Superselective arterial embolization for patients with high-flow priapism: results of follow-up for five or more years

PURPOSE: To retrospectively evaluate the long-term results of transcatheter arterial embolization for high-flow priapism. MATERIAL AND METHODS: The study comprised six patients with high-flow priapism treated by superselective embolization of the internal pudendal arteries at our institution. The cause of priapism was traumatic in five patients and idiopathic in one. Follow-up was > or = 5 years in all cases. RESULTS: A total of nine embolizations were performed in the six patients. Embolization was performed once in three patients, while repeated embolizations were performed in the remaining three. Eleven arteries were altogether treated. Embolic materials used were gelatin sponge in nine arteries, gelatin sponge and microcoils in one, and microcoils alone in one. Embolization of the internal pudendal arteries on both sides in one single session was performed in one patient. In one patient, complete occlusion of the pseudoaneurysm was not achieved. However, restoration of erectile function and detumescence were noted during follow-up. Complications during the procedure were not registered. At follow-up > or = 5 years after successful embolization, all six patients experienced detumescence as well as normal erectile function. CONCLUSION: Superselective embolization of the internal pudendal artery is the procedure of choice for treatment of high-flow priapism.     

Treatment of “High-Flow” Priapism with Superselective Transcatheter Embolization: A Useful Alternative to Surgery

Purpose To review the efficacy of treatment of high-flow priapism with superselective transcatheter embolization. Methods Over a 2-year period, we reviewed five patients who were treated for traumatic high-flow priapism with superselective embolization. All patients underwent diagnostic angiography that demonstrated a communication between the cavernosal artery and the corpora cavernosa. Each identified fistula was embolized using gel-foam, blood clot, microcoils, or a combination of these. Results All five patients had successful detumesence of priapism postprocedure. There was normal recurrence of early morning erection with successful detumescence for each patient within a 2- to 4-week period. Two of five patients (40%) presented with recurrence of priapism at 6 months and required a repeat embolization procedure. At 1 year, four of the five patients (80%) had normal erectile function. Conclusion Superselective transcatheter embolization is a useful therapeutic modality in the treatment of high-flow priapism. It provides equivalent rates of detumesence when compared to surgical techniques, and appears to have a greater success in preserving erectile function.     

Morphologic and histopathologic changes in the bowel after super-selective transcatheter embolization for focal lower gastrointestinal hemorrhage

PURPOSE: To evaluate the safety of superselective arterial embolization therapy in the lower gastrointestinal tract. The sequelae on normal enteric tissue in lower gastrointestinal arterial embolization were retrospectively reviewed. MATERIAL AND METHODS: To control hemorrhage and tumor blood supply, 14 patients were treated by superselective transcatheter embolization at different levels of the colonic and small intestine vessels via the superior and inferior mesenteric arteries using microcoils and/or gelatin sponge. Normal enteric tissues in the embolized areas were analyzed for the occurrence of ischemic changes by clinical follow-up, colonoscopy, and surgery. RESULTS: Normal bowel function was preserved in 13 patients. In 1 patient treated with numerous gelatin sponge particles delivered from the proximal arcade of the superior mesenteric artery, significant muscular fibrosis occurred. CONCLUSION: Superselective arterial embolization for lower gastrointestinal hemorrhage can be safely performed by minimizing the amount of embolic materials and delivering them as distally as possible.     

血管内栓塞治疗肾脏良性血管性病变

目的探讨选择性肾动脉栓塞治疗肾脏良性血管病变的临床价值。方法收集2008年3月至2011年7月肾脏良性血管病变患者27例,其中肾损伤12例(外伤8例,医源性损伤4例),肾血管畸形10例(动静脉畸形5例,动静脉瘘3例,动脉瘤2例),肾血管平滑肌脂肪瘤3例,多囊肾2例。27例中,血尿19例,腹部疼痛15例,腰部酸痛3例,低血压休克3例。术前均进行CT或MRI检查明确诊断。采用Seldinger技术穿刺行股动脉插管,先行肾动脉造影,了解病变性质、部位、范围、程度及血供情况,然后超选择插管至病变处,进行栓塞治疗。栓塞方法及栓塞剂的种类、剂量根据病变性质、造影表现及插管具体位置进行选择。术后随防1～36个月。结果 27例患者均由肾动脉参与病变供血。介入治疗后所有患者临床症状消失。随访中,除1例多囊肾患者栓塞后2个月又出现血尿外,其余患者均无相关临床症状复发,CT显示栓塞满意。结论血管内栓塞治疗肾良性血管性病变安全有效、创伤小、并发症少,并能最大程度地保护肾功能,是可靠的治疗方法。     

