding, intestinal ischemia, or necrosis was observed on follow-up capsule endoscopy. We confirmed that peptic ulcers/ulcer scars were the cause of bleeding for all patients.

CONCLUSION

Embolization with 0.010-inch coils using a 1.7-Fr catheter and catheterization of the vasa recta of bleeding vessels was effective and safe for treating small intestinal bleeding.

Preoperative transarterial embolization using gelatin sponge for hypervascular bone and soft tissue tumors in the pelvis or extremities

BACKGROUND

Preoperative transcatheter arterial embolization for hypervascular bone and soft tissue tumors plays an important role in reducing intraoperative blood loss (IBL).

PURPOSE

To evaluate the use of a gelatin sponge in preoperative transcatheter arterial embolization for hypervascular bone and soft tissue tumors in the pelvis or extremities.

MATERIAL AND METHODS

Thirty-seven patients (21 men, 16 women; median age, 61 years; age range, 23-79 years) underwent preoperative transcatheter arterial embolization between April 2004 and January 2015. Medical records and images were reviewed, and the technical success rate, clinical success rate, and complications were evaluated. Technical success was defined as a devascularization rate of 75% or higher, and clinical success was defined as intraoperative blood loss (IBL) <1500 mL in cases undergoing surgery within 3 days of transarterial embolization and <3000 mL in cases operated 4 or more days later.

RESULTS

Tumor sizes were in the range of 2.0-13.0 cm (median, 5.0 cm). The devascularization rate was decreased by >75% at follow-up angiography in all cases, and the technical success rate was 100 % (37/37). The median IBL was 491 mL (range, 30-3800 mL), and the clinical success rate was 89% (33/37). The minor complication of local pain was observed in 13 out of 37 cases (35%) during or after embolization, but was controllable by an analgesic.

CONCLUSION

Preoperative transarterial embolization using a gelatin sponge appears to be feasible and safe, and may contribute to decreasing IBL.

New advances in lower gastrointestinal bleeding management with embolotherapy

Lower gastrointestinal bleeding (LGIB) is associated with high morbidity and mortality. Embolization is currently proposed as the first step in the treatment of acute, life-threatening LGIB, when endoscopic approach is not possible or is unsuccessful. Like most procedures performed in emergency setting, time represents a significant factor influencing outcome. Modern tools permit identifying and reaching the bleeding site faster than two-dimensional angiography. Non-selective cone-beam CT arteriography can identify a damaged vessel. Moreover, sophisticated software able to detect the vessel may facilitate direct placement of a microcatheter into the culprit vessel without the need for sequential angiography. A further important aspect is the use of an appropriate technique of embolization and a safe and effective embolic agent. Current evidence shows the use of detachable coils (with or without a triaxial system) and liquid embolics has proven advantages compared with other embolic agents. The present article analyses these modern tools, making embolization of acute LGIB safer and more effective.