Endovascular Treatment of 12 Cases of Renal Arteriovenous Malformations: The Experience of 1 Center and an Overview of the Literature

2017 ◽  
Vol 52 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Zhen-Yu Jia ◽  
Chun-Gao Zhou ◽  
Jin-Guo Xia ◽  
Lin-Bo Zhao ◽  
Wen Zhang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Malformations ◽  
Clinical Success ◽  
Vascular Diseases ◽  
Arterial Embolization ◽  
Renal Arteries ◽  
Proximal Portion ◽  
Technical Success ◽  
Treatment Techniques ◽  
Embolic Materials

Objectives: Congenital renal arteriovenous malformations (rAVMs) represent rare vascular diseases. The heterogeneous vascular architecture of each rAVM determines the endovascular treatment techniques employed. We reported our experience with the endovascular treatment of a series of rAVMs. Materials: This retrospective study consisted of 12 patients with 12 rAVMs who underwent renal arterial embolization (RAE) in our hospital. Embolic materials, including particles, liquid embolic agents (n-butyl 2-cyanoacrylate, Onyx, and ethanol), and coils, were selectively used based on the decisions of interventional radiologists. Technical success was defined as the complete occlusion of the feeding arteries and nidus on postprocedure renal arteriography. Clinical success was defined as the resolution of hematuria or the disappearance of rAVM-relevant symptoms. Results: The median follow-up period was 13.5 months (range: 4-72). The technical success based on 12 procedures in 12 patients was 83.3% (10 of 12). In the 2 procedures that technically failed, the existence of multiple fine feeding arteries arising from the proximal portion of different segmental renal arteries explains the incomplete embolization. One of the 2 patients achieved clinical success without additional RAE. The other patient had recurrent hematuria 25 months after initial treatment, which was successfully managed conservatively with hemostatic agents. Thus, the clinical success was 91.7% (11 of 12). Conclusions: Renal artery embolization with the selective use of various embolic materials is an effective treatment for patients with rAVMs. The existence of multiple fine feeding vessels arising from the proximal portion of different segmental renal arteries is likely to affect the technical success of treatment.

scholarly journals Urgent Transcatheter Arterial Embolization for Wunderlich Syndrome With Hypovolemic Shock Secondary to Ruptured Renal Angiomyolipoma

2021 ◽  
Vol 8 ◽  
Author(s):  
Maofeng Gong ◽  
Zhengli Liu ◽  
Haobo Su ◽  
Boxiang Zhao ◽  
Jie Kong ◽  
...  
Keyword(s):  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Hypovolemic Shock ◽  
Arterial Embolization ◽  
Renal Angiomyolipoma ◽  
Technical Success ◽  
Embolic Agents ◽  
Nontarget Embolization ◽  
Glubran 2 ◽  
Embolic Materials

Purpose: Wunderlich syndrome (WS) with hypovolemic shock secondary to ruptured renal angiomyolipoma (rAML) represents an urgent condition. Hence, we reported our experience with transcatheter arterial embolization (TAE) using different embolic materials under this condition.Methods: This retrospective study consisted of 22 patients. Embolic materials including particles, microcoils, and liquid embolic agents were selectively used based on the decisions of interventional radiologists. Technical success was defined as the complete occlusion of bleeding vessels on the final renal angiogram. Clinical success was defined as the absence of re-hemorrhage needed for repeat endovascular or surgery treatment after TAE.Results: The articulated materials were used when WS presented without aneurysms; a combination of particulate materials and microcoils or Glubran 2 alone were used for WS with aneurysms. The technical success based on 24 episodes of TAEs in 22 patients was 100% (24 of 24). Repeat TAE was achieved in two patients with hemorrhages re-occurring two days after the initial embolization with microcoils alone. The clinical success was 90.9% (20 of 22). No nontarget embolization or embolization-related complications occurred during the TAE procedure. Of the patients, 27.3% (6 of 22) experienced minor complications of post-embolization syndrome (PES). During a median follow-up time of 34 months, no recurrent hemorrhage that required repeat endovascular or surgical treatment for hemostasis occurred.Conclusion: Urgent TAE with the selective use of different embolic materials is an effective alternative to control WS with hypovolemic shock secondary to ruptured rAML. The condition of presenting with or without aneurysms may determine the embolic materials employed.

