Nontarget embolization

If a coil does get misplaced, retrieval with snares can be attempted. This can be quite difficult since the errant coil may often wedge itself into the peripheral aspect of another branch. That plus the spasm that frequently occurs from excessive manipulation makes it difficult to open a snare sufficiently to get around the coil. An unusual form of nontarget embolization is delayed migration of coils from the original point of deployment into another structure. Coils placed in an intrahepatic pseudoaneurysm have been reported in two cases to migrate (presumably via erosion of the adjacent structures) into the bile ducts [8,55]. In these cases biliary obstruction resulted and required percutaneous or surgical removal of the coils. 

Nontarget embolization can ruin an otherwise good result and while coils are one of the most commonly used embolic devices, they can he difficult to form properly. Better control over the coils is desirable. The Guglielmi detachable coils (Target Therapeutics Fremont, CA) do provide the ability to redo the deployment if it is unsatisfactory, and they have... 

If the aneurysm is amenable to direct percutaneous puncture, another option includes direct thrombin injection or coiling via an 18-gauge needle. Simultaneous balloon occlusion of the aneurysm neck via arterial access can be performed to prevent nontarget embolization. 

Complications of the embolization procedure include those of diagnostic angiography with the addition of aneurysm rupture, nontarget embolization, ischemia or infarction, abscess formation, and rarely sepsis. In earlier literature, spontaneous... 

Complications of the embolization procedure include those of diagnostic angiography with the addition of aneurysm rupture, nontarget embolization, splenic infarction, abscess formation, and rarely sepsis (Fig. 8.5). Total splenic infarction can occur, which puts the patient at an increased risk of infection with encapsulated bacteria such as pneumococcus. Older literature suggests that bland splenic artery aneurysms rupture at a rate of approximately 2% [30]. However, in pregnant patients, rupture occurs in nearly every case with mortality rates for mother and fetus 70% and 95% respectively [31]. Obviously, any aneurysm in the pregnant female should be addressed since over 95% will rupture if left untreated [30, 32]. 

One of the feared complications of deploying coils, injecting thrombin or glue, or infusing particulate embolics is nontarget embolization. Stringent technique to ensure satisfactory positioning... 

Nontarget embolization - radiation gastritis/duodenitis Anti-ulcer, antacid medication x 2 weeks... 

Such complications from radioembolization are exceedingly rare allowing the vast majority of patients to have this procedure on an outpatient basis. Rarely, treatment may be complicated by post-embolization syndrome and symptomatic support may be necessary. Nontarget embolization can be all but eliminated by meticulous technique and pre-procedure planning... 

Inadvertent extrahepatic deposition of embolic material is relatively common. Although any nontarget embolization is undesirable and may cause complications, the frequency of significant clinical sequela is low [72]. Asymptomatic deposition of embolic material maybe seen in the lung, stomach, pancreas, duodenum, gallbladder, diaphragm, and... 

Similar to complete splenic arterial embolization, PSE is prone to complications and adverse effects, but PSE is much better tolerated than complete splenic ablation. In addition to those mentioned above, patients might develop pancreatitis (likely a result of nontarget embolization of dorsal pancreatic and pancreatic magna arteries), pleural effusions requiring thoracentesis, paralytic ileus, or the post-embolization syndrome consisting of fever, leukocytosis, and abdominal pain [119]. 

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