Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer - feasibility, technical outcomes, and clinical outcomes

VASA ◽  
2016 ◽  
Vol 45 (6) ◽  
pp. 497-504 ◽  
Author(s):  
Tom De Beule ◽  
Jan Vranckx ◽  
Peter Verhamme ◽  
Veerle Labarque ◽  
Marie-Anne Morren ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Arteriovenous Malformations ◽  
Clinical Success ◽  
Transarterial Embolization ◽  
Recurrent Bleeding ◽  
Complete Disappearance ◽  
Ethylene Vinyl Alcohol ◽  
Initial Symptoms

Abstract. Background: The technical and clinical outcomes of catheter-directed embolization for peripheral arteriovenous malformations (AVM) using Onyx® (ethylene-vinyl alcohol copolymer) are not well documented. The purpose of this study was to retrospectively assess the safety, technical outcomes and clinical outcomes of catheter-directed Onyx® embolisation for the treatment of symptomatic peripheral AVMs. Patients and methods: Demographics, (pre-)interventional clinical and radiological data were assessed. Follow-up was based on hospital medical records and telephone calls to the patients’ general practitioners. Radiological success was defined as complete angiographic eradication of the peripheral AVM nidus. Clinical success was defined as major clinical improvement or complete disappearance of the initial symptoms. Results: 25 procedures were performed in 22 patients. The principal indications for treatment were pain (n = 10), limb swelling (n = 6), recurrent bleeding (n = 2), tinnitus (n = 3), and exertional dyspnoea (n = 1). Complete radiological success was obtained in eight patients (36 %); near-complete eradication of the nidus was achieved in the remaining 14 patients. Adjunctive embolic agents were used in nine patients (41 %). Clinical success was observed in 18 patients (82%). Major complications were reported in two patients (9 %). During follow-up, seven patients (32 %) presented with symptom recurrence, which required additional therapy in three patients. Conclusions: Catheter-directed embolisation of peripheral AVMs with Onyx® resulted in major clinical improvement or complete disappearance of symptoms in the vast majority of patients, although complete angiographic exclusion of the AVMs occurred in only a minority of patients.

scholarly journals Angiographic features and transarterial embolization of retained placenta with abnormal vaginal bleeding

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Ryo Takaji ◽  
Hiro Kiyosue ◽  
Miyuki Maruno ◽  
Norio Hongo ◽  
Ryuichi Shimada ◽  
...  
Keyword(s):  
Vaginal Bleeding ◽  
Transarterial Embolization ◽  
Recurrent Bleeding ◽  
Study Cohort ◽  
Technical Success ◽  
Retained Placenta ◽  
Vascular Channel ◽  
Abnormal Bleeding ◽  
Abnormal Vaginal Bleeding

Abstract Objectives To clarify characteristic angiographic features and clinical efficacy of selective transarterial embolization (TAE) of retained placenta with abnormal vaginal bleeding. Methods The study cohort comprised 22 patients (mean age, 33.5 years; range, 22–24 years) who underwent selective TAE for retained placenta with abnormal bleeding between January 2018 and December 2020 at our institution. Angiographic images were reviewed by two certified radiologists with consensus. Medical records were reviewed to evaluate the efficacy of TAE. Angiographic features of retained placenta, technical success (disappearance of abnormal findings on angiography), complications, clinical outcomes (hemostatic effects and recurrent bleeding) were evaluated. Results Pelvic angiography showed a dilated vascular channel mimicking arteriovenous fistulas or an aneurysm contiguous with dilated uterine arteries in the mid-arterial–capillary phase in 20 patients; it showed contrast brush in the remaining two patients. TAE technical success was achieved in all patients. No major complications were observed in any patients. Fifteen patients were followed up with expectant management after TAE; all but one patient showed no re-bleeding during the follow-up period (mean follow-up interval, 3.4 months; range, 1–17 months). One patient showed minor rebleeding, which resolved spontaneously. Seven patients underwent scheduled hysteroscopic resection within 1 week after TAE, and no excessive bleeding was observed during or after the surgical procedure in all seven patients. Conclusions The characteristic angiographic feature of retained placenta is “dilated vascular channel that mimic low flow AVM.” TAE is a safe and effective treatment to manage retained placenta with abnormal bleeding.

scholarly journals Supratentorial Brain AVM Embolization with Onyx-18 and Post-Embolization Management