Endovascular management of vascular renal injuries: outcomes and comparison between traumatic and iatrogenic settings

2021 ◽  
pp. 039156032110178
Author(s):  
Fabio Salvatori ◽  
Marco Macchini ◽  
Marzia Rosati ◽  
Pietro Boscarato ◽  
Salvatore Alborino ◽  
...  
Keyword(s):  
Renal Function ◽  
Endovascular Treatment ◽  
Clinical Success ◽  
Technical Success ◽  
Group I ◽  
Embolic Agents ◽  
Iatrogenic Damage ◽  
Embolic Materials ◽  
Venous Fistula ◽  
Renal Injuries

Purpose: To evaluate the efficacy of endovascular treatment for vascular renal injuries (VRIs) like bleeding, pseudoaneurysm and artero-venous fistula (AVF) and to compare patients with blunt trauma (T-VRIs) with those with iatrogenic damage (I-VRIs). Methods: We retrospectively assessed 49 renal artery embolizations performed to treat T-VRIs (26.5%) and I-VRIs (73.5%). Different embolic materials were used based on the type of lesion. Technical success was defined as the complete occlusion of target arteries with no further visualization of VRIs. Clinical success was defined if no recurrence was present and if renal function (difference between creatinine after and before treatment <0.5 mg/dl) was preserved after 1 month. Results: Angiography showed bleeding in 27 patients, pseudoaneurysm in 29 and an AVF in 6. Embolic agents used were coils in 39 procedures, coils with sponge in four and others in six. Technical success was 100% while clinical success was 85.7% due to seven patients with recurrence. The group I-VRIs showed a higher rate of clinical success than the group T-VRIs (94.4% vs 61.5%; p < 0.05). Moreover, the group I-VRIs had a higher incidence of pseudoaneurysms and AVFs compared with the group T-VRIs (69.4% vs 30.8% and 16.7% vs 0%; p < 0.05). Conclusion: Endovascular treatment for VRIs showed satisfactory results and no patient had a worsening of renal function. I-VRIs had better clinical success and more frequently appeared as pseudoaneurysms compared to T-VRIs: probably iatrogenic injury is localized and pseudoaneurysm is easily identifiable and treatable with endovascular treatment.

scholarly journals Renal artery embolization for iatrogenic renal vascular injuries management: 5 years’ experience

2020 ◽  
Vol 93 (1106) ◽  
pp. 20190256 ◽  
Author(s):  
Andrea Contegiacomo ◽  
Enrico Maria Amodeo ◽  
Alessandro Cina ◽  
Carmine Di stasi ◽  
Roberto Iezzi ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Renal Artery ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Vascular Injuries ◽  
Technical Success ◽  
Artery Embolization ◽  
Renal Artery Embolization ◽  
Embolic Materials ◽  
Renal Vascular

Objective: Evaluate the efficacy and safety of renal artery embolization (RAE) for iatrogenic renal vascular injuries (IRVI) management at Fondazione Policlinico Universitario "A. Gemelli" IRCCS, in the last 5 years. Methods: Retrospective analysis of all RAE procedures performed from January 2013 to December 2017. Patients-related (age, sex, vascular variants, hemoglobin and serum creatinine), IRVI-related (type and vascular level of IRVI, presence and extension of hematoma), management-related (temporal interval between diagnostic imaging and RAE) and procedure-related (embolic materials, technical success, clinical success and complications) parameters were evaluated. Results: 28 RAE procedures performed on 28 patients (21 males; 7 females) were included. 19/28 patients had pseudoaneurysm, 7/28 active bleeding and 1/28 arteriovenous fistula; 4/28 patients had a combination of 2 IRVI. The extent of perirenal hematoma showed correlation with the cause of IRVI (p = 0.028). Technical success was achieved in all patients whereas clinical success in 25/28 (89.3%), with 3 patients requiring re-treatment. Minor complications were observed during 2/28 (7.1%) endovascular procedures. No major complications occurred. A longer procedural time was observed in patients with lower pre-procedural levels of hemoglobin (p = 0.016). No differences were found in mean serum creatinine (p = 0.23) before and immediately after treatment, while values of creatinine at 1 week from the procedure were significantly lower (p = 0.04). Conclusion: RAE is safe and effective for the management of iatrogenic IRVI showing high technical and clinical success rate and low complication rate. Advances in knowledge: Low pre-procedural hemoglobin levels increase procedural duration time. Glue alone or in combination with other materials is as safe as coils.

