scholarly journals Endovascular Use of Cyanoacrylate-Lipiodol Mixture for Peripheral Embolization: Properties, Techniques, Pitfalls, and Applications

2021 ◽  
Vol 10 (19) ◽  
pp. 4320
Author(s):  
Pierre-Olivier Comby ◽  
Kévin Guillen ◽  
Olivier Chevallier ◽  
Marc Lenfant ◽  
Julie Pellegrinelli ◽  
...  
Keyword(s):  
Vascular Diseases ◽  
Mechanisms Of Action ◽  
Endovascular Embolization ◽  
Polymerization Rate ◽  
Target Vessel ◽  
Vascular Abnormalities ◽  
Endovascular Interventions ◽  
Peripheral Embolization ◽  
Embolic Agents ◽  
Ethiodized Oil

Endovascular embolization agents are particles and fluids that can be released into the bloodstream through a catheter to mechanically and/or biologically occlude a target vessel, either temporarily or permanently. Vascular embolization agents are available as solids, liquids, and suspensions. Although liquid adhesives (glues) have been used as embolic agents for decades, experience with them for peripheral applications is generally limited. Cyanoacrylates are the main liquid adhesives used for endovascular interventions and have a major role in managing vascular abnormalities, bleeding, and many vascular diseases. They can only be injected as a mixture with ethiodized oil, which provides radiopacity and modulates the polymerization rate. This review describes the characteristics, properties, mechanisms of action, modalities of use, and indications of the cyanoacrylate-Lipiodol® combination for peripheral embolization.

Contrast-enhanced ultrasound of the abdominal aorta – current status and future perspectives

VASA ◽  
2019 ◽  
Vol 48 (2) ◽  
pp. 115-125 ◽  
Author(s):  
Xin Li ◽  
Daniel Staub ◽  
Vasileios Rafailidis ◽  
Mohammed Al-Natour ◽  
Sanjeeva Kalva ◽  
...  
Keyword(s):  
Real Time ◽  
Vascular Diseases ◽  
Aneurysm Rupture ◽  
Vasa Vasorum ◽  
Current Status ◽  
Contrast Enhanced Ultrasound ◽  
Aortic Diseases ◽  
Cross Sectional ◽  
Vascular Abnormalities ◽  
Contrast Enhanced

Abstract. Ultrasound has been established as an important diagnostic tool in assessing vascular abnormalities. Standard B-mode and Doppler techniques have inherent limitations with regards to detection of slow flow and small vasculature. Contrast-enhanced ultrasound (CEUS) is a complementary tool and is useful in assessing both the macro- and microvascular anatomy of the aorta. CEUS can also provide valuable physiological information in real-time scanning sessions due to the physical and safety profiles of the administered microbubbles. From a macrovascular perspective, CEUS has been used to characterize aortic aneurysm rupture, dissection and endoleaks post-EVAR repair. With regard to microvasculature CEUS enables imaging of adventitial vasa vasorum thereby assessing aortic inflammation processes, such as monitoring treatment response in chronic periaortitis. CEUS may have additional clinical utility since adventitial vasa vasorum has important implications in the pathogenesis of aortic diseases. In recent years, there have been an increasing number of studies comparing CEUS to cross-sectional imaging for aortic applications. For endoleak surveillance CEUS has been shown to be equal or in certain cases superior in comparison to CT angiography. The recent advancement of CEUS software along with the ongoing development of drug-eluting contrast microbubbles has allowed improved targeted detection and real-time ultrasound guided therapy for aortic vasa vasorum inflammation and neovascularization in animal models. Therefore, CEUS is uniquely suited to comprehensively assess and potentially treat aortic vascular diseases in the future.

scholarly journals Embolic Protection in Complex Femoropopliteal Interventions: Safety, Efficacy and Predictors of Filter Macroembolization

2020 ◽  
Author(s):  
Michael Czihal ◽  
Zeynep Findik ◽  
Christoph Bernau ◽  
Max Seidensticker ◽  
Jens Ricke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Balloon Angioplasty ◽  
Critical Limb Ischaemia ◽  
Lesion Length ◽  
Limb Ischaemia ◽  
Distal Embolization ◽  
Embolic Protection ◽  
Endovascular Interventions ◽  
Directional Atherectomy ◽  
Peripheral Embolization