2009 ◽  
Vol 15 (3) ◽  
pp. 275-282 ◽  
Author(s):  
J. W. Pan ◽  
H.J. Zhou ◽  
R.Y. Zhan ◽  
S. Wan ◽  
M. Yan ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Subsequent Treatment ◽  
Additional Surgery ◽  
Brain Avm ◽  
Initial Symptoms ◽  
Complete Obliteration ◽  
Long Term Follow Up ◽  
Long Term Prognosis

Onyx is increasingly used in endovascular therapy of intracranial arteriovenous malformations (AVMs). However, the embolic effect and post-embolization management are still under discussion. We report our experience in the treatment of supratentorial brain arteriovenous malformations (SBAVMs) with Onyx and discuss post-embolic management. From June 2006 to July 2008, 20 patients with SBAVM were embolized with Onyx. There were 14 men and six women ranging from 14 to 64 years of age (mean 38.3 years). Initial symptoms included spontaneous hemorrhage (n=12), headaches (n=4), seizure (n=3) and incidentally disclosed after head trauma (n=1). After the endovascular procedure, all had subsequent treatment (follow-up angiogram, stereotactic radiosurgery or microsurgery) according to the obliteration degree. At angiography, seven patients (35%, 7/20) were completely obliterated (over 95% closure) after embolization while one suffered a small subarachnoid hemorrhage without permanent clinical sequelae. Four patients (20%, 4/20) were subtotally obliterated (over 80% closure), one patient who suffered severe cerebral edema after embolization underwent decompressive craniectomy, two patients had additional radiosurgery and one patient had follow-up angiogram. Nine patients (45%, 9/20) were partially obliterated (20–80% closure), five patients had additional surgery, two patients had additional radiosurgery and two patients had follow-up angiogram (one patient had intraventricular hemorrhage three months after embolization). Of all 20 AVMs, an average of 2.2 ml Onyx was used per patient and average volume reduction was 80% (range, 30%–99%). Onyx is suitable for embolization of SBAVMs because of its diffuse controllable properties. We suggest clinical follow-up after complete obliteration, additional radiosurgery or angiographic follow-up after subtotal obliteration and additional surgery after partially obliteration. More cases with long-term follow-up are needed to evaluate the long-term prognosis of our post-embolization management.

scholarly journals Curative Glubran 2 Embolization of Cerebral Arteriovenous Malformations Patient Selection and Initial Results

2014 ◽  
Vol 20 (6) ◽  
pp. 722-728 ◽  
Author(s):  
Jie Liu ◽  
Ming Lv ◽  
Xianli Lv ◽  
Hongwei He ◽  
Aihua Liu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Clinical Results ◽  
Hemorrhagic Complication ◽  
Cerebral Arteriovenous Malformations ◽  
Complete Obliteration ◽  
Glubran 2 ◽  
Cerebral Avms

The liquid embolic agents currently used for embolization of cerebral arteriovenous malformations are Onyx and NBCA. Glubran 2, a cyanoacrylate-based synthetic glue, has recently been applied for embolization of cerebral arteriovenous malformations (AVMs). We report the clinical results of selected cerebral AVMs treated with Glubran 2 targeting for curative embolization. Between October 2011 and March 2013, 31 patients with cerebral AVMs were selected for curative embolization with Glubran 2. There were 19 men and 12 women with a mean age of 32 years (range 4–65 years). Initial clinical presentation included hemorrhage in 28 and seizures in three patients. AVM location was frontal in eight patients, parietal in four, occipital in eight temporal in six, cerebellar in two and cerebellar vermis in three patients. Follow-up was performed clinically and with angiography examination at three to six months. Clinical outcomes were evaluated based on the modified Rankin Scale (mRS). A mean of 2.5 (range, 1–12) feeding pedicles were embolized per patient. Complete angiographic obliteration of AVM was achieved in 27 patients. A hemorrhagic complication was observed in one patient, an ischemic complication in one patient and technical complications in four patients. There was no procedure-related disabling neurological deficit or death at discharge. Additional gamma knife radiosurgery was performed in five patients, including one patient with recurrent AVM. All of the patients had favorable clinical outcomes at three to six month follow-up (mRS≤2). The curative embolization technique with Glubran 2 for selected cerebral AVMs achieved a high initial complete obliteration rate with an acceptable complication frequency.