scholarly journals Prolonged international normalized ratio and vascular injury at divisional level predict embolization failures of patients with iatrogenic renal vascular injuries

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Shen-Yang Lee ◽  
Mei-Lin Wang ◽  
Yon-Cheong Wong ◽  
Cheng-Hsian Wu ◽  
Li-Jen Wang
Keyword(s):  
Vascular Injury ◽  
Clinical Success ◽  
Arterial Embolization ◽  
International Normalized Ratio ◽  
Technical Failure ◽  
Clinical Failure ◽  
Technical Success ◽  
Inadequate Information ◽  
Renal Function Deterioration ◽  
Renal Vascular

AbstractTranscatheter arterial embolization (TAE), as an alternative to surgery for iatrogenic renal vascular injury (IRVI), may have unsatisfactory outcomes. Nonetheless, there is inadequate information regarding the predictors of TAE outcomes for IRVI in the literature. The aim of this retrospective study was to investigate the predictors of TAE outcomes for IRVI. Of 47 patients, none had major complications, 17 (36.2%) patients had minor complications, and none suffered significant renal function deterioration after TAE. Technical success and clinical success were 91.5% and 93.6%, respectively. Technical failure was associated with older age, thrombocytopenia, prolonged international normalized ratio (INR) and divisional IRVI. Clinical failure was associated with kidney failure, use of steroids, prolonged INR, and divisional IRVI. In addition, prolonged INR was a significant predictor of technical failure. This implies that aggressive measures to control the INR prior to TAE are warranted to facilitate technical success, and technical success could then be validated on post-TAE images. Furthermore, divisional IRVI was a predictor of clinical failure. Thus, divisional IRVI should undergo surgery first since TAE is prone to clinical failure. The avoidance of clinical failure is validated if divisional IRVI does not need further intervention.

scholarly journals Transcatheter arterial embolization for massive hemobilia with N-butyl cyanoacrylate (NBCA) Glubran 2

2021 ◽  
pp. 028418512199297
Author(s):  
Yadong Shi ◽  
Liang Chen ◽  
Boxiang Zhao ◽  
Hao Huang ◽  
Zhaoxuan Lu ◽  
...  
Keyword(s):  
Transcatheter Arterial Embolization ◽  
Coil Embolization ◽  
Treatment Time ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Technical Success ◽  
Promising Alternative ◽  
Major Complications ◽  
Glubran 2

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.

scholarly journals Báo cáo 9 trường hợp can thiệp nội mạch bệnh nhân tiểu máu tại Bệnh viện Trung ương Huế.

2020 ◽  
Author(s):  
Duy Cát Lê
Keyword(s):  
Transcatheter Arterial Embolization ◽  
Arteriovenous Malformations ◽  
Arterial Embolization ◽  
Endovascular Embolization ◽  
Central Hospital ◽  
Arteriovenous Fistulas ◽  
Endovascular Interventions ◽  
Ureteral Fistula ◽  
Embolic Materials ◽  
Recurrent Hematuria

APPLICATIONS ENDOVASCULAR EMBOLIZATION FOR PERSISTENT HEMATURIA AT HUE CENTRAL HOSPITAL: NINETEEN CASES SERIES Background: Due to an induced arterio-ureteral fistula is very common after a renal partial surgery, traumatic, biopsy, arteriovenous malformations (AVM), arteriovenous fistulas (AVF). Endovascular interventions include a variety of methods and embolic materials of different circuit nodes for the purpose of completely vascular embolization causing extravasation or reduce the size of the AVM, AVF and False aneurysms, minimizing complications and recurrence. Patient and Method: Nineteen patients were performed the transcatheter arterial embolization (TAE) in Hue central hospital from 10 /2013 to 12 /2018, 19 cases had persistent hematuria. Results: All had excluded extravasation after embolization, no recurrent hematuria. Conclusion: Applications endovascular embolization in persistent hematuria is an effective and safe therapeutic method, it can be widely apply. Keywords: Intravascular intervention, prolonged hematuria

scholarly journals MVP (Micro Vascular Plug®) Embolization Experience on 104 Patients: How to Select to Proper Model and Avoid Technical Failures

