Embolotherapy complications

The Ideal Vascular Occlusion Technique 4 Classification of Intravascular Embolic Agents 4 Essential Elements for Success in Successful Embolotherapy 5 Complications of Embolotherapy 5 Guidelines and Techniques to Prevent and Manage Complications 6... 

The advance of endovascular therapy for aorto-iliac aneurysmal disease has also brought about yet another flourishing application of embolotherapy. Embolization of the internal iliac artery plays an important adjunct initial modality to allow endovascular treatment of aortic aneurysms with extension into the common iliac arteries [78-80], It also plays an crucial role in the secondary management of complications related to endoleaks [81-84],... 

The complications of embolotherapy are well described, but vary in their manifestations depending on the affected end-organ [85, 86]. By nature, success depends on complete abolishment of vascular supply, be it normal or abnormal vasculature. This can often be accomplished but not without a risk of compromise to adjacent normal tissue. Moreover, aggressive pursuit of difficult vascular territories poses a risk for non-target embolization. 

A spectrum of end-organ ischemic complications can occur with embolotherapy. Bowel infarction can complicate splanchnic embolization targeting bleeding or could result from inadvertent non-target embolization from an upstream source [88]. Gallbladder infarction or bile duct necrosis can complicate hepatic artery embolization or che-moembolization [89, 90]. Splenic abscess and overwhelming sepsis can occurs following splenic embolization [91]. Skin necrosis and nerve injury have been reported as a result of ethanol embolization of vascular malformations [53, 54]. Buttock muscular necrosis, buttock claudication and sexual dysfunction can occur as a result of internal iliac branch embolization, especially when distal or bilateral [92-95]. 

Preoperative and palliative embolization of renal cell carcinoma may benefit a large number of patients. However, because of a paucity of scientific evidence, the technique remains underutilized. Similarly, although embolization is an accepted treatment for acute hemorrhage in patients with angiomyo-lipoma, it is not widely used to treat asymptomatic patients with this condition. Patient selection, technical details, expected complications, and outcomes all remain unclear at this time. Prospective clinical trials and randomized clinical trials are necessary to evaluate the true value of embolotherapy in the management of renal tumors. 

Ten to 20% of hemangiomas need to be treated [11]. Medical treatment is the first choice using steroids, interferon, or vincristine. Embolotherapy is only indicated in cases of ineffective medical treatment. Embolization is mostly performed in cases of hepatic hemangioma with cardiac failure, hemangioendothelioma complicated by Kasabach-Merritt phenomenon, and uncontrolled proliferative hemangioma with functional disorder (e.g. tongue with feeding problem). 

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