Ethylene Vinyl Alcohol Copolymer Embolization for Acute Renal Hemorrhage: Initial Experience in 24 Cases

Mahdjoub, Elyas; Serhal, Ali; Maleš, Lada; Tligui, M.; Hermieu, Jean-François; Khalil, Antoine

doi:10.2214/ajr.19.21508

Cited by 10 publications

(13 citation statements)

References 16 publications

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“…Onyx, despite its use is technically demanding, was the chosen option for the case previously presented above because it is effective regardless any underlying coagulopathy, and its differential characteristics (permanent embolic agent, no need of free flow to embolize, minimal risk of reflux, no risk of microcatheter entrapment) were considered advantageous in embolizing the vascular network responsible for the bleeding. There is wide evidence in the literature that Onyx is safe and effective in the treatment of retroperitoneal haemorrhage (Mahdjoub et al, 2020 ; Kolber et al, 2015 ), and the final result was excellent, achieving a complete embolization as detailed in the case presentation. The major complication rate as Kolber et al (Kolber et al, 2015 ) point out in a systematic review article is under 5%.…”

Section: Discussionmentioning

confidence: 85%

Endovascular management of an unsual case of spontaneous Retroperitoneal Haemorrhage due to Fibromuscular Dysplasia

et al. 2020

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Background Fibromuscular dysplasia (FMD) is an uncommon vascular disease that results in stenosis, dissection or aneurysmal degeneration. However, it can sometimes manifest atypically, as we show in this case. Case presentation A 24-year old patient with no relevant medical history with severe left hypochondrium pain. The physical examination showed blood pressure levels of 160/90 mmHg. An abdominopelvic CT evidenced left retroperitoneal haematoma associated with active bleeding and left renal artery stenosis. Given these findings, it was decided to perform an endovascular treatment. Significant stenosis was seen during the arteriography in both renal arteries, suggesting fibromuscular dysplasia and development of a collateral neovascular network responsible for the retroperitoneal haematoma. It was embolised in association with angioplasty of the left renal artery. The patient had a favourable outcome; however, high blood pressure levels persisted. A new bilateral renal angioplasty was performed, which returned blood pressure values to normal. The patient was discharged without needing antihypertensives. Conclusions FMD is a rare disease that can show multiple clinical presentations and need individualized treatment options. Endovascular techniques are in the first therapeutic line regarding fibromuscular dysplasia.

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Section: Discussionmentioning

confidence: 85%

Endovascular management of an unsual case of spontaneous Retroperitoneal Haemorrhage due to Fibromuscular Dysplasia

et al. 2020

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“…In this regard, the primary clinical success rate was high (88.9%), confirming the experiences of previous authors, which have already demonstrated the efficacy of superselective embolization. Pozzi Mucelli et al [ 2 ] reported on the effectiveness of embolization above 85% in renal trauma; Contegiacomo et al [ 15 ] reviewed 5 years of renal artery embolization for iatrogenic renal vascular injuries, describing clinical success after a single embolization of 89.3%; Giurazza et al [ 18 , 19 ] focused their analysis on the use of the MVP in renal hemorrhages and reported 100% clinical successes, with the preservation of healthy renal parenchima; Mahdjoub et al [ 20 ] analyzed the effectiveness of liquid embolization with ethylene vinyl alcohol copolymer, reporting 100% technical and clinical success.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding procedural complications, the rate reported here is low and confirms the intervention’s safety, as described in previous study: Giurazza et al found no complications according to CIRSE classification standards [ 18 ]. Neither did Dong et al, who saw no major complications in 49 patients [ 22 ]; Mahdjoub et al also reported no serious complications attributable to liquid embolization, but found a mean infarcted renal area of 10% [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, to the best of our knowledge, no studies have specifically compared the different embolics, and there are few findings concerning the use of glue [ 15 , 28 ]. In this sample, one patient was treated with Phil ® , which is part of the relatively novel cohesive liquid embolics, which are mainly adopted for the treatment of vascular malformations [ 29 , 30 ] but seem to also be effective for renal hemorrhages [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Post-Traumatic Intraparenchymal Renal Hemorrhages: Correlation between CT and DSA Vascular Findings for Superselective Embolization Procedures

et al. 2021

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Background: This study aims to investigate the correlation between computed tomography (CT) and digital subtraction angiography (DSA) findings in patients affected by acute post-traumatic intraparenchymal renal hemorrhages and evaluate their conservative management with superselective embolization. Methods: This retrospective multicenter analysis focuses on patients affected by renal bleedings detected by contrast-enhanced CT and treated with superselective endovascular embolization. CT findings were compared to DSA. Embolization procedural data were analyzed and renal function was evaluated before and after the intervention. Results: Twenty-seven patients were retrospectively evaluated in one year. Compared to DSA, CT showed 96.3% diagnostic accuracy in terms of hemorrhage recognition; concerning the type of vascular lesion, there was discrepancy between CT and DSA in five cases. The technical success rate of embolization was 100%, while primary clinical success was 88.9%. The inferior parenchymal third was the most frequent site of renal injury. Microcoils were the most adopted embolics. Renal function did not change significantly before and after embolization. Conclusions: CT has elevated diagnostic accuracy in detecting post-traumatic intraparenchymal renal hemorrhages; in a small percentage, the type of vascular lesion may differ from the findings observed at DSA. In this scenario, superselective embolization presents high clinical success with a low complication rate.

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“…Renal embolization can be performed with various embolic agents, including an absorbable gelatin sponge. There is no consensus on which embolic agent to use, and the final decision depends on each situation and on the interventional radiologist’s preferences [ 61 ]. Because their aim is to induce clot formation, the efficacy of absorbable gelatin sponge, coils, and particles depends on the patient’s coagulation status.…”

Section: Tumor Embolizationmentioning

confidence: 99%

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

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Curti

et al. 2021

JCM

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This review focuses on the use of “new” generation of non-adhesive liquid embolic agents (NALEA). In literature, non-adhesive liquid embolic agents have mainly been used in the cerebral district; however, multiple papers describing the use of NALEA in the extracranial district have been published recently and the aim of this review is to explore and analyze this field of application. There are a few NALEA liquids such as Onyx, Squid, and Phil currently available in the market, and they are used in the following applications: mainly arteriovenous malformations, endoleaks, visceral aneurysm or pseudoaneurysm, presurgical and hypervascular lesions embolization, and a niche of percutaneous approaches. These types of embolizing fluids can be used alone or in combination with other embolizing agents (such as coils or particles) so as to enhance its embolizing effect or improve its possible defects. The primary purpose of this paper is to evaluate the use of NALEAs, predominantly used alone, in elective embolization procedures. We did not attempt a meta-analysis due to the data heterogeneity, high number of case reports, and the lack of a consistent follow-up time period.

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Ethylene Vinyl Alcohol Copolymer Embolization for Acute Renal Hemorrhage: Initial Experience in 24 Cases

Cited by 10 publications

References 16 publications

Endovascular management of an unsual case of spontaneous Retroperitoneal Haemorrhage due to Fibromuscular Dysplasia

Endovascular management of an unsual case of spontaneous Retroperitoneal Haemorrhage due to Fibromuscular Dysplasia

Post-Traumatic Intraparenchymal Renal Hemorrhages: Correlation between CT and DSA Vascular Findings for Superselective Embolization Procedures

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

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