Evaluation of Multiple Embolic Agents for Embolization of the Superior Rectal Artery in an Animal Model

Tradi, Farouk; Panneau, Julien; Brige, Pauline; Mège, Diane; Habert, Paul; Hak, Jean-François; Bisceglie, Mathieu Di; Vidal, Vincent

doi:10.1007/s00270-021-03041-7

Cited by 6 publications

(5 citation statements)

References 35 publications

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“…EVOH should be a damaging embolization material for hemorrhoids. However, despite the fact that the vascular anatomy of pigs and humans are pretty comparable, these results may not be wholly reproducible [37].…”

Section: Outcomes and Safety In Current Literaturementioning

confidence: 89%

Prevalent Technique and Results of Hemorrhoidal Embolization

Gil

Puchol

Solaz

et al. 2022

JCM

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Hemorrhoids are blood cushions located in the anus and lower rectum, acknowledged as a common cause of bleeding, which can reduce quality of life. The development of minimally invasive techniques such as endovascular embolization of superior rectal artery, “Emborrhoid technique”, is an effective treatment, with no pain or ischemic complications, and allows quick patient recovery. Our purpose is to describe the general technique and discuss the results of the current literature.

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Section: Outcomes and Safety In Current Literaturementioning

confidence: 89%

Prevalent Technique and Results of Hemorrhoidal Embolization

Gil

Puchol

Solaz

et al. 2022

JCM

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“…In this sense, Tradi F et al [ 13 ] advise that other embolizing agents should be studied closely before being used, such as embolic fluids, especially as microcoils, which have been shown to be very effective and safe. In our experience, the microcoil Prestige Plus (Balt, Montmorency, France) is a new, novel coil with good deliverability combined with reliable detachment.…”

Section: Discussionmentioning

confidence: 99%

“…We did not experience any technical failures during our series of procedures. Additionally, a report [ 13 ] indicated that ethylene vinyl alcohol copolymer may be an unsafe agent for hemorrhoid embolization, as in their experimental study in pigs, necrosis of the distal rectum with mural infarction was observed in animals that underwent embolization with a copolymer of ethylene vinyl alcohol.…”

Section: Discussionmentioning

confidence: 99%

“…Coils and microparticles or spheres are the most widely used embolizing agents, although, in theory, other agents could be used. Nevertheless, Tradi F et al [ 13 ] recommend that embolic fluids should be studied closely before being used, especially as microcoils are mostly very effective and safe. There are 47 types of coils on the market made by nine companies [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Safety and Effectiveness of a New Electrical Detachable Microcoil for Embolization of Hemorrhoidal Disease, November 2020–December 2021: Results of a Prospective Study

Gregorio

Bernal

Ciampi-Dopazo

et al. 2022

JCM

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Purpose: The purpose of this study was to prospectively evaluate the efficacy and safety of a new, bare platinum, detachable microcoil as a metallic embolization agent in the treatment of hemorrhoidal disease. Material and Methods: This prospective single-center study evaluated a new, bare platinum, electrical, detachable microcoil (Prestige plus coil (Balt Montmorency France)) for use in vascular embolization in patients with hemorrhoidal disease. Between January 2020 and January 2021, 24 embolization procedures were performed in 21 patients (12 males, 9 females; mean age 44.3 ± 7.3). The inclusion criteria were: (a) participants with grade I, II and III hemorrhoidal disease on the Goligher classification; (b) patients older than 18 years of age with a score of greater than 4 on the French bleeding score (FBS) scale; (c) patients with scores greater than 2 on the scale of discomfort proposed by Tradi and Farfallah. (d) patients who underwent treatment that included the use of the new novel coil (Prestige plus coil (Balt)) as an embolic material. The exclusion criteria were participants who failed to provide informed consent and participants diagnosed with rectal bleeding due to other causes (cancer, fissures or others). Participants with severe renal insufficiency, non-correctable coagulation abnormalities and adverse reactions to the contrast medium not correctable with medication were also excluded. The symptoms, technical aspects, the transarterial approach, clinical and technical success complications and short-term outcomes were assessed. Results: Technical success was obtained in 100% of the cases. Seventeen (80.9%) patients experienced improvements in their hemorrhoidal disease. The VAS and QL scores improved by 4 and 1.5 points (81.2% and 87.5%), respectively, after embolization (pV: 0001). Three (14.2%) patients underwent a second embolization due to rebleeding. One patient (4.7%) underwent surgery. No major complications were observed. Three patients had minor complications. The assessment of subjective post-treatment symptoms and QL surveys showed significant differences from the baseline survey. Likewise, the measurement of the degree of satisfaction using a telephone survey at 12 months revealed a high degree of patient satisfaction over 10 points (mean 8.3 ± 1.1). Conclusions: The present study demonstrates that the use of the new, platinum, detachable, electrical microcoil is safe and well-tolerated in the treatment of hemorrhoidal disease. Key points: Catheter-directed hemorrhoidal dearterialization (CDHD) is the procedure of embolization with embolic agents for the treatment of internal hemorrhoids. CDHD is a simple and safe procedure that is accepted by patients and preserves the anal sphincter; it presents few complications when metal devices or microspheres are used as embolic agents. As the recommended embolization agent in treatments, the Prestige electrical, detachable coil is a safe, easy-to-use and effective arterial embolic device.

