Uterine Artery Embolization in Sheep: Comparison of Acute Effects with Polyvinyl Alcohol Particles and Calibrated Microspheres

Pelage, Jean-Pierre; Laurent, Alexandre; Wassef, Michel; Bonneau, Michel; Germain, D.; Rymer, Roland; Flaud, Patrice; Martal, J.; Merland, J. J.

doi:10.1148/radiol.2242010847

Cited by 147 publications

(79 citation statements)

References 26 publications

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“…Moreover, an experimental animal study on ewes found that polyvinyl alcohol particles were associated with more intense uterine necrosis than were calibrated microspheres, and uterine necrosis occurred more frequently with small rather than large polyvinyl alcohol particles and microspheres. 39 In our study, polyvinyl alcohol particles were never used, and the nature of the embolisation agent did not differ between the women with or without synechia. The only factors significantly associated with severe synechia were a higher rate of abnormal placentation (62.5% versus 8.3%, P = 0.001) and postpartum fever >38.5°C (50% versus 15%, P = 0.04).…”

Section: Discussionmentioning

confidence: 60%

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

Sentilhes

Gromez

Clavier

et al. 2009

BJOG

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Objectives To determine and compare the fertility and pregnancy outcomes following embolisation with or without uterine-sparing surgery for postpartum haemorrhage, and to attempt to identify specific risk factors associated with an increased likelihood of intrauterine synechia.Design Retrospective study.Setting University-affiliated tertiary referral centre.Population All consecutive women who had an embolisation with or without uterine-sparing surgery (vessel ligation and/or uterine compression) for postpartum haemorrhage between 1994 and 2007 were included.Methods Data were retrieved from medical files and telephone interviews.Main outcome measure(s) Fertility and pregnancy outcomes, synechia.Results Data were available for 68 of the 85 women (80%) included in the study. Among the 15 women who complained of amenorrhoea or decreased flow of menstruation, synechia was found in all those who decided to undergo an ambulatory hysteroscopy (n = 8). Seventeen women had 26 pregnancies with 19 term deliveries, one ectopic pregnancy, two abortions and four miscarriages. The clinical courses of the 19 complete gestations were uneventful, but postpartum haemorrhage recurred in six women (31.6%) (caused by placenta accreta in two women). Fertility and pregnancy outcomes did not differ between women who had undergone embolisation versus both embolisation and a uterine-sparing surgical procedure. The occurrence of synechia was significantly associated with a higher rate of placenta accreta/ percreta (P < 0.001) and postpartum fever above 38.5°C (P = 0.04).Conclusions Embolisation, whether or not associated with a uterine-sparing surgical procedure, for postpartum haemorrhage does not appear to compromise a woman's subsequent fertility and obstetric outcome. Nevertheless, these women should be considered at high risk for postpartum haemorrhage during future deliveries.

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Section: Discussionmentioning

confidence: 60%

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

Sentilhes

Gromez

Clavier

et al. 2009

BJOG

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“…with 26 and 31 years of experience, respectively) according to the following scale: grade 0, saline-like injection; grade 1, resistance; and grade 2, catheter occlusion. The target injection grade for these procedures was grade 1 (1).…”

Section: Angiography and Embolization Protocolmentioning

confidence: 99%

“…Uterine fibroid embolization (UFE) is a therapeutic option in the management of symptomatic fibroids (1). Even though polyvinyl alcohol (PVA) particles are the most commonly utilized embolic material in UFE, their irregular shape and large granulometric size range may lead to clogs in the catheter or proximal portion of the target vessels.…”

mentioning

confidence: 99%

MRI traceability of superparamagnetic iron oxide nanoparticle-embedded chitosan microspheres as an embolic material in rabbit uterus

Choi

Kwak

Shim

et al. 2015

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSEWe aimed to compare polyvinyl alcohol (PVA) particles with calibrated superparamagnetic iron oxide (SPIO) nanoparticle-loaded chitosan microspheres in a rabbit model, specifically regarding the relative distribution of embolic agents within the uterus based on magnetic resonance imaging (MRI) and pathological evaluation. METHODSTwelve New Zealand white rabbits underwent uterine artery embolization using either standard PVA particles (45-150 µm or 350-500 µm) or calibrated SPIO-embedded chitosan microspheres (45-150 µm or 300-500 µm). MRI and histopathological findings were compared one week after embolization. RESULTSCalibrated SPIO-loaded chitosan microspheres 45-150 µm in size were detected on T2-weighted images. On histological analysis, calibrated SPIO-embedded chitosan microspheres were found in both myometrium and endometrium, whereas PVA particles were found only in the perimyometrium or extrauterine fat pads. A proportional relationship was noted between the calibrated SPIO-embedded chitosan microsphere size and the size of the occluded artery. CONCLUSION Calibrated SPIO-embedded chitosan microspheres induced greater segmental arterial occlusion than PVA particles and showed great potential as a new embolic material. SPIO-embedded chitosan microspheres can be used to follow distribution of embolic particles through MRI studies.