骶髂骨肿瘤切除术前介入栓塞价值

目的 评估骶、髂骨肿瘤术前经导管超选择性动脉栓塞的价值和作用.方法对15 例骶、髂骨肿瘤用明胶海绵颗粒行超选择性动脉栓塞,栓塞后1～3 d行手术切除.疾病包括:骨巨细胞瘤5 例、动脉瘤样骨囊肿2例、转移瘤2 例、软骨肉瘤4例、脊索瘤3例.结果本组15 例栓塞后造影均显示肿瘤染色范围均较术前减少80 %以上.术中失血500～2600 ml 之间,平均为1100 ml .所有肿瘤均被顺利切除.结论 骶、髂骨肿瘤手术治疗前超选择性动脉栓塞能安全有效地减少术中出血, 提高肿瘤手术治疗效果并降低手术的风险.     

Safety and Efficacy of Transcatheter Arterial Embolization for Lower Gastrointestinal Bleeding: A Single-center Experience with 112 Patients

PurposeTo assess the safety and efficacy of transcatheter arterial embolization for lower gastrointestinal bleeding (LGIB) and to determine the prognostic factors that affect clinical outcome.Materials and MethodsAll patients diagnosed with LGIB by angiography at a single institution from April 2006 to January 2013 were included in a retrospective study. The rates of technical success, early recurrent bleeding, major complications, clinical success, and in-hospital mortality for transcatheter arterial embolization were determined. The influence of possible prognostic factors on the outcome was analyzed.ResultsA total of 112 patients were included (36 with small-bowel LGIB, 36 with colon LGIB, and 40 with rectal LGIB). N-butyl cyanoacrylate (NBCA) was the embolic agent for 84 patients (75.0%), whereas gelatin sponge pledgets (n = 20), microcoils (n = 2), polyvinyl alcohol particles with adjunctive gelatin sponge pledgets (n = 1), and blood clots (n = 1) were used in the other patients. The technical success rate was 96.4%. For the entire group, the rates of early recurrent bleeding, major complications, clinical success, and in-hospital mortality were 17.4%, 4.6%, 74.5%, and 25.0%, respectively. These were 15.2%, 4.8%, 75.3%, and 26.2%, respectively, in the NBCA group. Hematologic malignancy, immobilization status, and coagulopathy were significant prognostic factors for clinical outcomes.ConclusionsTranscatheter arterial embolization is a safe and effective treatment for LGIB. NBCA could be used as a primary embolic agent for this procedure.     

Selective embolization of bilateral arterial cavernous fistulas for posttraumatic penile arterial priapism

A 22-year-old man suffered a hiking accident with perineal trauma and developed a nonpainful priapism secondary to bilateral arterial-cavernosal fistulas. To minimize the risk of impotence in this young patient, successive selective embolizations with autologous blood clot were performed to close the fistulas. This led to an uncomplicated full recovery. No fistula was detectable on Doppler ultrasonography at 1-year follow-up. Review of the literature confirms the safety of embolization with autologous clot. Received: 0/00/00/Accepted: 0/00/00     

微圈栓塞海绵体动脉瘘治疗外伤性阴茎异常勃起的疗效评价

目的评价微弹簧圈超选择性栓塞治疗外伤性高流量性阴茎异常勃起的技术与疗效。方法2002年6月至2006年3月我科共收治典型高流量性阴茎异常勃起患者7例。所有患者均有会阴部外伤病史。彩色超声均诊断阴茎单侧海绵体动脉瘘,且均经血管造影证实。所有动脉海绵体瘘均经微导管超选择插管,微圈栓塞。栓塞术后即刻对患者阴茎勃起状态进行体检评价,并分别于术后3、6个月对患者进行彩色超声随访,对勃起功能则长期随访评价。结果超选择动脉插管及栓塞均获得成功。其中6例首次治疗即使用微圈栓塞,另1例是在明胶海绵颗粒栓塞1周后复发,再次栓塞时使用的微圈技术。所有患者栓塞后即刻至1h检查,阴茎勃起状态明显消退。7例使用微圈栓塞患者长期随访阴茎勃起功能正常。结论超选择微圈栓塞对治疗高流量性阴茎异常勃起安全、有效。微圈应作为首选栓塞物取代传统的海棉颗粒。     