Treatment of Type II Endoleaks With Ethylene-Vinyl-Alcohol Copolymer (Onyx)

2012 ◽  
Vol 46 (3) ◽  
pp. 251-257 ◽  
Author(s):  
Kamal Massis ◽  
William G. Carson ◽  
Alexandra Rozas ◽  
Vishal Patel ◽  
Bruce Zwiebel
Keyword(s):  
Vinyl Alcohol ◽  
Transarterial Embolization ◽  
Type Ii ◽  
Femoral Access ◽  
Ethylene Vinyl Alcohol ◽  
Ethylene Vinyl Alcohol Copolymer ◽  
Single Center Experience ◽  
Aneurysm Size ◽  
Treat All

We report our single-center experience in treating 101 type II endoleaks with ethylene-vinyl-alcohol copolymer (EVOH, Onyx). In all, 65 endoleaks were embolized transarterially, and 36 were treated through a translumbar approach. Since the first transarterial embolization, when we began attempts to treat all patients initially via common femoral access, 58 (65.9%) of 88 patients were successfully embolized transarterially. All endoleaks in the translumbar group were successfully treated. At a median follow-up length of 15 weeks, a decrease or stabilization in aneurysm size was observed in 39 (73.6%) of the 53 endoleaks that had adequate follow-up computed tomography imaging. The overall residual endoleak rate was 34.0%. There was no difference in efficacy when comparing transarterial and translumbar approaches. We demonstrate that in most cases, transarterial access of the endoleak nidus is feasible, and controlled embolization is possible using EVOH. Furthermore, EVOH appears effective in long-term stabilization of aneurysm size and in preventing residual endoleaks.

scholarly journals Transarterial embolization for renal angiomyolipomas: A single centre experience in 79 patients

2017 ◽  
Vol 45 (2) ◽  
pp. 706-713 ◽  
Author(s):  
Chengen Wang ◽  
Min Yang ◽  
Xiaoqiang Tong ◽  
Jian Wang ◽  
Haitao Guan ◽  
...  
Keyword(s):  
Medical Records ◽  
Clinical Success ◽  
Tumour Size ◽  
Transarterial Embolization ◽  
Arterial Embolization ◽  
Success Rates ◽  
Single Centre Experience ◽  
Computed Tomography Scans

Objective To evaluate the long-term efficacy and safety of selective arterial embolization (SAE) in the treatment of renal angiomyolipomas (AMLs). Methods This was a retrospective review of medical records and imaging findings from patients with renal AMLs who attended our clinic and received SAE between January 2007 and January 2014. Only patents with complete medical records, preoperative computed tomography scans using typical imaging and follow-up data were included. Results A total of 79 patients were enrolled in the study. Technical and clinical success rates were 100% and 91% ( n = 72), respectively. Only two patients experienced major complications. Post-embolization syndrome (i.e. fever, abdominal pain, nausea or vomiting) was reported in 68 (86%) patients, but all symptoms were mild and resolved with conservative measures. Mean radiological and clinical follow-up periods were 16.8 and 35.9 months, respectively. In 75 (95%) patients, tumours decreased in size; mean ± SD tumour size significantly decreased from 8.4 ± 3.5 cm pre-embolization to 6.7 ± 3.0 cm post-embolization . Conclusions This study provides long-term evidence that SAE is a safe and effective method in the treatment of patients with renal AMLs.

scholarly journals Clinical Outcomes after Arthroscopic Repair of Gluteus Medius with a Two-year Minimum Follow-up

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0044
Author(s):  
David Bloom ◽  
David Kirby ◽  
Thomas Youm ◽  
Jordan Fried
Keyword(s):  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Hip Arthroscopy ◽  
Gluteus Medius ◽  
Arthroscopic Repair ◽  
Harris Hip Score ◽  
Inclusion Criteria ◽  
Partial Group ◽  
Patient Reported

