Endovascular Embolization by Transcatheter Delivery of Particles: Past, Present, and Future

Sheth, Rahul A.; Sabir, S.; Krishnamurthy, Savitri; Avery, Reginald K.; Zhang, Yu Shrike; Khademhosseini, Ali; Öklü, Rahmi

doi:10.3390/jfb8020012

Cited by 68 publications

(61 citation statements)

References 30 publications

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“…Gelfoam induces foreign body reaction and necrotizing arteritis, resulting in the formation of a thrombus. 25 Gelfoam as a standalone EA provides a temporary vessel occlusion; recanalization typically occurs within 3 weeks to 3 months, but the exact time and the extent cannot reliably be predicted. 23 A combined coils-Gelfoam embolization may be particularly well suited for coagulopathic patients as such vessel occlusion is precise, fast, and permanent.…”

Section: Embolization Agentsmentioning

confidence: 99%

“…The most notable downside of using microspheres is the necessity to intermittently agitate the particle-saline suspension prior to application in order to prevent sedimentation. 18,25,26 Also of note is the fact that microspheres of different manufacturers vary in elasticity and, as a consequence, particles of identical size range but different composition occlude vessels at different levels of the vascular tree. 25,27 NBCA (TruFill, Cordis, Miami Lakes, FL; Histoacryl, B. Braun Aesculap, Tokyo, Japan; Glubran 2, Gem, Viareggio, Lucca, Italy) is a synthetic adhesive liquid EA (glue) that is accompanied by a separately packed tantalum powder, acting as a radiographic opacifier, and ethiodized oil, functioning as a polimerization retardant.…”

Section: Embolization Agentsmentioning

confidence: 99%

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Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma

Langel

Lovrič

Zabret

et al. 2020

Radiology and Oncology

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BackgroundSevere bleeding after blunt maxillofacial trauma is a rare but life-threatening event. Non-responders to conventional treatment options with surgically inaccessible bleeding points can be treated by transarterial embolization (TAE) of the external carotid artery (ECA) or its branches. Case series on such embolizations are small; considering the relatively high incidence of maxillofacial trauma, the ECA TAE procedure has been hypothesized either underused or underreported. In addition, the literature on the ECA TAE using novel non-adhesive liquid embolization agents is remarkably scarce.Patients and methodsPubMed review was performed to identify the ECA TAE literature in the context of blunt maxillofacial trauma. If available, the location of the ECA injury, the location of embolization, the chosen embolization agent, and efficacy and safety of the TAE were noted for each case. Survival prognostic factors were also reviewed. Additionally, we present an illustrative TAE case using a precipitating hydrophobic injectable liquid (PHIL) to safely and effectively control a massive bleeding originating bilaterally in the ECA territories.Results and conclusionsBased on a review of 205 cases, the efficacy of TAE was 79.4–100%, while the rate of major complications was about 2–4%. Successful TAE haemostasis, Glasgow Coma Scale score ≥ 8 at presentation, injury severity score ≤ 32, shock index ≤ 1.1 before TAE and ≤ 0.8 after TAE were significantly correlated with higher survival rate. PHIL allowed for fast yet punctilious application, thus saving invaluable time in life-threatening situations while simultaneously diminishing the possibility of inadvertent injection into the ECA-internal carotid artery (ICA) anastomoses.

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Section: Embolization Agentsmentioning

confidence: 99%

Section: Embolization Agentsmentioning

confidence: 99%

Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma

Langel

Lovrič

Zabret

et al. 2020

Radiology and Oncology

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“…In this review, previous standard ERCP failed in several patients [S10- 13,15,17,22,24,26,36,49]. Embolization by endoscopy was not attempted in any study.…”

Section: Discussionmentioning

confidence: 98%

“…1) or plugs, or solidifying embolic agents such as polymers (ethylene-vinyl alcohol copolymer [EVOH] or n-butyl cyanoacrylate) are all used. 13 The aim of this systematic interdisciplinary review was to analyze all reports on percutaneous embolization of biliary leak to direct nonsurgical interventions (ERCP vs. PBI).…”

mentioning

confidence: 99%

Percutaneous Embolization of Biliary Leaks: A Systematic Interdisciplinary Review and Proposal for a New Classification