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“…Side effects were divided into early adverse effects (within 6 days after embolization) and late effects after this 6-day period. All the adverse effects linked to the embolization technique were collected: EVOH allows more distal embolization than the particles [ 1 , 6 ], and one could expect a postembolization syndrome linked to more pronounced prostatic ischaemia, characterized by nausea, vomiting, fever, perineal pain, dysuria, haematuria, and urine retention. For this last symptom, it was also noted whether evacuating bladder catheterization was necessary within 12 h of the intervention.…”

Section: Methodsmentioning

confidence: 99%

Non-target embolic events during prostatic embolization with ethylene vinyl alcohol copolymer (EVOH)

Sédat,

Arnoffi,

Poirier

et al. 2023

CVIR Endovasc

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Background This study evaluated nontarget embolization (NTE) during prostatic artery embolization (PAE) with ethylene vinyl alcohol copolymer (EVOH). Results Ten consecutive patients treated by PAE with EVOH for the presence of disabling benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) between June 22 and January 2023 were included in this prospective study. The inclusion criteria were as follows: LUTS attributed to BPH, LUTS duration ≥ 6 months, failure to respond to standard pharmacotherapy, IPSS > 18 or QoL score > 2, and prostate volume > 40 mL. Embolization was performed under general anaesthesia. According to established techniques, a microcatheter was positioned bilaterally within the feeding arteries, and EVOH was injected slowly under X-ray control. Unenhanced pelvic computed tomography scans were carried out before and after embolization to assess the NTE. The safety of the prostatic embolization procedure with EVOH was assessed by collecting adverse effects over 3 months of evaluation that included the International Prostate Symptom Score (IPSS) and quality of life (QoL) score.-up evaluations, occurring at 3, 6, and 12months, included International Prostate Symptom Score. Bilateral PAE was technically successful in 9 patients, and unilateral injection was performed in one patient. The postoperative scanner showed a distribution of the embolization material in the two lobes of the prostate in all patients. The procedure time varied from 120 to 150 (mean: 132) minutes. Eight out of 10 patients developed pollakiuria within 24 h; none of the patients had postoperative pain. Two patients required catheterization for postoperative urinary retention. Catheters were removed successfully at the end of the first day for one of these patients and on the tenth day for the other. At the 3-month follow-up, patients showed significant improvement in the International Prostate Symptom Score (n = 10; mean = -11,5; P < 0.01) and quality of life score (n = 10; mean = -3,40; P < 0.01). Only one patient presented one asymptomatic muscular NTE. Conclusions PAE with EVOH is safe, effective, and associated with few NTEs and no postoperative pain. Prospective comparative studies with longer follow-ups are warranted. Trial registration IDRCB, 2021-AO29-56–35. Registered 27 May 2022, http://clinicaltrials.gov/study/NCT05395299?cond=embolization&term&rank=1.

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Evaluation of Multiple Embolic Agents for Embolization of the Superior Rectal Artery in an Animal Model

Cited by 6 publications

References 35 publications

Prevalent Technique and Results of Hemorrhoidal Embolization

Prevalent Technique and Results of Hemorrhoidal Embolization

Safety and Effectiveness of a New Electrical Detachable Microcoil for Embolization of Hemorrhoidal Disease, November 2020–December 2021: Results of a Prospective Study

Non-target embolic events during prostatic embolization with ethylene vinyl alcohol copolymer (EVOH)

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