Objectives: Hip arthroscopy has replaced the need for many open surgeries including repairs of gluteus medius tendon tear. There are only a few studies that have analyzed patient reported outcomes at 2 years for arthroscopic gluteus medius tendon repair. The purpose of the current study is to evaluate clinical outcomes in patients who underwent arthroscopic gluteus medius repair with at least 2 year follow-up. Methods: This was a single-center, retrospective IRB approved study. Between August 2010 and August 2016, patients who underwent hip arthroscopy with gluteus medius repair by a single surgeon were evaluated at baseline and two year follow-up via Modified Harris Hip Score (MHHS) and Non-arthritic Hip Score (NAHS). Inclusion criteria included all patients who received arthroscopic repair of the full or partial thickness tears of the gluteus medius tendon and had a minimum follow up of at least two years. Paired t-test was used for statistical comparison between baseline and follow-up for each respective outcome score and group. Results: 20 hips were evaluated, met the inclusion criteria and separated based on partial (group one) or full thickness tear (group two). The study population comprised of 15 (79%) females and 4 (21%) males. Group one presented with a mean age of 54.8 ± 11.3 years and an average BMI of 25.1 ± 4.0. Group two presented with a mean age of 46 ± 11.4 and an average BMI of 25.5 ± 4.0. Patients in group one reported an average preoperative MHHS and NAHS of 33.6 ± 11.3 and 40.4 ± 14.9, respectively. At 2 year follow-up, an average MHHS and NAHS of 72.9 ± 22.9 and 77.2 ± 19.7 was reported, respectively. Patients in group two reported an average preoperative MHHS and NAHS of 43.8 ± 14.7 and 46.4 ± 8.3, respectively. At 2 year follow-up, an average MHHS and NAHS of 80.1 ± 8.5 and 79.5 ± 10.1, respectively. There was significant clinical improvement at the 2 year follow-up, relating to both outcome measures in each subject group (p<0.0004). Conclusions: After a minimum of two years for follow-up, arthroscopic repair of gluteus medius tears proves to be an effective approach and treatment. In the future, studies looking at longer follow-up time would help determine if the current approach maintains long-term clinical improvement.

Periprocedural intracranial hemorrhage after embolization of cerebral arteriovenous malformations: a meta-analysis

2020 ◽  
Vol 133 (5) ◽  
pp. 1417-1427 ◽  
Author(s):  
Yosuf W. Subat ◽  
Hormuzdiyar H. Dasenbrock ◽  
Bradley A. Gross ◽  
Nirav J. Patel ◽  
Kai U. Frerichs ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Meta Analysis ◽  
Transarterial Embolization ◽  
Endovascular Embolization ◽  
Cerebral Arteriovenous Malformations ◽  
Curative Intent ◽  
Mortality And Morbidity ◽  
Ethylene Vinyl Alcohol ◽  
Procedural Complications ◽  
Hemorrhage Risk

OBJECTIVEThe primary goal of the treatment of cerebral arteriovenous malformations (AVMs) is angiographic occlusion to eliminate future hemorrhage risk. Although multimodal treatment is increasingly used for AVMs, periprocedural hemorrhage after transarterial embolization is a potential endovascular complication that is only partially understood and merits quantification.METHODSSearching the period between 1990 and 2019, the authors of this meta-analysis queried the PubMed and Embase databases for studies reporting periprocedural hemorrhage (within 30 days) after liquid embolization (using cyanoacrylate or ethylene vinyl alcohol copolymer) of AVMs. Random effects meta-analysis was used to evaluate the pooled rate of flow-related hemorrhage (those attributed to alterations in AVM dynamics), technical hemorrhage (those related to procedural complications), and total hemorrhage. Meta-regression was used to analyze the study-level predictors of hemorrhage, including patient age, Spetzler-Martin grade, hemorrhagic presentation, embolysate used, intent of treatment (adjuvant vs curative), associated aneurysms, endovascular angiographic obliteration, year of study publication, and years the procedures were performed.RESULTSA total of 98 studies with 8009 patients were included in this analysis, and the mean number of embolization sessions per patient was 1.9. The pooled flow-related and total periprocedural hemorrhage rates were 2.0% (95% CI 1.5%–2.4%) and 2.6% (95% CI 2.1%–3.0%) per procedure and 3.4% (95% CI 2.6%–4.2%) and 4.8% (95% CI 4.0%–5.6%) per patient, respectively. The mortality and morbidity rates associated with hemorrhage were 14.6% and 45.1%, respectively. Subgroup analyses revealed a pooled total hemorrhage rate per procedure of 1.8% (95% CI 1.0%–2.5%) for adjuvant (surgery or radiosurgery) and 4.6% (95% CI 2.8%–6.4%) for curative intent. The treatment of aneurysms (p = 0.04) and larger patient populations (p < 0.001) were significant predictors of a lower hemorrhage rate, whereas curative intent (p = 0.04), angiographic obliteration achieved endovascularly (p = 0.003), and a greater number of embolization sessions (p = 0.03) were significant predictors of a higher hemorrhage rate. There were no significant differences in periprocedural hemorrhage rates according to the years evaluated or the embolysate utilized.CONCLUSIONSIn this study-level meta-analysis, periprocedural hemorrhage was seen after 2.6% of transarterial embolization procedures for cerebral AVMs. The adjuvant use of endovascular embolization, including in the treatment of associated aneurysms and in the presurgical or preradiosurgical setting, was a study-level predictor of significantly lower hemorrhage rates, whereas more aggressive embolization involving curative intent and endovascular angiographic obliteration was a predictor of a significantly higher total hemorrhage rate.