Abstract Objectives To evaluate the safety and efficacy of a filter embolic protection device (FEPD) in endovascular interventions of the femoropopliteal arteries. Methods Patients who underwent endovascular interventions of the femoropopliteal arteries between 2008 and 2016 and in whom the SpiderFXTM FEPD was applied were included in this retrospective study. Clinical and angiographic characteristics, filter macroembolization (FME), device-related complications, distal embolization, as well as the early clinical and hemodynamic outcome, were assessed. Potential risk factors for FME were evaluated by multivariate analysis. Results A total of 244 cases were identified (203 patients, claudication 60.4%, critical limb ischaemia 39.6%, mean lesion length 13.2 ± 12.9 cm, complete occlusions in 72.7%). Balloon angioplasty ± stenting (BAP), directional atherectomy ± balloon angioplasty ± stenting (DA) and rotational thrombectomy ± balloon angioplasty ± stenting (RT) were performed in 141, 61 and 42 cases, respectively. FEPD placement and retrieval were successful in all but one case each. Permanent filter-related vessel damage was not observed. The rate of FME was 37.3% (BAP 36.2%, DA 32.8%, RT 47.7%). Risk factors for FME in the BAP- and DA-group were total occlusion, lesion length > 19 cm, visible thrombus and diabetes mellitus. The distal embolization rate despite filter protection was 4.1 % (BAP 4.9%, DA 1.6%, RT 4.8%) and was higher in cases with FME compared with those without FME (8.7% vs. 1.5%, p = 0.02). Conclusion The Spider FXTM device is safe and effective in capturing embolic debris during femoropopliteal interventions. A residual risk of peripheral embolization remains. Level of Evidence III, Cohort study

scholarly journals Endovascular management of spinal dural arteriovenous fistulas

2009 ◽  
Vol 26 (5) ◽  
pp. E15 ◽  
Author(s):  
Walavan Sivakumar ◽  
Gabriel Zada ◽  
Parham Yashar ◽  
Steven L. Giannotta ◽  
George Teitelbaum ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Vascular Malformations ◽  
Endovascular Embolization ◽  
Embolic Agent ◽  
Endovascular Management ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Embolic Agents ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Object Spinal dural arteriovenous fistulas (DAVFs) are the most common spinal vascular malformations and can be a significant cause of myelopathy, yet remain inefficiently diagnosed lesions. Over the last several decades, the treatment of spinal DAVFs has improved tremendously due to improvements in neuroimaging, microsurgical, and endovascular techniques. The aim of this paper was to review the existing literature regarding the clinical characteristics, classification, and endovascular management of spinal DAVFs. Methods A search of the PubMed database from the National Library of Medicine and reference lists of all relevant articles was conducted to identify all studies pertaining to spinal DAVFs, spinal dural fistulas, and spinal vascular malformations, with particular attention to endovascular management and outcomes. Results The ability to definitively treat spinal DAVFs using endovascular embolization has significantly improved over the last several decades. Overall rates of definitive embolization of spinal DAVFs have ranged between 25 and 100%, depending in part on the embolic agent used and the use of variable stiffness microcatheters. The majority of recent studies in which N-butyl cyanoacrylate or other liquid embolic agents were used have reported success rates of 70–90%. Surgical treatment remains the definitive option in cases of failed embolization, repeated recanalization, or lesions not amenable to embolization. Clinical outcomes have been comparable to surgical treatment when the fistula and draining vein remain persistently occluded. Improvements in gait and motor function are more likely following successful treatment, whereas micturition symptoms are less likely to improve. Conclusions Endovascular embolization is an increasingly effective therapy in the treatment of spinal DAVFs, and can be used as a definitive intervention in the majority of patients that undergo modern endovascular intervention. A multidisciplinary approach to the treatment of these lesions is required, as surgery is required for refractory cases or those not amenable to embolization. Newer embolic agents, such as Onyx, hold significant promise for future therapy, yet long-term follow-up studies are required.

scholarly journals Endovascular Therapy of 103 Aneurysms in the Internal Carotid Artery with Flow Re-Direction Endoluminal Device

2021 ◽  
Author(s):  
Vinicius Fialho Teixeira ◽  
Albedy Moreira Bastos ◽  
Rafael Brito Santos
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Options ◽  
Cross Sectional ◽  
Vascular Abnormalities ◽  
Endovascular Interventions ◽  
Effective Option ◽  
Aneurysm Occlusion ◽  
Carotid Aneurysms

