Superselective embolization using a co-axial catheter technique

Abstract

A method of superselective embolization of 0.64 mm or 0.89 mm coils using a coaxial catheter system is described. The normally functioning parts of an organ can be easily preserved. A number of clinical cases are briefly described which illustrate the application of this method. It is particularly suited to the control of bleeding points in diseased organs or precious organs such as transplants where embolization of a larger volume of tissue would have serious consequences.

Embolotherapy for Lower Urinary Tract Hemorrhage

“…However, our preference was to superselectively embolize the vesical artery when possible to help prevent ischemic complications elsewhere in the territory of the internal iliac artery territory. Our rates of technical success (100%), initial clinical success (100%), and recurrent hematuria (18%) are comparable to the experience of other authors (technical success, 99%; initial clinical success, 85%; and recurrent hematuria, 9%) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). However, our complication rate (9%) is lower than that of other series in which nonselective embolization was performed (complication rate, 46%) and on par with those series where superselective embolization was performed (complication rate, 17%) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

“…Our only technical complication occurred with this technique, with the rate (17%) comparable to the complication rate for selective embolization of the anterior division of the internal iliac artery in the literature (12%) (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). However, our patient remained asymptomatic despite occlusion of the posterior division of the right internal iliac artery.…”

“…Successful unilateral internal iliac artery embolizations for the treatment of intractable hematuria have been reported (2,6,7,9,14,15); however, the rich collateral blood supply to the internal iliac artery from the contralateral internal iliac, inferior mesenteric, external iliac, and femoral arteries underscores the need for bilateral embolization (12). One of the recurrences in our series occurred in the only patient who had undergone a unilateral embolization.…”

“…The embolization was initially successful, but bleeding recurred much earlier than our other recurrence (at 11 days after treatment vs 84 days after treatment). The fact that recurrences occurred in 15% (three of 20) of initially clinically successful unilateral embolizations for hematuria in the literature versus 6% (four of 62) of bilateral embolizations also highlights the need for bilateral embolization (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

“…Two cases of unilateral embolization of the vesical artery with gelatin sponge were described in 1980 (14). One case of unilateral embolization of the vesical artery with coils was described in 1990 (15). Two cases of bilateral vesical artery embolization with particulate material were described in 1996 (16).…”