Ultraselective Arterial Embolization of Vasa Recta Using 1.7-French Microcatheter With Small-Sized Detachable Coils in Acute Colonic Hemorrhage After Failed Endoscopic Treatment

Koganemaru, Masamichi; Abe, Toshi; Iwamoto, Ryoji; Kusumoto, Masashi; Suenaga, Masako; Saga, Tsuyoshi; Hayabuchi, Naofumi

doi:10.2214/ajr.11.7295

Cited by 12 publications

(12 citation statements)

References 8 publications

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“…Renal tumors, such as renal angiomyolipoma or renal cell carcinoma and renal arteriovenous malformations, are also important causes of acute renal bleeding. Bleeding from these causes might be in the form of aneurysm, pseudoaneurysm (PA), extravasation, AVF, ACF, or perinephric hematoma [4,5]. In our study, trauma represented 86.6% of our patients.…”

Section: Discussionmentioning

confidence: 81%

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Clinical outcome and safety of selective renal artery embolization using permanent occlusive agents for acute renal bleeding

Alwarraky

Abdallah

Elgharbawy

2020

Egypt J Radiol Nucl Med

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Background To evaluate how far is selective renal artery embolization (RAE) using permanent agents effective in treating acute renal artery bleeding. We retrospectively reviewed the medical records of patients (n = 45) with renal bleeding who were managed by selective RAE using coils, N-butyl-cyanoacrylate glue (NBCA glue), and polyvinyl alcohol (PVA). Data retrieved included the cause, number, and type of the bleeding lesions as well as the results of the embolization for 1 year after RAE. Clinical success was the primary outcome while re-bleeding and complications were the secondary outcomes. Results There were 55 bleeding lesions detected by angiography in the included 45 patients. Coils were used in 23/45 patients (51.1%), NBCA glue in 15/45 patients (33.3%), and PVA in 7 patients (15.6%). Bleeding could be controlled with embolization in a single session in 41/45 patients with primary clinical success 91.1%. Four patients needed re-embolization sessions to control bleeding and only one patient was controlled, giving secondary clinical success of 92.3%. Three patients failed to respond to embolization and nephrectomy was done. Iatrogenic dissection of the segmental branch was seen in one patient. Post embolization syndrome was seen in 14/45 patients (31.1%). Non-target embolization was seen in 2 patients: one during treatment with NBCA glue and the other with PVA. No other complications were recorded. No significant differences between clinical success among coil, NBCA glue, and PVA subgroups (P > 0.05). Conclusion Selective RAE using permanent agents is effective in controlling renal bleeding and no significant difference among coil, NBCA glue, and PVA.

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Section: Discussionmentioning

confidence: 81%

“…Permanent agents involve coils, NBCA-glue, PVA particles, and microvascular plug (MVP). The clinical outcome regarding the stoppage of bleeding or the recurrence usually depends on the type of the embolic material used [5,6].…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome and safety of selective renal artery embolization using permanent occlusive agents for acute renal bleeding

Alwarraky

Abdallah

Elgharbawy

2020

Egypt J Radiol Nucl Med

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“…These factors should be considered for prompt surgical intervention in those high-risk patients. [24] 32 patients Immediate hemostasis 97 % Ischemia rate 1 % Gillespie et al [27] 38 patients Immediate hemostasis 100 % Ischemia rate 8 % Rebleeding rate 24 % Koganemaru et al [28] 4 patients Immediate hemostasis 100 % Ischemia rate 0 % Rebleeding rate 0 % Finally, ischemia remains the main problem, and the risk decreased with better embolization technique. Recently, Tan et al [26] described only one patient (3 %) suffering from ischemic complications that required immediate surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results

