Transcatheter arterial embolization—Major complications and their prevention

Miller, Franklin J.; Mineau, DE

doi:10.1007/bf02552766

Cited by 39 publications

(13 citation statements)

References 51 publications

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“…[31][32][33] Embolization (either with Ivalon or coils) of hepatic AVMs has been associated with significant risk. 34,35 In fact, a meta-analysis of the literature shows a mortality rate of nearly 20%. 1,13,15,[20][21][22][23][24][25][26][27] Reported complications of HA embolization include inadvertent pulmonary embolization, reflux migration of particles to distant sites, parenchymal necrosis, liver failure, and death.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation as definitive therapy for complications after arterial embolization for hepatic manifestations of hereditary hemorrhagic telangiectasia

et al. 1998

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Experience with hepatic artery embolization for the treatment of symptomatic hepatic arteriovenous malformations (AVMs) in Rendu-OslerWeber disease is limited. We report 2 cases of hepatic AVMs that caused mesenteric angina-like symptoms that were treated with embolization. Both patients developed parenchymal and bile duct necrosis, intrahepatic bilomas, and refractory biliary sepsis, subsequently leading to liver failure. We hypothesize that the pathophysiological cause of biliary necrosis in this setting is similar to that which occurs in the setting of hepatic artery thrombosis of the liver allograft. Progressive liver failure in these patients was treated successfully by liver transplantation. Liver transplantation offers definitive therapy by removing the source of ongoing sepsis, restoring normal liver function, and eliminating the intrahepatic AV shunt.

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Section: Discussionmentioning

confidence: 99%

Liver transplantation as definitive therapy for complications after arterial embolization for hepatic manifestations of hereditary hemorrhagic telangiectasia

et al. 1998

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“…Similar complications have been reported by other authors [15,21,30], and occurrence of biliary sepsis or liver failure may even necessitate emergency liver transplantation [25,29,30]. Consequently, reservations regarding this therapy form exist in some institutions [29,[38][39][40][41]. Possible means of reducing the severity of these complications would be embolizing smaller portions of the liver at each session and placing the catheter tip distal to the origin of the cystic artery in order to avoid the occurrence of ischemic cholecystitis.…”

Section: Discussionmentioning

confidence: 50%

Hepatic artery embolization for treatment of patients with hereditary hemorrhagic telangiectasia and symptomatic hepatic vascular malformations

et al. 2004

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At present there is no established therapy for treating patients with hereditary hemorrhagic telangiectasia (HHT) and symptomatic hepatic involvement. We present the results of a prospective study with 15 consecutive patients who were treated with staged hepatic artery embolization (HAE). Branches of the hepatic artery were selectively catheterized and embolized in stages using polyvinyl alcohol particles (PVA) and platinum microcoils or steel macrocoils. Prophylactic antibiotics, analgesics and anti-emetics were administered after every embolization. Clinical symptomatology and cardiac output were assessed before and after therapy as well as at the end of follow-up (median 28 months; range 10-136 months). Five patients had abdominal pain and four patients had symptoms of portal hypertension. The cardiac output was raised in all patients, with cardiac failure being present in 11 patients. After treatment, pain resolved in all five patients, and portal hypertension improved in two of the four patients. The mean cardiac output decreased significantly ( P<0.001) from 12.57+/-3.27 l/min pre-treatment to 8.36+/-2.60 l/min at the end of follow-up. Symptoms arising from cardiac failure resolved or improved markedly in all but one patient. Cholangitis and/or cholecystitis occurred in three patients of whom two required a cholecystectomy. One patient with pre-existent hepatic cirrhosis died as a complication of the procedure. Staged HAE yields long-term relief of clinical symptoms in patients with HHT and hepatic involvement. Patients with pre-existing hepatic cirrhosis may be poor candidates for HAE.

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“…4 The choice of treatment is based on the condition of the individual patient, and TAE was selected as the most appropriate approach for the present patient. However, TAE has the potential to cause ischemia or necrosis of bowel 5 and therefore must be undertaken with care and appropriate postprocedure monitoring.…”

Section: Discussionmentioning

confidence: 99%