Palliative embolization

If structural abnormalities such as vascular malformations, hypervascular tumors, vessel wall irregularities suggesting erosion etc., are visualized, then we may try for a palliative embolization with Gelfoam or particulates. Rarely, curative embolization of an arteriovenous malformation or fistula is achievable with non-resorbable agents, such as glue or detachable balloons. 

Embolization Adrenal arterial emboKzation was performed in nine of our patients, four with inoperable adrenal cortical carcinoma and five with metastatic adrenal tumors. In eight patients, palliative embolization was performed either to decrease tumor bulk, suppress tumor hormonal function (n=3), or relieve pain (n=4). In four patients in whom it was possible to assess the effect of embolization, a striking reduction in size had occurred in one (Fig. 9.13), the lesion remained stable in size for 12 months in two, and the tumor continued to grow in the fourth. A reduction in the production of cortisol for 12 months was seen in two of the three patients with Cushing s syndrome (Fig. 9.13). Adrenal emboKzation resulted in the effective palliation of pain in three out of four patients and may have contributed to its amehoration in the fourth. Apart from a hypertensive episode in one patient, no serious compKcations occurred (O Keeffe et al. 1988). 

Weber J (1982) Palliative embolization in bone metastasis of hypernephroma using oily contrast-labeled gel. Ann Radiol (Paris) 25 460-462... 

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. 

Bleeding from hypervascular tumors, such as duodenal metastasis of renal cell carcinoma, can be stopped by palliative particulate embolization (Fig. 5.8), although other authors preferred Gelfoam [88,89). 

Future perspectives calibrated particles of polyvinyl alcohol or gelatin penetrate deeper into the vascular system due to lower viscosity. Risk of ischemia is probably higher, but no clinical experience reported. Palliative tumor embolization might be more efficient with calibrated particles, in analogy with uterine fibroid embolization. 

Palliation of symptoms in nonoperable patients was also included in some outcome analyses. The details of symptoms and therapeutic effects of renal artery embolization are generally lacking, but studies generally reported thathematuria, pain, and paraneoplastic symptoms were alleviated. In one study, severe hematuria resolved in 11 of 14 patients, and incomplete embolization of the tumor blood supply from parasitized lumbar arteries resulted in persistent hematuria in 3 of 14 patients [11]. In another study, malignant hypercalcemia resolved after embolization [10]. Kalman and Varenhorst concluded that a small group of patients with specific, tumor-related symptoms may benefit from embolization. However, the palliative effect of embolization cannot be evaluated from the available data, and the effectiveness of the procedure awaits validation. 

Nurmi M, Satokari K, Puntala P (1987) Renal artery embolization in the palliative treatment of renal adenocarcinoma. Scand J Urol Nephrol 21 93-96... 

Embolization of these tumors is usually performed with 200-350 microns in size polyvinyl alcohol (PVA). After particle injection, ligation of the arterial supply can be performed with Gelfoam strip injection. This will facilitate the intratumoral thrombosis. Liquid embolic agents are usually reserved for palliative lesions and only when strict flow control can be achieved. 

Chaloupka JC, Mangla S, Huddle DC, Mitra S, Ross DA, Sasaki CT (1999) Evolving experience with direct puncture therapeutic embolization for adjunctive and palliative management of head and neck hypervascular neoplasms. Laryngoscope 109 1864-1872... 

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