Rossetti

Buchs

Bréguet

et al. 2012

Int J Colorectal Dis

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Background Lower gastrointestinal bleeding represents 20 % of all gastrointestinal bleedings. Interventional radiology has transformed the treatment of this pathology, but the long-term outcome after selective embolization has been poorly evaluated. The aim of this study is thus to evaluate the short-term and long-term outcomes after selective embolization for colonic bleeding.Methods From November 1998 to December 2010, all acute colonic embolizations for hemorrhage were retrospectively reviewed and analyzed. The risk factors for post-embolization ischemia were also assessed. Results Twenty-four patients underwent colonic embolization. There were 6 men and 18 women with a median age of 80 years (range, 42-94 years). The underlying etiologies included diverticular disease (41.9 %), post-polypectomy bleeding (16.7 %), malignancy (8.2 %), hemorrhoid (4.1 %), and angiodysplasia (4.1 %). In 23 patients, bleeding stopped (95.8 %) after selective embolization. One patient presented a recurrence of bleeding with hemorrhagic shock and required urgent hemorrhoidal ligature. Four patients required an emergent surgical procedure because of an ischemic event (16.7 %). One patient died of ileal ischemia (mortality, 4.1 %). The level of embolization and the length of hypoperfused colon after embolization were the only risk factors for emergent operation. Mean hospital stay was 18 days (range, 9-44 days). After a mean follow-up of 28.6 months (range, 4-108 months), no other ischemic events occurred. Conclusion In our series, selective transarterial embolization for acute colonic bleeding was clinically effective with a 21 % risk of bowel ischemia. The level of embolization and the length of the hypoperfused colon after embolization should be taken into consideration for emergent operation.

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“…or smaller. [6][7][8][9] The triaxial system was previously shown to be useful for super-selective catheterization under various conditions. 5 In particular, it should be very effective for cases which definitely need super-selective catheterization, such as those with pseudoaneurysm, gastrointestinal bleeding, or type 2 endoleak after EVAR.…”

Section: Discussionmentioning

confidence: 99%

“…microcatheters with 0.010-in. electrically detachable coils has been reported in embolization for gastrointestinal bleeding, 7,8 for which the triaxial system was also shown to be useful. 11 Alterations in blood flow in TACE for HCC were performed in two cases in the present study.…”

Section: Discussionmentioning

confidence: 99%

Use of 0.014-in. pushable bare platinum coils in super-selective embolization through the 1.6-Fr. microcatheter of the triaxial system

Tsukahara

Shimohira

Nagai

et al. 2020

Acta Radiologica Open

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Background A triple-coaxial (triaxial) system, which consists of a small microcatheter, a large microcatheter, and a 4-Fr. catheter, has been reported to allow super-selective catheterization. A 1.6-Fr. microcatheter has recently become available as the small microcatheter for the triaxial system, in addition to 0.014-in. pushable bare platinum coils that may be introduced into the 1.6-Fr. microcatheter. Purpose The purpose of the present study was to evaluate the feasibility of 0.014-in. pushable bare platinum coils in embolization through the 1.6-Fr. microcatheter of the triaxial system. Material and Methods Between November 2015 and October 2019, 19 embolizations were performed on 18 patients, 9 males and 9 females with a median age of 77 years (range, 41–88 years), using 0.014-in. pushable bare platinum coils through the 1.6-Fr. microcatheter of the triaxial system. The technical success rate, clinical success rate, and complications associated with the procedure were assessed. Technical success was defined as the successful delivery and placement of 0.014-in. pushable bare platinum coils, and clinical success as the immediate postembolic complete cessation of blood flow confirmed by digital subtraction angiography. Results Eighty-four 0.014-in. pushable bare platinum coils were delivered and 19 arteries were successfully embolized. The median number of 0.014-in. pushable bare platinum coils was 4 (range, 1–12). The technical success rate was 100% (84/84) and the clinical success rate was also 100% (19/19). There were no complications associated with the procedures. Conclusion The use of 0.014-in. pushable bare platinum coils in super-selective embolization through the 1.6-Fr. microcatheter of the triaxial system appears to be feasible and safe.

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Ultraselective Arterial Embolization of Vasa Recta Using 1.7-French Microcatheter With Small-Sized Detachable Coils in Acute Colonic Hemorrhage After Failed Endoscopic Treatment

Abstract: We achieved technical success in all four patients with the sole use of short-segment embolization of the long branch of the vasa recta. Our findings suggest that this technique is useful for embolization in cases of colonic hemorrhage.

Cited by 12 publications

References 8 publications

Clinical outcome and safety of selective renal artery embolization using permanent occlusive agents for acute renal bleeding

Clinical outcome and safety of selective renal artery embolization using permanent occlusive agents for acute renal bleeding

Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results

Use of 0.014-in. pushable bare platinum coils in super-selective embolization through the 1.6-Fr. microcatheter of the triaxial system

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