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.

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

2020 ◽  
Author(s):  
Yadong Shi ◽  
Liang Chen ◽  
Boxiang Zhao ◽  
Jianping Gu ◽  
Hao Huang ◽  
...  
Keyword(s):  
Transcatheter Arterial Embolization ◽  
Coil Embolization ◽  
Treatment Modality ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Cystic Artery ◽  
Technical Success ◽  
Promising Alternative ◽  
Glubran 2

Abstract Background Massive hemobilia is a life-threatening scenario and therapeutic challenge. This study aimed to investigate the efficacy and safety of transcatheter arterial embolization (TAE) using N-butyl cyanoacrylate (NBCA) Glubran 2 for massive hemobilia with arterial injuries. Methods From January 2014 to February 2019, 12 patients (mean age, 63.2 ± 12 years) with massive hemobilia were retrospectively evaluated for TAE using NBCA Glubran 2. Patient 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 of the right hepatic artery (n = 10), and cystic artery (n = 2). Initial coil embolization distal to the lesions was required in 4 (33.3%) patients to control the high blood flow and prevent end-organ damage. After a mean treatment time of 10.1 ± 5.5 min, technical success was achieved in 100% of the patients without non-target embolization and catheter adhesion. Clinical success was achieved in 11 (91.7%) patients. Major complication was noted in 1 (8.3%) patient with gallbladder necrosis owing to embolization of the cystic artery. During a median follow-up time of 16 months (range, 6–36 months), one patient died owing to carcinoma, whereas no patient encountered recurrent hemobilia, embolic material migration or post-embolization complications. Conclusions TAE using NBCA Glubran 2 is a rapid, effective, and safe treatment modality for massive hemobilia. This treatment modality may be reserved as a promising alternative option to coil embolization.

scholarly journals Transcatheter arterial embolization for unruptured renal angiomyolipoma using a 1.8-Fr tip microballoon catheter with a mixture of ethanol and Lipiodol

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Kosuke Tomita ◽  
Tomohiro Matsumoto ◽  
Shunsuke Kamei ◽  
Shota Yamamoto ◽  
Satoshi Suda ◽  
...  
Keyword(s):  
Success Rate ◽  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
Renal Angiomyolipoma ◽  
Technical Success ◽  
Technical Success Rate ◽  
Median Volume ◽  
Estimated Glomerular Filtration Rates

Abstract Background To evaluate the efficacy and safety of transcatheter arterial embolization for renal angiomyolipoma using a 1.8-French tip microballoon catheter and a mixture of ethanol and Lipiodol. Methods Seven consecutive patients with total of eight angiomyolipomas underwent this procedure between June 2014 and June 2017. A 1.8-French tip microballoon catheter was advanced to the feeding artery of the angiomyolipoma, and transcatheter arterial embolization was performed with a mixture of ethanol and Lipiodol under microballoon inflation. We retrospectively evaluated the characteristics of angiomyolipomas, technical success rate, clinical success rate, renal function, and adverse events. Technical success and clinical success were defined as complete embolization of all feeding arteries and reduction of tumor size, respectively. Results The median size of the angiomyolipomas was 46 mm (range, 40–64 mm). Transcatheter arterial embolization was successful in all eight angiomyolipomas. The median volume of the mixture of ethanol and Lipiodol was 6.0 ml (range, 2.0–14 ml). The median ratio of ethanol to Lipiodol was 71% (range, 71–75%). All eight angiomyolipomas shrank with a median shrinkage rate of 34% in diameter (range, 9–63%) and 77% in volume (range, 48–94%). The median follow-up period was 13 months (range, 9–54 months). Clinical success was achieved in all cases. Serum creatinine concentrations and the pre- and post-procedural estimated glomerular filtration rates did not change notably, and there were no major complications. Conclusion Transcatheter arterial embolization for renal angiomyolipoma using a 1.8-French tip microballoon catheter with a mixture of ethanol and Lipiodol is effective and safe.

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.