急诊肝动脉栓塞治疗肝癌破裂出血

目的:探讨急诊肝动脉栓塞治疗原发性肝癌破裂出血的方法、临床效果、意义。方法:回顾性分析14例原发性肝癌破裂出血患者的病例资料,其中巨块型肝癌10例、结节型3例、小肝癌1例。所有患者均行急诊肝动脉超选择插管,采用弹簧圈、明胶海绵及碘化油等栓塞出血动脉。结果:14例原发性肝癌出血得到完全控制,患者术后生存期均在5个月以上,其中1例半年后死亡,5例随访24个月均存活。结论:急诊肝动脉栓塞治疗原发性肝癌破裂出血疗效肯定,创伤小,是安全、可靠的抢救手段。     

超选择性肾动脉栓塞治疗创伤性肾出血

目的 探讨超选择性肾动脉栓塞治疗创伤性肾出血的应用价值。方法 20例创伤性肾出血患者在数字减影血管造影下，采用明胶海绵或(和)钢丝圈进行肾动脉栓塞。14例患者损伤在肾动脉一级分支以下，作超选择性肾动脉栓塞；6例患者肾动脉分支主干损伤或无法进行超选择性肾动脉栓塞者，作肾动脉主干或一级分支主干栓塞。结果 所有患者术后3～5d肉眼血尿消失。平均随访29个月，无肾出血复发，血尿素氮、肌酐及血压正常。术后复查：超选择性肾动脉栓塞治疗组，患肾未栓塞部分肾功能恢复，肾外形基本正常；非超选择性肾动脉栓塞治疗组，2例患肾无功能，4例患肾部分肾功能恢复。肾外形明显缩小。结论超选择性肾动脉栓塞术创伤小、疗效好、并发症少，能最大限度保护病肾功能，是治疗Ⅰ型、Ⅱ型闭合性肾损伤出血的安全有效方法。     

Posttraumatic high-flow priapism treated by N-butyl-cyanoacrylate embolization

A patient with high-flow priapism was treated by transcatheter embolization of a posttraumatic left cavernosal arteriovenous fistula using N-butyl-cyanoacrylate (NBCA), resulting in complete detumescence. Erectile function has been preserved during a 3-month follow-up. Only two patients with NBCA embolization for high-flow priapism have been reported previously.     

单纯子宫动脉栓塞术在宫颈妊娠刮宫术前预防出血的应用

目的：探讨单纯子宫动脉栓塞术联合刮宫术治疗宫颈妊娠的临床疗效。方法对31例确诊宫颈妊娠患者,行超选择性子宫动脉插管后注射明胶海绵颗粒进行栓塞治疗,术后24-48h再行刮宫术。结果31例患者双侧子宫动脉超选择性插管及栓塞成功率均为100％,血β-HCG水平术后7-15天恢复正常,术后24-48h行刮宫术胚胎组织易于剥离,出血量少在5-25ml之间。结论单纯子宫动脉栓塞术能明显降低宫颈妊娠刮宫术中大出血的风险,成功率高、安全有效。     

Postbiopsy splenic bleeding in a dog model: comparison of cauterization, embolization, and plugging of the needle tract

OBJECTIVE: The purpose of our study was to compare radiofrequency cauterization, embolization using an absorbable gelatin sponge, and a Histoacryl-Lipiodol mixture plugging as postbiopsy bleeding reduction methods after splenic core needle biopsy in a dog model. MATERIALS AND METHODS: Eleven mongrel dogs were randomly separated into nonheparinized (n = 5) and heparinized (n = 6) groups. Eight splenic biopsies per animal were performed using an 18-gauge automated core biopsy needle: two as controls, two ablated by radiofrequency, two embolized using an absorbable gelatin sponge, and two plugged using a Histoacryl-Lipiodol mixture. Procedure times and postbiopsy bleeding amounts were assessed. Statistically significant differences were determined by repeated measures analysis of variance; the Tukey-Kramer test for multiple comparisons was used for post hoc comparisons. Three-day follow-up CT scans were obtained to check for procedure-related complications or delayed bleeding. RESULTS: The postbiopsy bleeding reduction groups showed significantly less blood loss than the control group for both the nonheparinized (p < 0.0001) and heparinized groups (p < 0.0001). In the heparinized group, both radiofrequency cauterization (p < 0.01) and gelatin sponge embolization (p < 0.05) significantly reduced bleeding compared with Histoacryl-Lipiodol mixture plugging. Gelatin sponge embolization was the longest procedure (p < 0.001). On follow-up CT, no delayed bleeding was observed. However, multiple Histoacryl-Lipiodol emboli were observed in the splenic and portal veins in all the dogs we treated. CONCLUSION: Radiofrequency cauterization was found to be the most useful postbiopsy bleeding reduction method in terms of the amount of bleeding and the procedure time.     

