A Damp-and-Push Technique for the Copolymer (Onyx) Embolization of Dural Arteriovenous Fistula

Omura, Yoshihiro; Imamura, Hirotoshi; Tani, Satoshi; Adachi, Hidemitsu; Fukumitsu, Ryu; Sunohara, Tadashi; Fukui, Nobuyuki; Sasaki, Natsuhi; Fukuda, Tatsumaru; Akiyama, Tomoaki; Kajiura, Shinji; Shigeyasu, Masashi; Asakura, Kento; Horii, Ryo; Sakai, Nobuyuki

doi:10.1016/j.jstrokecerebrovasdis.2021.105853

“…Yamauchi et al 7 reported the use of subcutaneous infiltration of epinephrine-containing lidocaine to control the blood flow from the STA during TAE of dural arteriovenous fistulas. Omura et al 12 reported a damp-and-push technique for embolization of dural arteriovenous fistulas while preserving cutaneous vessels. In this method, liquid embolic material is injected from a major feeder while occluding a high-flow feeder with a balloon microcatheter.…”

Section: Discussionmentioning

confidence: 99%

Manual superficial temporal artery compression using a circular plastic material for embolization of meningioma: illustrative case

Horio

¹

,

Miki²,

Kawano

³

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND In meningiomas that occur in the high-convexity region, the superficial temporal artery (STA) frequently feeds the tumor, and when embolizing from the middle meningeal artery (MMA), the embolic material may not reach the tumor vessels because of the pressure gradient resulting from the STA blood flow, resulting in inadequate embolization. In this case, a circular plastic material was used to apply circumferential pressure around the parietal foramen to control blood flow to the tumor. OBSERVATIONS A 45-year-old male underwent head magnetic resonance imaging that revealed a 2.2-cm meningioma in the right high-convexity region. Preoperative embolization was performed. When N-butyl-2-cyanoacrylate was injected from the right MMA while using a circular plastic material to compress the skin around the parietal foramen through which the bilateral STAs (the tumor feeders) flow, it was able to fully penetrate the tumor vessel and occlude the other feeders in a retrograde manner. The patient underwent tumor removal after embolization uneventfully. LESSONS Manual compression of the STA using a circular plastic material is useful when the tumor is fed by the STA through the parietal foramen and is also applicable to transarterial embolization of dural arteriovenous fistulas fed by the STA or occipital artery.

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“…Since their development in 1991, detachable coils have been recognized for their effectiveness and safety in the eld of vascular embolization, especially in neurointervention [1][2][3][4]. Attached to a delivery wire, these coils can be deployed with control and precision.…”

Section: Introductionmentioning

confidence: 99%

Enhancing Precision in Vascular Embolization: Evaluating the Effectiveness of the Intentional Early Detachment Technique with Detachable Coils in Complex Cases

Oka,

Kohno,

Arizono

et al. 2024

Preprint

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Background This study aimed to assess the effectiveness and versatility of an intentional early detachment technique with detachable coils to address challenging vascular embolization scenarios. This novel approach aims to provide interventional radiologists with an alternative method for achieving precise coil placement when standard methods of detachable coil placement are rendered ineffective owing to vascular anatomy or limited available equipment. Materials and Methods This was a retrospective study comprising 11 patients (9 males and 2 females; median age, 77 years) who underwent embolization procedures using the intentional early detachment technique via 1.6-Fr or 1.3-Fr microcatheters between October 2021 and December 2023. In this technique, detachable coils were intentionally detached within the microcatheter and placed using saline flushing. Technical success, complications, and clinical success were evaluated. Results The technique was applied in three distinct scenarios: tortuous vascular anatomy (4 cases), inadequate system backup (3 cases), and 1.3-Fr microcatheter use (4 cases). The technical and clinical success rates were 100%. No complications were observed, and there were no cases of coil migration or malpositioning. Conclusion The intentional early detachment technique is valuable for interventional radiologists and offers a solution for challenging vascular embolization scenarios. Although its application is limited to specific circumstances, it can significantly enhance coil placement in complex cases, thereby contributing to improved patient care.

