Elective embolization

Soulen MC, Faykus MH, Jr., Shlansky-Goldberg RD, Wein AJ, Cope C (1994) Elective embolization for prevention of hemorrhage from renal angiomyolipomas. J Vase Intervent Radiol 5 587-591... 

Before starting any elective embolization it is important to talk to the patient and obtain informed consent. In talking to the patient, emphasis should not only be on the advantages but also on the risks and complications of embolization therapy. Alternative therapeutic options should be discussed. In both emergency and elective embolization there is no scientific proof that antibiotics should be given prior to embolization. Always work as a team with the referring physician, to have a back-up plan for possible procedure failure or complications. 

Elective embolization can be performed for many indications as will be presented in other chapters in this book. Different indications have different appropriateness criteria and require different workup and preparations (Table 4.2). For example, preparation for a uterine fibroids embolization procedure varies greatly from preparation for a varicocele embolization. Work-up and preparation includes a focused history with physical examination, evaluation by an appropriate allied clinical specialist (for example, a gynecologist in the case of uterine... 

Life-threatening rupture, which commonly occurs in the third trimester of pregnancy, is a serious risk of splenic aneurysms. The small 2-3 cm asymptomatic lesions typically pose no immediate threat and can be observed with serial CT. There is some debate regarding the size of aneurysm that can be observed. However, patients who develop left upper quadrant or abdominal pain with no other identifiable source would likely benefit from elective embolization even if in the 2-3 cm range. Although not defined, rapid interval growth should also be an impetus to embolize because the morbidity from rupture is significant. 

Treatment If it is possible, elective resection is indicated. (98) However, due to cardiac or (increasing) hepatic insufficiency, invasive techniques cannot usually be attempted. External irradiation may be used in an effort to minimize the tumour. Ligature or embolization of the afferent hepatic artery is sometimes indicated. Steroid therapy has proved unsuccessful. The use of interferon-a is a new therapeutic approach tumour regression is accelerated and cardiac insufficiency is compensated. (103) Liver transplantations have also been carried out successfully. This infantile, benign tumour may regress with increasing age. 

Su WT, Stone DH, Lamparello PJ, Rockman CB (2004) Gluteal compartment syndrome following elective unilateral internal iliac artery embolization before endovascular abdominal aortic aneurysm repair. J Vase Surg 39 672-675... 

Due to its favorable success in the treatment of non-resectable HCC, transarterial embolotherapy has been tried in several studies for symptomatic cavernous hemangiomas (Srivastava et al. 2001 Zeng et al. 2004). However, the hemodynamics of hemangiomas are different from those of HCC and the advantages of embolization have not been fully realized in the treatment of hemangiomas (Cui et al. 2003). But still the use of embolization provides a safe and effective treatment of patient s symptoms while avoiding operative intervention, extended hospitalization, and postoperative recuperation. This treatment modality should be considered for symptomatic hemangioma under elective conditions (Deutsch et al. 2001). 

Despite the fact that minimally invasive embolization procedures have been performed for over twenty years, very few long-term data on VAA occlusion are available. Further investigation and development of newer techniques such as stent graft placement are needed. Coil, glue, thrombin, and particle embolization will continue to be effective methods for treatment of visceral artery aneurysms in both the elective and emergent settings. Good... 

Phillips CB, Barrett JA, Losina E, Mahomed NN, Lingard EA, Guadagnoli E, et al. Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. J Bone Joint Surg Am 2003 85-A(l) 20-6. 

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