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“…Entretanto, as partículas de PVA existentes comercialmente apresentam alguns aspectos indesejáveis como superfície irregular, o que facilita a sua aglutinação e agregação, muitas vezes dificultando sua passagem pelo cateter angiográfico ou limitando o grau de sua progressão dentro da lesão vascular. Somado a isto, as partí-culas de PVA-flocular são suscetíveis à degradação ao longo do tempo (biodegradabilidade), facilitando a futura recanalização do leito vascular tratado 1,4,[7][8][9] . Com intuito de se contornar as características indesejáveis inerentes às partículas de PVA comercialmente disponíveis, formas diferentes de uso têm sido experimentadas e várias novas substâncias têm sido criadas e testadas 1,4,[8][9][10][11][12][13][14][15] .…”

Section: Mendes Et Alunclassified

“…Somado a isto, as partí-culas de PVA-flocular são suscetíveis à degradação ao longo do tempo (biodegradabilidade), facilitando a futura recanalização do leito vascular tratado 1,4,[7][8][9] . Com intuito de se contornar as características indesejáveis inerentes às partículas de PVA comercialmente disponíveis, formas diferentes de uso têm sido experimentadas e várias novas substâncias têm sido criadas e testadas 1,4,[8][9][10][11][12][13][14][15] . Derdeyn et al 8 realizaram um estudo com objetivo de avaliar as características da partícula de PVA-flocular e determinar se ela muda de tamanho quando suspensa em meio de contraste não iônico ou quando suspensa em uma solução alternativa de contraste não iônico e álcool absoluto, e concluíram que a partícula de PVA-flocular aumentou significativamente de tamanho nas duas diferentes soluções, uma vez que o PVAflocular é uma espuma de polivinil que se comporta como esponja.…”

Section: Mendes Et Alunclassified

Estudo comparativo da reação inflamatória renal entre álcool de polivinil - flocular e álcool de polivinil + acetato de polivinil - esférico: estudo experimental

Mendes¹,

Chagas

Pinto

et al. 2005

Rev. Col. Bras. Cir.

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; Gaudencio Espinosa,TCBC-RJ 5 RESUMO: Objetivo: Avaliar as características e os efeitos de um agente embólico, disponível comercialmente, consistindo de Polivinil Álcool (PVA) de morfologia flocular, e comparar com um agente esférico, de tecnologia nacional, consistindo de Polivinil Álcool e Polivinil Acetato (PVA + PVAc). Método: Foram utilizadas fêmeas de coelho albino "New Zealand", submetidas à embolização arterial renal. PVA-flocular foi usado em 24 animais, assim como PVA+PVAc-esférico. Seis animais foram utilizados como controle. Todos foram mantidos em cativeiro até a morte, por períodos pós-operatórios de 48 horas, cinco dias, 10 dias e 30 dias. Resultados: Ambos os agentes promoveram oclusão do vaso e infarto do órgão. O estudo microscópico inicial das artérias embolizadas com PVA-flocular, mostra oclusão com trombo e PVA. Os vasos embolizados com PVA+PVAc-esférico, mostram os agentes ocupando praticamente todo o lúmen. No estudo de 30 dias, observa-se absorção do trombo e retração dos agentes de PVAflocular, criando espaços. E com PVA+PVAc-esférico, pode-se observar os agentes circundados por intensa fibrose. Conclusões: Ambas as partículas foram efetivas para causar isquemia tecidual. A reação inflamatória foi mais intensa com PVA+PVAc-esférico que também apresentou grau de penetração maior no sistema vascular (Rev. Col. Bras. Cir. 2005; 32(3): 120-126).

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Uterine Artery Embolization in Sheep: Comparison of Acute Effects with Polyvinyl Alcohol Particles and Calibrated Microspheres

Abstract: PVA particles are associated with intense uterine necrosis and extensive arterial occlusion regardless of size. Calibrated MS, which are associated with less uterine necrosis, permit a segmental arterial occlusion correlated with size.

Cited by 147 publications

References 26 publications

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

MRI traceability of superparamagnetic iron oxide nanoparticle-embedded chitosan microspheres as an embolic material in rabbit uterus

Estudo comparativo da reação inflamatória renal entre álcool de polivinil - flocular e álcool de polivinil + acetato de polivinil - esférico: estudo experimental

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