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A Retrospective Case-Control Study on Late Failure of Arteriovenous Fistula in Hemodialysis Patients and Prediction of Risk Factors

Ge

¹

,

Yu

²

,

Rao

³

2022

Computational and Mathematical Methods in Medicine

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Objective. A retrospective case-control study was conducted to explore the risk factors of late failure of arteriovenous fistula in hemodialysis patients. Methods. A total of 95 hemodialysis patients treated in our hospital from January 2018 to January 2021 were included. The HE staining results of late failure of arteriovenous fistula in hemodialysis patients were observed. The general data and laboratory indexes of the patients were recorded by using a questionnaire survey, hospital case system, and hemodialysis record. According to the functional status of internal fistula, the patients were divided into two groups: failure group ( n = 35 ) and patency group ( n = 60 ). SPSS22.0 software was employed for statistical analysis, and the relevant data of the two groups were compared. The independent sample t -test was employed for the comparison of variance between groups, and the χ 2 test was employed for counting data. Logistic multivariate regression was employed to analyze the risk factors of late loss of power in autologous arteriovenous fistula (AVF). Results. (1) Late failure of arteriovenous fistula in hemodialysis patients: the results of HE staining showed the following: (1) histological changes of venous intima: 100% of the patients had varying degrees of intimal hyperplasia, mainly eccentric hyperplasia, resulting in luminal stenosis, and annular uniform intimal hyperplasia in some patients, and (2) histological changes of venous media: 81.6% of the patients had venous media lesions, which were mainly in two cases; one was media smooth muscle hyperplasia with fibrous tissue hyperplasia, and the other was smooth muscle compression when intimal hyperplasia was serious, resulting in smooth muscle fiber rupture, disarrangement, focal necrosis, atrophy, and thinning, and some smooth muscle stroma showed vitreous degeneration and myxoid degeneration. A few cases showed multifocal neutrophil, lymphocyte, and plasma cell infiltration. (2) First of all, we surveyed the general data, and there were significant differences in age, history of diabetes, history of hypertension, and uric acid nephropathy ( P < 0.05 ). There was no significant difference in sex, body mass index, smoking history, polycystic kidney disease, chronic glomerulonephritis, and obstructive nephropathy between the two groups ( P > 0.05 ). Secondly, we compared the levels of hemoglobin, eosinophils, platelet count, and hematocrit. The levels of hemoglobin, eosinophils, and hematocrit in the failure group were higher, and the platelet count was lower compared to that of the unobstructed group ( P < 0.05 ). Furthermore, the calcium and phosphorus product and the level of C-reactive protein (CRP) in the failure group were higher, while the levels of fibrinogen and INR in the unobstructed group were lower. The levels of plasma protein, alkaline phosphatase, and cholesterol were higher in the failure group, while the level of triglyceride was lower in the failure group ( P < 0.05 ). Finally, logistic regression analysis showed that age, hemoglobin, hematocrit, and calcium-phosphorus product were the risk factors for late failure of arteriovenous fistula in hemodialysis patients ( P < 0.05 ). There exhibited no significant correlation between diabetes, hypertension, uric acid nephropathy, eosinophil, CRP, fibrinogen, INR, plasma protein, alkaline phosphatase, cholesterol, triglyceride, and late failure of arteriovenous fistula in hemodialysis patients. Conclusion. Age, hemoglobin, hematocrit, and calcium-phosphorus product are independent risk factors for late failure of arteriovenous fistula in hemodialysis patients. The hemoglobin, eosinophil, platelet count, and hematocele in hemodialysis patients with late failure of arteriovenous fistula were higher. The indexes related to biochemistry, blood coagulation, and nutrition were significantly different from those without late failure of arteriovenous fistula. Thus, the risk of late failure of arteriovenous fistula can be predicted.

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A Damp-and-Push Technique for the Copolymer (Onyx) Embolization of Dural Arteriovenous Fistula

Cited by 4 publications

References 15 publications

Manual superficial temporal artery compression using a circular plastic material for embolization of meningioma: illustrative case

Manual superficial temporal artery compression using a circular plastic material for embolization of meningioma: illustrative case

Enhancing Precision in Vascular Embolization: Evaluating the Effectiveness of the Intentional Early Detachment Technique with Detachable Coils in Complex Cases

A Retrospective Case-Control Study on Late Failure of Arteriovenous Fistula in Hemodialysis Patients and Prediction of Risk Factors

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