2021 ◽  
Author(s):  
Francesco Giurazza ◽  
Anna Maria Ierardi ◽  
Andrea Contegiacomo ◽  
Fabio Corvino ◽  
Gianpaolo Carrafiello ◽  
...  
Keyword(s):  
Clinical Success ◽  
Anticoagulation Therapy ◽  
Arterial Embolization ◽  
Vascular Pathology ◽  
Emergency Setting ◽  
Technical Success ◽  
Vascular Plug ◽  
Vessel Occlusion ◽  
Landing Zone ◽  
Peripheral Arterial

Abstract Aim: To describe a three years experience of peripheral arterial embolization with Micro Vascular Plug (MVP) (Medtronic, USA).Materials and methods: 116 MVP have been released in 104 patients (67 males and 37 females; mean age 61.3 years). The pullback release technique was adopted in each case. The following parameters were investigated: angiographic appearance of the vascular injury, anticoagulation therapy at time of procedure, district, caliper of the target artery, course of the landing zone, additional embolics, technical and clinical success.Technical success was defined as complete embolization without deployment of additional embolics.Primary clinical success was considered as hemodynamic stability in emergency setting and resolution of the underlying vascular pathology in elective cases; secondary clinical success was considered clinical success after a second embolization session.Results: Vessel occlusion was achieved in 78 patients after MVP release, while in 26 subjects additional embolics were required; the overall technical success was 75%. Primary clinical success was 96.1%.MVP was oversized between 30% and 40% compared to the target vessel caliper; MVP-3 and MVP-5 were the most frequently adopted in this sampleNo statistical differences in terms of effectiveness were observed among patients assuming anticoagulation. A straight and longer landing zone were statistically associated with higher technical success compared to a curved and a shorter ones, respectively. No clinically adverse events directly related to MVP device occurred; in 3 cases migration was registered without clinical complications.Conclusion: MVP is a safe and effective embolic device. Oversizing is recommended. While eventual concomitant anticoagulation therapy did not influence the technical outcome, straight course and length of the landing zone are essential parameters to evaluate before deployment.

Endovascular treatment of obstructive iliac artery dissections

2005 ◽  
Vol 46 (4) ◽  
pp. 359-365 ◽  
Author(s):  
B. Önal ◽  
E. T. Ilgit ◽  
S. Akpek ◽  
G. Erbas ◽  
A. Akkaya
Keyword(s):  
Endovascular Treatment ◽  
Iliac Artery ◽  
Clinical Success ◽  
Symptom Relief ◽  
False Lumen ◽  
Complete Relief ◽  
Technical Success ◽  
Technical Success Rate ◽  
Presenting Symptoms

Purpose: To report our results from a study of the endovascular treatment of flow restricting chronic atherosclerotic or catheter‐induced segmental iliac artery dissections with bare stents. Material and Methods: Thirty symptomatic patients with 32 lesions, including chronic atherosclerotic ( n = 21) and catheter‐induced ( n = 11) segmental arterial dissections, were treated with primary stenting. The common iliac artery was involved in 19 lesions and the external iliac artery in the remaining 13. Two patients had two lesions in the same vessel. Technical success was defined as restoration of the smooth contoured luminal patency with no more than 20% residual stenosis in diameter in atherosclerotic dissections associated with plaque formation or total obliteration of the false lumen in catheter‐induced dissections. Complete relief of, or marked improvements in, presenting symptoms, or at least single category improvement, was assessed for clinical success. Results: Technical success rate was 100%. No procedure‐related complications such as distal emboli or early occlusions were observed. Complete symptom relief was achieved in all patients with catheter‐induced dissection and in all but three cases with chronic spontaneous atherosclerotic dissection. In two cases, occlusion of the stents occurred during the follow‐up period. Clinical and radiological mean follow‐up for 24 months (range 3–55) revealed patency of all other stented segments. Cumulative primary patency rate was 97% over 12 months and 90% over 24 months. Conclusion: Endovascular treatment of chronic atherosclerotic and catheter‐induced short obstructive iliac arterial dissections with bare stents is safe and effective. Patency of the diseased arterial segment with a smooth lumen can be sustained for an extensive period.