Schmitz

Mutignani

Neumann

et al. 2020

Digestive Disease Interventions

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Objectives Biliary leak can be treated by percutaneous biliary embolization. The aim of this systematic interdisciplinary review was to analyze available reports on percutaneous embolization of biliary leak. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach to perform literature database search. The following terms were systematically analyzed: type of embolic agent, success rates, embolization-related adverse events, cause of biliary leak, fistula connection type, anatomic bile duct variants, and access routes. Results Of 713 publications identified, 45 reports with 101 patients were included. Six temporary and 4 permanent embolic agents were used in 55/101 (54.5%) and 46/101 (45.5%) patients; combined in 18/101 patients (17.8%). Bile leak was successfully embolized in 97/101 (96.0%) patients, in 48/101 (47.5%) patients after repeated procedures with the same agent, and in 4/101 (3.9%) patients after a failed embolization with other agents: isolated bile duct fistula (n = 2), intrahepatic fistula after liver resection, and biliary-bronchial fistula. Five types of biliary leak were associated with the following success rates: (A) common bile duct (CBD) or cystic duct: 4/4 (100%); (B) intrahepatic bile duct (IHBD), communicating with CBD: 16/18 (88.9%); (C) isolated IHBD: 49/51 (96%); (D) CBD or cystic duct, bile duct system (BDS) not accessible by endoscopic retrograde cholangiopancreatography (ERCP): 7/7 (100%); and (E) IHBD, communicating with CBD, BDS not accessible by ERCP: 9/9 (100%). Conclusions Embolization was highly successful without clear preference for one embolic agent. A new classification of biliary leak is proposed to direct nonsurgical treatments.

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“…Transcatheter embolization (TE) is a well-established technique in interventional radiology in which an occlusive agent is delivered through a catheter to obstruct flow within a targeted blood vessel (Sheth et al, 2017). Each embolic agent is characterized by its respective strengths and weaknesses and can be used alone or combined with other occlusive agents to enhance its embolic power.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter embolization with Squid, combined with other embolic agents or alone, in different abdominal diseases: a single-center experience in 30 patients

et al. 2019

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Background: Squid, as Onyx, is an ethylene-vinyl alcohol copolymer (EVOH)-based liquid embolic agent developed for neuroradiologic interventions with poor application in abdominal district. Our aim was to evaluate safety, complications, and efficacy of transcatheter embolization using the two available formulations Squid-18 and 12, in 30 patients affected by different abdominal diseases. Results: Transcatheter embolization with Squid, combined with other embolic agents, as poly vinyl alcohol (PVA) particles, coils and amplatzer plugs, or alone (type 2 endoleak), was performed in 30 patients, as follows: 10 portal vein embolizations (PVEs), 6 arteriovenous malformations (AVMs), 5 visceral artery aneurysms (VAAs), 4 type 2 endoleaks, 3 preoperative embolizations, 1 acute arterial bleeding, 1 female varicocele. Squid was always administered using dimethyl sulfoxide (DMSO) compatible microcatheters. Technical success, 30-day clinical success and complications were assessed. Technical success was 90%. 3 patients (2 AVMs, 1 VAA) required re-intervention successfully performed in all cases. Major complications, cases of microcatheter entrapment and DMSO-related poor pain control were not recorded. 30-day clinical success was 93.3%: in 2 patients submitted to PVE a sufficient future liver remnant (FLR) hypertrophy was not achieved. Conclusion:Squid was successfully used with low complication rate in many abdominal diseases showing a valid embolic action either combined with other embolic agents or alone in type 2 endoleak. The availability of different formulations (Squid-18 and Squid-12) variable for viscosity makes Squid preferable to Onyx as EVOH-based liquid embolic agent, even though comparable studies in different abdominal districts with a larger cohort of patients will be necessary.

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Endovascular Embolization by Transcatheter Delivery of Particles: Past, Present, and Future

Cited by 68 publications

References 30 publications

Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma

Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma

Percutaneous Embolization of Biliary Leaks: A Systematic Interdisciplinary Review and Proposal for a New Classification

Transcatheter embolization with Squid, combined with other embolic agents or alone, in different abdominal diseases: a single-center experience in 30 patients

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