Abstract Objective Intracranial aneurysms (AIs) are acquired vascular abnormalities that cause sacculations in the arterial wall and are present in ∼2 to 5% of the population. Among the treatment options are endovascular interventions with the use of flow-redirecting stents. In the present study, we analyzed the flow re-direction endoluminal device (FRED). Methods The present study aims to describe the results obtained from treatment with FRED in a series of patients affected by aneurysms in intracranial segments of the internal carotid artery. This is a cross-sectional, epidemiological, and observational study, whose data were obtained from the medical records of 81 patients from July 2018 to July 2019. Results One hundred and three internal carotid artery aneurysms were observed in 81 patients, with a prevalence of women (91.35%), small (< 10 mm) (89.33%), and located at the C6 level (73.78%) of the internal carotid artery. Of the 81 patients, 16 had multiple aneurysms in the same artery. One hundred and three FRED stents were used in the treatment. These patients underwent angiography 6 months after the surgery, using the O'Kelly-Marotta classification (OKM) to assess the effectiveness of the device, and it was observed that: in 91 of the 103 procedures (88.34%), the FRED was fully open and well positioned, thus restoring the arterial flow and leading to a statistically significant result. In addition, a low complication rate (4.85%) was found, with ischemic stroke being the main complication (1.94%). Conclusion This device can be an effective option in the treatment of internal carotid aneurysms since the aneurysm occlusion rate is excellent with a low rate of complications.

scholarly journals Peripheral Vascular Stents in Clinical Practice

1970 ◽  
Vol 1 (1) ◽  
pp. 81-83
Author(s):  
GMM Hossain
Keyword(s):  
Treatment Options ◽  
Vascular Diseases ◽  
Primary Treatment ◽  
Major Advance ◽  
Peripheral Vascular ◽  
Endovascular Stents ◽  
Vascular Stents ◽  
Endovascular Interventions ◽  
Arterial Lesions ◽  
Peripheral Arterial

The development of endovascular stents has been a major advance in the treatment of vascular diseases. Endovascular interventions are quickly replacing bypass surgery and endarterectomy as the primary treatment options for stenotic peripheral arterial lesions. Studies using stents in the carotid and iliac arteries have shown acceptable clinical outcome. In this review the basic aspects of different stents are discussed. Key words: Peripheral vascular diseases, Vascular stents, Peripheral angioplasty DOI: http://dx.doi.org/10.3329/cardio.v1i1.8215 Cardiovasc. j. 2008; 1(1) : 81-83

Asystole during Onyx embolization of 64-year-old patient with dural arteriovenous fistula

2021 ◽  
pp. 197140092110474
Author(s):  
Muhammad H Malik ◽  
Waleed Brinjikji ◽  
Luis E Savastano
Keyword(s):  
Arteriovenous Fistula ◽  
Side Effect ◽  
Dural Arteriovenous Fistula ◽  
Endovascular Embolization ◽  
Embolic Agents ◽  
Liquid Embolic

Asystole or bradycardia is a relatively uncommon side effect seen in patients undergoing endovascular embolization using dimethylsulfoxide based liquid embolic agents. We present a case of a patient who underwent dural arteriovenous fistula embolization and experienced bradycardia during Onyx injection but was stabilized and the procedure was completed successfully.

scholarly journals Preparedness of neurosurgery graduates for neuroendovascular fellowship: a national survey of fellowship programs

2015 ◽  
Vol 123 (5) ◽  
pp. 1113-1119 ◽  
Author(s):  
Nohra Chalouhi ◽  
Mario Zanaty ◽  
Stavropoula Tjoumakaris ◽  
Philip Manasseh ◽  
David Hasan ◽  
...  
Keyword(s):  
Clinical Skills ◽  
Treatment Plan ◽  
Program Directors ◽  
Femoral Access ◽  
Good Communication ◽  
Vascular Abnormalities ◽  
Endovascular Interventions ◽  
Major Vessel ◽  
Fellowship Programs ◽  
Graduate Trainees

OBJECT Endovascular interventions have become an essential part of a neurosurgeon’s practice. Whether endovascular procedures have been effectively integrated into residency curricula, however, remains uncertain. The purpose of this study was to assess the preparedness of US neurosurgery graduate trainees for neuroendovascular fellowship. METHODS A multidomain, global assessment survey was sent to all directors/faculty of neuroendovascular fellowship programs involved in training of US neurosurgery graduates. Surveyees were asked to assess trainees as they entered fellowship. RESULTS The response rate was 78% (25/32). Of respondent program directors, 38% reported that new fellows did not know the history and imaging of the patient and 50% were unable to formulate an appropriate treatment plan. As many as 79% of fellows were unfamiliar with endovascular devices and 75% were unfamiliar with angiographic equipment. Furthermore, 58% of fellows were unable to perform femoral access, 54% were unable to perform femoral closure, 79% were unable to catheterize a major vessel, 86% were unable to perform a 4-vessel angiogram, and 100% were unable to catheterize an aneurysm. Additionally, program directors reported that over 50% of fellows could not recognize neurovascular anatomy and 54% could not recognize/classify vascular abnormalities. There was an overall agreement that fellows demonstrated professionalism and interest in research and had good communication/clinical skills. CONCLUSIONS The results of this study suggest potential gaps in the training of neurosurgery residents with regard to endovascular neurosurgery. In an era of minimally invasive therapies, changes in residency curricula may be needed to keep pace with the ever-changing field of neurosurgery.