Superselective Embolization in Posttraumatic Priapism with Glubran 2 Acrylic Glue

Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, resulting in temporary penile detumescence and an apparent resolution of the artero-venous fistula. In both cases, priapism recurred 24 hours after the procedure and was successfully treated through selective transcatheter embolization of the nidus using acrylic glue (Glubran 2). The patients showed complete recovery of sexual activity within 30 days from the procedure and persistent exclusion of the artero-venous fistula after a 12-month follow-up.     

经导管栓塞治疗肝脏外伤出血

目的 探讨经导管栓塞治疗肝脏外伤出血的疗效、适应证、并发症等.方法 回顾性分析我院从1996年5月到2006年5月收治肝脏外伤出血患者33例,其中24例行肝动脉造影证实为肝动脉假性动脉瘤形成,再超选择插管至病变部位,根据载瘤动脉受损情况,予明胶海绵和(或)弹簧圈栓塞.结果 24例28枚假性动脉瘤栓塞技术上均一次成功.2例分别在栓塞后48 h、72 h再次出血.再次栓塞后1例康复,1例在第2次栓塞后1周因再出血和严重腹腔感染死亡.发热9例,均与栓塞无直接相关.结论 经导管栓塞治疗肝脏外伤出血安全、迅速、有效.     

Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage

PURPOSE: To evaluate the safety and effectiveness of superselective microcoil embolization for the treatment of lower gastrointestinal (LGI) hemorrhage. MATERIALS AND METHODS: A retrospective review of LGI superselective microcoil embolization data for a 10-year period was performed. During this period, twenty-two patients with evidence on angiography of LGI bleeding underwent superselective microcoil embolization. Hemorrhage was treated in the colon (n = 19) and jejunum (n = 3). Ivalon was used adjunctively in two patients and gelfoam was used as a secondary agent in two additional patients. Postembolization ischemia was evaluated objectively in 14 patients by colonoscopy (n = 10), surgical specimen (n = 3), and barium enema (n = 1). All patients were followed for clinical evidence of bowel ischemia. Four patients died before further follow-up could be performed. Additionally, 122 cases of LGI hemorrhage treated with superselective microcoil embolization were identified in a review of the literature. A meta-analysis was then performed, combining the data in this study and the data from the literature, to estimate the rate of major and minor ischemic complications on a total of 144 superselective microcoil embolizations. RESULTS: Immediate hemostasis was achieved in all 22 patients in this study. Complete clinical success was achieved in 86% of patients (19 of 22 patients). Rebleeding occurred in 14% of patients (3 of 22 patients) and each underwent colonoscopic intervention with success. Postembolization objective follow-up was performed in 64% of patients (14 of 22 patients). Ten patients underwent follow-up colonoscopy; one patient received a follow-up barium enema; and three patients underwent subsequent surgery. Colonic resection (one partial and one total) was performed in two patients. The partial colectomy was performed in a patient who had been diagnosed with colonic polyps and dysplasia. The total colectomy was performed on a patient with history of chronic LGI bleeding complicated by long-term anticoagulation therapy and a history of tubular adenoma resection. The third surgical patient (16 months old) underwent a follow-up exploratory laparotomy after embolization of a proximal jejunal branch of the superior mesenteric artery. None of the three patients who underwent surgery were found to have postembolic ischemic changes in the bowel specimen. Four patients in this study died, for reasons unrelated to hemorrhage or embolization, before further follow-up could be performed. The last four patients were followed clinically and experienced no symptoms of intestinal ischemia. A minor ischemic complication was reported in 4.5% of patients (1 of 22 patients), and there were no major ischemic complications (0%) in this series. A review of the data from 122 cases of LGI superselective microcoil embolization in the literature is also presented. Combined with the data in this study, the minor complication rate was 9% (13 of 144 patients), and the major complication rate was 0% (0 of 144 patients). CONCLUSION: Superselective microcoil embolization is a safe and effective treatment for LGI hemorrhage.     