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 Transcatheter Arterial Embolization in Acute Non-Variceal Gastrointestinal Bleedings: A Ten-Year Single-Center Experience in 91 Patients and Review of the Literature

2021 ◽  
Vol 10 (21) ◽  
pp. 4979
Author(s):  
Federico Fontana ◽  
Filippo Piacentino ◽  
Christian Ossola ◽  
Andrea Coppola ◽  
Marco Curti ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Clinical Success ◽  
Therapeutic Option ◽  
Arterial Embolization ◽  
Gelatin Sponge ◽  
Technical Success ◽  
Single Center Experience ◽  
Embolic Agents ◽  
Upper Gastrointestinal

Objective: To report the safety and efficacy of trans-arterial embolization (TAE) for upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB) due to different etiologies in 91 patients for ten years. Methods: A retrospective analysis of GIB treated between January 2010 and December 2020 was performed. TAE was performed using different embolic agents (coils, particles, glue, gelatin sponge, and EVOH-based agents). Technical success, secondary technical success, clinical success, and complications were evaluated. Results: Technical success was achieved in 74/91 (81.32%) patients. Seventeen patients (18.68%) required re-intervention. Secondary technical success was achieved in all cases (100.0%). Clinical success was achieved in 81/91 patients (89.01%). No major complications were recorded; overall, minor complications occurred in 20/91 patients. Conclusions: TAE is a technically feasible and safe therapeutic option for patients with GIB from a known or blind anatomic source where endoscopic therapy has failed or is deemed unfeasible.

scholarly journals Endovascular Therapy of Severe Non-Variceal Gastrointestinal Bleeding – One Decade Experience.

2021 ◽  
Author(s):  
Martin Vorčák ◽  
Ján Sýkora ◽  
Martin Ďuriček ◽  
Peter Bánovčin ◽  
Marian Grendár ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Endovascular Embolization ◽  
Favorable Outcome ◽  
Recurrent Bleeding ◽  
Clinical Effects ◽  
Technical Success ◽  
Technical Success Rate

Abstract Introduction Severe non-variceal gastrointestinal bleeding is a life-threatening condition with complicated treatment if endoscopic rescue fails. In that case, transcatheter arterial embolization is recommended to stop the bleeding. The technical and clinical effects of this technique were analyzed in this group of patients, as well as its complication rate and 30-day mortality.Method Patient data of the one-decade period (from 2010 to 2019) were analyzed retrospectively. Twenty-seven patients (18 men and nine women, median age 61 years) treated by endovascular embolization in our institution with clinically significant gastrointestinal hemorrhage after unsuccessful or impossible endoscopic treatment were identified.Results The source of bleeding was found in 88% of patients, but embolization was performed in 96% of them. The technical success rate in the sample was 100%, and the clinical favorable outcome rate was 88.5%. The bleeding recurrence occurred in eight cases, five of whom had technically successful re-embolization in four cases. The incidence of recurrent bleeding was significantly higher in patients with two or more comorbidities with (p = 0.043). There was one serious complication (4%) in the group and minor difficulties occurred in 18% of patients; 30-day mortality reached 22%. Mortality was significantly higher in the group of patients with re-bleeding (p = 0.044).Discussion Our documented results in common are in the established rank of previously published results, which range from 62-100% for technical success, 52-94% for the clinical favorable outcome, 9-66% for re-bleeding and 4-46% for 30-day mortality.Conclusion Transcatheter arterial embolization is a safe mini-invasive method with high technical and clinical success in patients with endoscopically untreatable gastrointestinal bleeding. It is also suitable for high-risk cases. Mortality (to a significant extent) typically depends on the re-bleeding presence and the patient's comorbidity.

scholarly journals Transcatheter Arterial Embolization with N-butyl-2 Cyanoacrylate Glubrans 2 for the Treatment of Acute Renal Hemorrhage Under Coagulopathic Condition

2020 ◽  
Author(s):  
Maofeng Gong ◽  
Xu He ◽  
Boxiang Zhao ◽  
Jie Kong ◽  
Tao Wang ◽  
...  
Keyword(s):  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Hemodynamic Instability ◽  
Attractive Alternative ◽  
Safe Alternative ◽  
Renal Hemorrhage ◽  
Active Hemorrhage ◽  
Significant Difference

