Analysis of Nontarget Embolization Mechanisms During Embolization and Chemoembolization Procedures

Complications of embolization and chemoembolization remain a problem even with the development of low-profile catheter material and the introduction of new embolization agents. In recent years many new embolization materials have become available for clinical use, so the possibilities and limitations of these new materials must be understood to allow safe and effective embolization. Although up to now some scientific work has been published reporting the basic risk of embolization procedures, the underlying pathomechanism remains the object of speculation. Besides complications like drug toxicity, allergic reactions, and bleeding of the puncture site, the characteristics of embolization materials must be known to understand the potential complications of nontarget embolization and reflux of embolization material. This article gives an overview of established and new embolization materials, their potential risks, and the underlying pathophysiology.     

肾切除术前的肾动脉栓塞术：造影及栓塞方法

８例肾癌患者行旨在配合肾切除术的肾动脉栓塞术。其中５例取得了明显减少出血、操作容易、缩短手术时间的好效果。本文认为肾切除术前２￣７天行栓塞术较有利。无水乙醇比明胶海绵中断血运效果更佳。用无水乙醇只要栓塞至二极分支就足以中断肾血供。造影应显示供血动脉、肿瘤血管、引流静脉，为肾切除及栓塞术提供参考。栓塞前后应注意保护健肾，一般可以一次完成诊断造影及栓塞治疗。     

Embolization in neonates and infants

Several conditions presenting in the neonatal and infant period benefit from embolization, including hemangioma, vascular shunts, and tumors. The physiological delicacy and small size of newborns create distinct challenges. This paper discusses embolization of these patients and illustrates the techniques involved.     

Ovarian Artery: Angiographic Appearance,Embolization and Relevance to Uterine Fibroid Embolization

Purpose: To describe the angiographic appearance of the ovarian artery and its main variations that may be relevant to uterine fibroid embolization. Methods: The flush aortograms of 294 women who had been treated by uterine artery embolization for fibroids were reviewed. Significant arterial supply to the fibroid, and the origin and diameter of identified ovarian arteries were recorded. In patients with additional embolization of the ovarian artery, the follow-up evaluation also included hormonal levels and Doppler imaging of the ovaries. Results: A total of 75 ovarian arteries were identified in 59 women (bilaterally in 16 women and unilaterally in 43 women). All ovarian arteries originated from the aorta below the level of the renal arteries with a characteristic tortuous course. Fifteen women had at least one enlarged ovarian artery supplying the fibroids. Fourteen women (14/15, 93%) presented at least one of the following factors: prior pelvic surgery, tubo-ovarian pathology or large fundal fibroids. Conclusion: We advocate the use of flush aortography in women with prior tubo-ovarian pathology or surgery or in cases of large fundal fibroids. In the case of an ovarian artery supply to the fibroids, superselective catheterization and embolization of the ovarian artery should be considered.     

部分性脾栓塞术不同栓塞方法的对比研究

目的探寻脾亢患者部分性脾栓塞(PSE)术较为合适的栓塞方法。方法78例脾亢患者中32例为脾动脉主干内PSE术(主干组),46例为脾动脉分干内PSE术(分干组)。所有患者术后观察并发症情况,第15d、30d、60d、90d分别复查白细胞和血小板计数,并与术前比较,以此评价PSE术的疗效。然后对主干组和分干组结果进行对比分析。结果78例患者术后均无严重并发症,脾外栓塞及呼吸系统并发症分干组较主干组轻而少。术后白细胞和血小板计数,第15天时主干组和分干组比较差异均无显著性意义(P>0.05);第30天时二者比较差异均有显著性意义(P<0.05);第60天、90天时二者比较差异则均有非常显著性意义(P<0.001)。结论对于脾亢患者,脾动脉分支若呈二干型或三干型,则应尽量行分干内PSE术;分支若呈无干型或主干明显扭曲而插管困难时,则宜行主干内PSE术。     

Embolization for intractable epistaxis

It is estimated that 60% of the population experiences epistaxis at least once in a lifetime, and that approximately 6% of these patients require treatment. We discuss the risks and benefits of an endovascular approach in our experience. We believe this option is often offered too late. By following basic rules the procedure is very safe and highly effective.     

Embolization of musculoskeletal tumors

Transarterial embolization should be considered in the treatment algorithm of primary or secondary bone tumors. Specific benefit is present where there is a high risk of bleeding at surgery, where there is spinal involvement and neural encroachment, where active bleeding is present, or in awkward surgical locations where prolonged surgery is anticipated.     

Embolization of paraspinal masses

Arterial embolization is a method of palliative therapy for both primary and metastatic tumors. This treatment is frequently used in the liver and kidney, but has not been previously extended to paraspinal masses. Five patients with recurrent renal cell carcinoma or neurofibrosarcoma underwent palliative embolization for pain or mass effect. All had relief of pain after embolization. Four patients showed change in the mass on follow-up computed tomography scan with one demonstrating tumor shrinkage. Arterial embolization can be an effective method for palliation of pain and mass effect caused by paraspinal masses.