scholarly journals Use of microspheres in embolization for unruptured renal angiomyolipomas

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 655-659
Author(s):  
Masashi Shimohira ◽  
Keiichi Nagai ◽  
Kengo Ohta ◽  
Yusuke Sawada ◽  
Taku Naiki ◽  
...  
Keyword(s):  
Success Rate ◽  
Complication Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
Major Complication ◽  
Shrinkage Rate ◽  
Technical Success ◽  
Technical Success Rate ◽  
Major Complication Rate

Abstract Purpose To describe our initial experience with use of microspheres in transcatheter arterial embolization (TAE) for unruptured sporadic renal angiomyolipomas (AMLs). Materials and methods Seven consecutive patients with seven unruptured sporadic renal AMLs, 6 females and 1 male, with a median age of 45 years (range, 30–69 years), underwent TAE using microspheres between November 2016 and February 2020. We evaluated the technical success rate, complications related to the procedure, clinical success rate, and the shrinkage rate of renal AML. Technical success was defined as the completion of TAE. Clinical success was defined as presence of shrinkage of the renal AML after TAE. Results In all patients, TAE using microspheres was accomplished and technical success rate was 100% (7/7). Three patients exhibited slight pain, but it improved with only observation, and the minor complication rate was 43% (3/7) and major complication rate was 0% (0/7). After the TAE, shrinkage of renal AML was confirmed in 6 of 7 patients, and clinical success rate was 86% (6/7). The median of shrinkage rate was 47% (range, 26–83%) with a median follow-up period of 19 months (range, 4–30 months). Conclusion TAE using microspheres appears to be effective and safe for unruptured sporadic renal AMLs.

scholarly journals Embolization with MVP (Micro Vascular Plug®): experience on 104 patients in emergent and elective scenarios

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Francesco Giurazza ◽  
Anna Maria Ierardi ◽  
Andrea Contegiacomo ◽  
Fabio Corvino ◽  
Giampaolo Carrafiello ◽  
...  
Keyword(s):  
Clinical Success ◽  
Anticoagulation Therapy ◽  
Arterial Embolization ◽  
Vascular Pathology ◽  
Embolic Agent ◽  
Emergency Setting ◽  
Technical Success ◽  
Vascular Plug ◽  
Landing Zone ◽  
Clinical Complications

Abstract Aim To describe a 3 years experience of peripheral arterial embolization with Micro Vascular Plug (MVP) (Medtronic, USA). Materials and methods The following parameters were investigated: type of vascular injury, anticoagulation therapy at time of procedure, anatomical district, caliper of the target artery, course of the landing zone, additional embolics, technical and clinical success, device related clinical complications. Technical success was defined as complete embolization without deployment of additional embolics after MVP release. Primary clinical success was considered as hemodynamic stability in emergency setting and resolution of the underlying vascular pathology in elective cases; secondary clinical success was considered clinical success after a second embolization session. Results 116 MVP have been released in 104 patients (67 males and 37 females; mean age 61.3 years). The pullback release technique was adopted in each case. 85 patients were treated in emergent settings while in 19 patients the procedure was scheduled. The overall technical success was 75%. Primary clinical success was 96.1%, secondary clinical success 3% and clinical failure 0.9%. No statistical differences in terms of effectiveness were observed among patients assuming anticoagulation (p-value = 0.6). A straight and longer landing zone were statistically associated with higher technical success compared to curved and shorter ones, (p-values < 0.001 and = 0.048 respectively). MVP-3 and MVP-5 were the most frequently adopted models in this sample, in 29.8% and 49% of the patients respectively. No clinically adverse events directly related to MVP occurred; in 3 cases device migration was registered without clinical complications. Conclusion MVP is a safe and effective embolic agent. While eventual concomitant anticoagulation therapy did not influence the technical outcome, straight course and length of the landing zone are essential parameters to evaluate before deployment.

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