Abstract Background:The efficacy and safety of transcatheter arterial embolization (TAE) using the N-butyl-2 cyanoacrylate (NBCA) Glubran2 in the treatment of acute renal hemorrhage (RH) under coagulopathic conditionsarestill no consensus.Methods: Between February 2014 and June 2019, 8 patients underwent TAE with the NBCA Glubran2 for acute RH under coagulopathic conditions. Coagulopathy was defined as abnormal values of prothrombin time and activated partial thromboplastin time and/or a reduced platelet count.Angiograms and medical records were retrospectively reviewed to determine technical/clinical success, complications and recurrent hemorrhage after TAE, and follow-up outcomes were assessed.Results: Of note, one patient presented with severe coagulopathy, and three presented with severe RH and hemodynamic instability. The NBCA Glubran2 was employed as a sole embolic material in sixpatients. In the remaining two patients, it was employed for secondary embolization.Under coagulopathic conditions, due to the use of the NBCA Glubran2, both technical success and clinical success for acute RH were achieved in all patients. Duringa mean follow-up time of 30.1 months (range, 3-84 months), neither persistent nor recurrent active hemorrhage required repeat endovascular or surgical treatment for hemostasis. No Glubran2related complications occurred mid-TAE pro-cedure. In addition, renal function information was available for all patients, and there was no significant difference between the serum creatinine levels [(83.8 ± 15.5) vs (85.8 ± 32.2) μmol/L] before and one week after Glubran2 embolization (p=0.89; CI, -34.5 to 30.5).Conclusions: The present findings suggest that TAE with the NBCA Glubran2 may be a safe alternative treatment for the management of RH under coagulopathic conditions. In particular, this method appears to be a potentially attractive alternative when con-ventional embolic materials fail in patients with ongoing hemodynamic instability or even under severe coagulopathic conditions.

scholarly journals Selective Arterial Embolization of Renal Angiomyolipoma: Efficacy, Tumor Volume Reduction and Complications

2021 ◽  
Vol 73 (5) ◽  
Author(s):  
Walailak Chaiyasoot ◽  
Jirawadee Yodying ◽  
Thanita Limsiri
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Three Dimensional ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
P Value ◽  
Renal Angiomyolipoma ◽  
Tumor Rupture ◽  
Selective Arterial Embolization ◽  
Density Histogram

Objective: To evaluate the efficacy and complications of selective arterial embolization in renal angiomyolipoma and to identify predictive factors for tumor rupture.Materials and Methods: Overall, 21 patients with 25 renal angiomyolipoma (AML) underwent selective arterial embolization (SAE) between January 2008 and June 2019, comprising 15 cases involving prophylaxis embolization of a tumor >4 cm diameter and 10 involving embolization for a ruptured tumor. Multidetector computed tomography (MDCT) was performed pre- and post-SAE, using the 2D tumor diameter in the ruptured AMLs. Three-dimensional volumetry and density histogram were performed for determining the total tumor volume, fat, and angiomyogenic component reduction in the unruptured AMLs. The predictive factors for tumor rupture, the treatment outcome and complications were analyzed. Results: The clinical success rate was 84% (21/25 cases) and the technical success rate was 96% (24/25 cases). The 3D volume post-SAE within 1-3 months showed a greater decrement of the enhanced angiomyogenic component than the fat component, with median percentages of -62.2% and -18.4%, respectively (p-value = 0.333). Minor complications were post-embolization syndrome (5 case, 20%) and minimal renal infarction (4 cases, 16%). Renal abscesses were the major complications (3 cases, 12%). A factor associated with tumor rupture was the presence of an intra-tumoral aneurysm (p-value < 0.05).Conclusion: SAE is an effective treatment for renal AML with a high technical and clinical success rate and limited complications. Three-dimensional volume measurement and density histogram analysis might be better tools than two-dimensional CT to evaluate post-SAE response, which is crucial for management planning.

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.

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