Embolization

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Micrograph of embolic material in the artery of a kidney. The kidney was surgically removed because of cancer. H&E stain.

Embolization is a nonsurgical, minimally invasive procedure performed by interventional radiologists and interventional neuroradiologists. It involves the selective occlusion of blood vessels by purposely introducing emboli, in other words deliberately blocking a blood vessel.

Therapeutic applications[edit]

Embolization is used to treat a wide variety of conditions affecting different organs of the human body.

Hemorrhage[edit]

The treatment is used to occlude:

Growths[edit]

The treatment is used to slow or stop blood supply thus reducing the size of the tumour:

Malignant Hypertension[edit]

It could be useful for managing malignant hypertension due to end stage renal failure.[3]

Other[edit]

Procedure[edit]

Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.

The procedure is a minimally invasive alternative to surgery. The purpose of embolization is to prevent blood flow to an area of the body, which can effectively shrink a tumor or block an aneurysm.

The procedure is carried out as an endovascular procedure by a consultant radiologist in an interventional suite. It is common for most patients to have the treatment carried out with little or no sedation, although this depends largely on the organ to be embolized. Patients who undergo cerebral embolization or portal vein embolization are usually given a general anesthetic.

Access to the organ in question is acquired by means of a guidewire and catheter(s). Depending on the organ this can be very difficult and time consuming. The position of the correct artery or vein supplying the pathology in question is located by digital subtraction angiography (DSA). These images are then used as a map for the radiologist to gain access to the correct vessel by selecting an appropriate catheter and or wire, depending on the 'shape' of the surrounding anatomy.

Once in place, the treatment can begin. The artificial embolus used is usually one of the following:

Once the artificial emboli have been successfully introduced, another set of DSA images are taken to confirm a successful deployment.

Agents[edit]

Liquid embolic agents - Used for AVM, these agents can flow through complex vascular structures so the surgeon does not need to target his catheter to every single vessel. Onyx is an example for a liquid embolic agent.

Sclerosing agents - These will harden the endothelial lining of vessels. They require more time to react than the liquid embolic agents. Therefore, they cannot be used for large or high-flow vessels.

Particulate embolic agents - These are only used for precapillary arterioles or small arteries. These are also very good for AVM deep within the body. The disadvantage is that they are not easily targeted in the vessel. None of these are radioopaque, so they are difficult to view with radiologic imaging unless they are soaked in contrast prior to injection.

Mechanical occlusion devices - These fit in all vessels. They also have the advantage of accuracy of location; they are deployed exactly where the catheter ends.

Advantages[edit]

Disadvantages[edit]

See also[edit]

References[edit]

  1. ^ Chauleur C, Fanget C, Tourne G, Levy R, Larchez C, Seffert P (2008). "Serious primary post-partum hemorrhage, arterial embolization and future fertility: a retrospective study of 46 cases". Hum. Reprod. 23 (7): 1553–1559. doi:10.1093/humrep/den122. PMID 18460450. 
  2. ^ Whittingham-Jones P, Baloch I, Miles J, Ferris B (2010). "Persistent haemarthrosis following total knee arthroplasty caused by unrecognised arterial injury". Grand Rounds 10: 51–54. doi:10.1102/1470-5206.2010.0010 (inactive 2014-01-31). 
  3. ^ Naji Alhamid1, Hani Alterky1, Mohammad Imad Othman2 (2011-02-05). "Renal artery embolization for managing uncontrolled hypertension in a kidney transplant candidate Alhamid N, Alterky H, Othman MI". Avicenna J Med. doi:10.4103/2231-0770.112791. Retrieved 2014-01-09. 
  4. ^ Gelfoam at Pfizer
  5. ^ Carretero, C; Munoz-Navas, M; Betes, M; Angos, R; Subtil, JC; Fernandez-Urien, I; De La Riva, S; Sola, J; Bilbao, JI (2007). "Gastroduodenal injury after radioembolization of hepatic tumors". The American journal of gastroenterology 102 (6): 1216–20. doi:10.1111/j.1572-0241.2007.01172.x. PMID 17355414. 
  6. ^ Arepally, A; Chomas, J; Kraitchman, D; Hong, K (2013). "Quantification and reduction of reflux during embolotherapy using an antireflux catheter and tantalum microspheres: Ex vivo analysis". Journal of vascular and interventional radiology : JVIR 24 (4): 575–80. doi:10.1016/j.jvir.2012.12.018. PMID 23462064. 

External links[edit]