scholarly journals Emerging embolic agents in endovascular embolization: an overview

2020 ◽  
Vol 2 (1) ◽  
pp. 012003 ◽  
Author(s):  
Courtney Y Wang ◽  
Jingjie Hu ◽  
Rahul A Sheth ◽  
Rahmi Oklu
Keyword(s):  
Endovascular Embolization ◽  
Embolic Agents

Removal of distal fragments of liquid embolic agents during arteriovenous malformation embolization using the TIGERTRIEVER 13: a technical report

2020 ◽  
Vol 12 (8) ◽  
pp. 794-797 ◽  
Author(s):  
Faith LY Ho ◽  
René Chapot
Keyword(s):  
Cerebral Artery ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Vascular Lesions ◽  
Embolic Agent ◽  
Embolic Material ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Retrograde Filling ◽  
Distal Migration

BackgroundArteriovenous malformations (AVMs) are vascular lesions that may be treated by an endovascular approach using liquid embolic agents but the control of the liquid embolic agent remains poor and a potential complication may be distal migration of embolic material. The TIGERTRIEVER 13 is a new stent retriever designed for stroke thrombectomy and has a version ideal for distal occlusions. We report our experience in the removal of embolic agent which had migrated into the distal vessels using the TIGERTRIEVER during PHIL/Onyx embolization of AVMs.Clinical presentationsThree patients with brain and spinal AVMs underwent endovascular embolization. During trans-arterial embolization of the AVM with PHIL/Onyx, retrograde filling of distal arterial feeders was followed by migration into the normal arterial branches (cortical middle cerebral artery, distal posterior cerebral artery, and anterior spinal artery). This resulted in occlusion or sluggish distal flow in these branches with potential significant neurological deficits. In all three cases, a Headway Duo microcatheter was navigated distally in the occluded vessel beyond the embolic material using a Traxcess microwire. The TIGERTRIEVER 13 was deployed with recanalization of the vessel after a single attempt. In all three patients there were no complications related to the retrieval of embolic agent.ConclusionDistal migrated embolic agents such as PHIL or Onyx can be removed from various arterial vascular territories using stent retrievers dedicated to small vessels.

Evaluation of a novel liquid embolic agent (precipitating hydrophobic injectable liquid (PHIL)) in an animal endovascular embolization model

2017 ◽  
Vol 10 (3) ◽  
pp. 268-274 ◽  
Author(s):  
Dominik F Vollherbst ◽  
Ruth Otto ◽  
Andreas von Deimling ◽  
Johannes Pfaff ◽  
Christian Ulfert ◽  
...  
Keyword(s):  
Waiting Time ◽  
Transarterial Embolization ◽  
Endovascular Embolization ◽  
Embolic Agent ◽  
Rete Mirabile ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Group Survival

BackgroundThe choice of the embolic agent and the embolization technique can have a significant impact on the success of endovascular embolization.ObjectiveTo evaluate a novel iodinated copolymer-based liquid embolic agent (precipitating hydrophobic injectable liquid (PHIL)) in the porcine rete mirabile (RM), serving as an endovascular embolization model. Onyx, as an established liquid embolic agent, served as comparator.Materials and methodsSixteen embolization procedures were performed using PHIL (n=8) or Onyx (n=8) as liquid embolic agent. Waiting time between injections was set to 30 or 60 s (n=4 per study group). Survival time after intervention was 2 hours or 7 days. Embolization characteristics (eg, procedure times, number of injections and volume of embolic agent) and embolization extent (percentage of embolized RM in post-interventional x-ray) were assessed. Post-interventional CT and histopathological analyses were performed.ResultsEmbolization characteristics and embolization extent were not significantly different for PHIL and Onyx, including subgroups (eg, embolization extent 44% vs 69% (medians); p=0.101). For PHIL, extension of the waiting time from 30 to 60 s led to a significantly higher embolization extent (24% vs 72% (medians); p=0.035). Moderate disintegration and mild inflammation of the embolized blood vessels were present for both embolic agents.ConclusionPHIL is feasible for transarterial embolization in an acute and subacute endovascular embolization model. In this preliminary experimental in vivo study, embolization characteristics, embolization extent, and biocompatibility seem to be similar to those of Onyx.

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