New plastic-coated coaxial catheter system for superselective hepatic catheterization: Technical note

With the use of a new improved coaxial catheter system, superselective hepatic catheterization has become easier. The improvements consist of a decrease in the outer and an increase in the inner diameters of the coaxial catheters from 0.98 to 0.96 mm and from 0.55 to 0.65 mm, respectively, and thickening of core guidewire material from 0.014 inch (0.35 mm) to 0.018 inch (0.40 mm). With this new catheter system, it is possible to inject contrast medium (iopamidol 300) at a higher rate (3 ml/sec) and gelatin sponge particles instead of gelatin powder for arterial embolization. The success rates for superselective catheterization using conventional (n=10 procedures) and the improved coaxial catheter systems (n=7) were 30% and 86%, respectively.     

选择性动脉明胶海绵栓塞治疗子宫大出血的临床研究

目的:探讨明胶海绵介入治疗子宫大出血的临床应用价值。方法:回顾性分析13例子宫大出血患者,所有病例均采用Seldinger技术行右股动脉穿刺插管双侧髂内动脉造影,明确部位后,超选择双侧子宫动脉插管注入明胶海绵颗粒,阻断供血,行子宫动脉或髂内动脉栓塞。结果:13例患者均获有效止血,无严重并发症发生,并保留了子宫和卵巢完整的生理功能。结论:采用明胶海绵介入治疗子宫大出血是一种安全有效的治疗方法,具有明显的临床诊断和治疗价值。     

The positive predictive value of mammography.

OBJECTIVE. The major risk of transcatheter embolotherapy for acute hemorrhage in the lower gastrointestinal tract is irreversible intestinal ischemia. The authors studied the efficacy and safety of superselective transcatheter embolization with polyvinyl alcohol particles in arresting acute hemorrhage in the lower gastrointestinal tract. SUBJECTS AND METHODS. All patients with clinical or scintigraphic evidence of acute hemorrhage in the lower gastrointestinal tract were considered for superselective embolization. The nine patients with angiograms that showed active hemorrhage in the lower gastrointestinal tract underwent the procedure. Superselective embolization was done through a 3-French catheter and was accomplished by using 100- to 590-microns polyvinyl alcohol particles. The segments of the intestinal tracts involved in the embolizations were examined for the presence of ischemia by endoscopy (n = 7) or histologic evaluation of a surgical specimen (n = 2) 2-44 days (mean, 11 days) after embolization or by clinical evaluation (n = 1). RESULTS. The lesions treated by this method were located in the colon (n = 8) and jejunum (n = 1). Immediate hemostasis was achieved in every case. Three patients had recurrent lower gastrointestinal hemorrhage 1-24 days (mean, 9 days) after initial embolization. Two of these patients had surgery, while one had a successful second embolization. Two asymptomatic patients were found endoscopically to have small areas of ischemia involving only the mucosa. Only one patient was shown to have severe mucosal ischemia; this involved the colon in a distribution that suggested it was not caused by the embolization. CONCLUSION. Ten superselective embolization procedures that used polyvinyl alcohol particles successfully controlled hemorrhage in the lower gastrointestinal tract in nine patients. In no case was intestinal infarction induced by the procedure, and only two endoscopically proved cases of asymptomatic mucosal ischemia occurred.     

Efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles in the preoperative embolization of meningiomas

BACKGROUND AND PURPOSE: Trisacryl gelatin microspheres are a new, commercially available nonabsorbable embolic agent. The purpose of this study was to evaluate their efficacy in the preoperative embolization of meningiomas as compared with polyvinyl alcohol (PVA) particles of various sizes. METHODS: In 30 consecutive patients, trisacryl gelatin microspheres (150-300 microm) were used for the preoperative superselective embolization of meningiomas (group 1). Thirty other consecutive patients had embolization with PVA particles of 45 to 150 microm (n = 15, group 2) and of 150 to 250 microm (n = 15, group 3). Extent of devascularization, intraoperative blood loss, blood transfusion, and hemostasis at the time of surgery were recorded for every patient. The inflammatory reaction, the extent of necrotic areas, and the most distal intravascular location of the embolic agent (arterial, arteriolar, precapillary, capillary) were recorded. RESULTS: There was no significant difference in the extent of angiographic devascularization among the groups. Intraoperative blood loss differed significantly between groups 1 and 2 and groups 1 and 3, but not between groups 2 and 3. The trisacryl gelatin microspheres were located more distally in tumor vessels than were the PVA particles of either size. The extent of intratumoral necrosis was not significantly different between the two embolic agents. In all groups there was a mild inflammatory tissue reaction in the vicinity of the embolic agent. CONCLUSION: Trisacryl gelatin microspheres may be effective in the preoperative embolization of meningiomas, producing significantly less blood loss at surgery than seen with PVA particles of either size, possibly because of the significantly more distal vascular penetration of the microspheres.