Transarterial embolization

Results of combined stereotactic, radiosurgery and transarterial embolization for dural arteriovenous fistulas of the transverse and sigmoid sinuses. Journal of Neurosurgery 94 886-891... 

Transarterial embolization (TAE) By occluding the smaller tumour-feeding arteries, it is possible to achieve a hypoxia-induced necrosis of the HCC. This is more successful if the tumour is encapsulated. Such embolization can be carried out using collagen particles, polyvinyl alcohol, gelfoam or galactose spheres. However,... 

Niechajev I, Clodius L (1990) Histologic investigation of vascular malformations of the face after transarterial embolization with ethibloc and other agents. Plast Recon-str Surg 86 664-671... 

Aziz A, Petrucco OM, Mikinoda S, et al. (1998) Transarterial embolization of the uterine arteries patient reactions and effects on uterine vasculature. Acta Ohstet Gynecol Scand 77 334-340... 

Sclerotic agents such as ethanol and polidocanol are pure liquids which penetrate into the capillary bed, causing coagulation necrosis [97] and therefore are not suitable for transarterial embolization. Detachable balloons are very helpful in the rare case of an arteriovenous fistula [98]. 

Luchtefeld MA, Senagore AJ, Szomstein M, Fedeson B, van Erp J, Rupp S (2000) Evaluation of transarterial embolization for lower gastrointestinal bleeding. Dis Colon Rectum 43 532-534... 

Chun HJ, Byun JY, Yoo SS, Choi BG (2003) Added benefit of thoracic aortography after transarterial embolization in patients with hemoptysis. AJR Am J Roentgenol 180 1577-1581... 

Transarterial Embolization Transvenous Embolization Sinus Recanalization 159 Surgical Treatment 159 Stereotactic Irradiation (Radiosurgery) 160 Management Strategy and Choice of Treatment 160... 

In case of high-risk (Borden II-III) DAVMs, particulate embolization as a sole treatment does not provide safe and permanent prevention from subsequent bleeding. If transarterial embolization is considered in such cases because neither surgery nor transvenous embolization is feasible or recommended, liquid embolics should be chosen (Fig. 4.21). Cyanoacrylate glue mixed with Lipiodol... 

Because transvenous embolization is not feasible for spinal lesions, transarterial embolization with glue is the treatment of choice for a spinal DAVM with an arterial feeder that allows safe and distal catheterization and does not supply the anterior spinal artery. Glue should be pushed until it reaches the draining vein (Fig. 4.18) (Cognard et al. 1996 Song et al. 2001). Clinical outcome seems to dependent on the severity of the symptoms at the time of treatment (Nagata et al. 2006). 

Skeletonization, or removal of the sinus, requires extensive exploration of the dura and may be associated with significant blood loss and morbidity. Preoperative transarterial embolization is therefore recommended if that type of surgery is required. Such a combination is usually associated with excellent results an anatomical cure rate of 100%, with 0% permanent procedure-related morbidity and no mortality, is reported by several studies in series consisting of 17-34 patients with high-risk intracranial DAVM (Goto et al. 1999 Collice et al. 2000). 

Embolization Transarterial embolization produces a reduction in surgical blood loss and allows more extensive surgical procedures to be done. Embolization has also been used for the palliation of pain caused by skeletal metastases (Fig. 9.19) (Reuter et al. 1992). Our efforts have been mostly concentrated on hypervascular metastases such as those from renal and thyroid carcinomas. Metastases from renal cell carcinoma like the primary neoplasm are hypervascular in 65%-85% of cases. The incidence of skeletal metastases is 30%-45% for patients with renal cell or thyroid carcinoma (Monteil et al. 1985 Rowe et al. 1984 Weber 1982). The 5- and 10-year survival rates for this patient population is 65% and 18%, respectively (Marcocci et al. 1989), compared with an 80%-95% 10-year survival in the absence of bone metastases (Schlumberger 1998). 

Castells A, Bruix J, Ayuso C, Bru C, Montanya X, Boix L, RodesJ (1995) Transarterial embolization for hepatocellular carcinoma. Antibiotic prophylaxis and clinical meaning of postembolization fever. J Hepatol 22 410-415 Caturelli E, Siena DA, Fusilli S, Villani MR, Schiavone G, Nardella M, Balzano S, Florio F (2000) Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with cirrhosis evaluation of damage to nontumorous liver tissue-long-term prospective study. Radiology 215 123-128... 

ISHiKAWA et al. (2000) suggested that microwave coagulation therapy can destroy the peripheral part of the tumor that might remain viable after transarterial embolization (TAE), but combination therapy with TAE was preferable, especially when a viable part existed within tumors. 

Bruix J, Llovet JM, Castells A et al (1998) Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma results of a randomized, controlled trial in a single institution. Hepatology 27 1578-1583... 

In contrast embolization does not play any role in the treatment of hepatic adenoma despite an acute hemorrhage due to adenoma rupture where transarterial embolization might be a therapeutic option (Terkivatan et al. 2001). 

Hagiwara A, Murata A, Matsuda T et al. (2002) The efficacy and limitations of transarterial embolization for severe hepatic injury. J Trauma 52 1091-1096... 

Mariano RT, Stein B, Vine HS, Rosshirt W, Sussman SK, Ohki SK (2000) Angiographic diagnosis and transarterial embolization of iatrogenic ovarian artery injury. J Vase Interv Radiol 11 625-628... 

Loewe C, Schindl M, et al. (2003) Permanent transarterial embolization of neuroendocrine metastases of the liver using yyanoacrylate and lipiodol assessment of mid- and long-term results. Am J Roentgenol 180 1379-1384... 

Osuga K, Khankan AA, et al. (2002) Transarterial embolization for large hepatocellular carcinoma with use of superabsorbent polymer microspheres initial experience. J Vase Interv Radiol 13 929-934... 

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