Endoarterial Management of Dural Arteriovenous Malformations with Isolated Sinus Using Onyx-18: Technical Case Report

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONSE293-ONSE294 ◽  
Author(s):  
César de Paula Lucas ◽  
Charbel Mounayer ◽  
Laurent Spelle ◽  
Michel Piotin ◽  
Marco T. Rezende ◽  
...  
Keyword(s):  
Clinical Cure ◽  
Arteriovenous Malformations ◽  
Superior Sagittal Sinus ◽  
Transarterial Embolization ◽  
Sigmoid Sinus ◽  
Embolic Agent ◽  
Ethylene Vinyl Alcohol ◽  
Sagittal Sinus ◽  
Surgical Exposure ◽  
Meningeal Artery

Abstract Objective: Anatomic and clinical cure of dural arteriovenous malformations (DAVM) with isolated sinus is difficult to achieve by endovascular means without previous surgical exposure. We propose a new management technique using a new liquid embolic agent (ethylene-vinyl alcohol copolymer [Onyx-18]; ev3 Inc., Plymouth, MN) via an endoarterial approach that would avoid surgical craniotomy. Background: Data of three consecutive patients with a DAVM with isolated sinus treated at our department between January 2005 and June 2005 are described. Procedures performed under general anesthesia consist of an arterial approach whereby a microcatheter is navigated via a meningeal feeder to the DAVM. Onyx-18, which diffuses under aqueous conditions, is then delivered, mechanically filling the isolated sinus and ultimately treating it. Results: The patients included two men and one woman aged 69, 71, and 64 years, respectively. All patients were classified as Merland Type IV. Two patients presented with DAVMs involving the transverse-sigmoid sinus, and one patient presented with a DAVM involving the superior sagittal sinus with an isolated venous collector. All three fistulae were treated with transarterial embolization, using Onyx-18, through the filling of the pathological sinus via the anterior meningeal artery branch of the ophthalmic artery (DAVM at the superior sagittal sinus), and the other two patients were treated by means of the petrosquamous branch of the middle meningeal artery (DAVM at the transverse-sigmoid sinus). Postoperative digital subtraction angiography confirmed the elimination of the DAVMs in all three patients. The follow-up study ranging from 3 to 12 months (average, 7.5 mo) revealed no recurrence, and all of the patients had clinical improvement and recovered to their full activities. Conclusion: DAVMs with isolated sinus and retrograde venous drainage to the cortical system are aggressive vascular lesions that can be treated by transarterial embolization using Onyx-18. This procedure allowed us to achieve an anatomic and clinical cure in the three patients consecutively treated without the need for surgical exposure of the compromised sinus.

Prospective study of cervical arthroplasty in 98 patients involved in 1 of 3 separate investigational device exemption studies from a single investigational site with a minimum 2-year follow-up

2010 ◽  
Vol 13 (6) ◽  
pp. 715-721 ◽  
Author(s):  
Domagoj Coric ◽  
Joseph Cassis ◽  
John D. Carew ◽  
Margaret O. Boltes
Keyword(s):  
Clinical Outcomes ◽  
Clinical Success ◽  
Total Disc Replacement ◽  
Neck Disability Index ◽  
Self Report ◽  
Cervical Disc ◽  
Adjacent Level ◽  
Cervical Arthroplasty ◽  
Investigational Device Exemption

Object Cervical total disc replacement (TDR) was developed to address some of the shortcomings associated with anterior cervical discectomy and fusion (ACDF) by preserving motion at the treated level. To establish an evidence-based rationale for cervical TDR to serve as a viable alternative to ACDF, cervical arthroplasty must establish equivalent or superior clinical outcomes while maintaining motion. The authors report on 98 patients from a single investigational site involved in 3 separate prospective, randomized, controlled investigational device exemption multicenter trials comparing cervical arthroplasty to ACDF with a 2–6-year follow-up. Methods Patients with 1- and 2-level cervical disc disease producing radiculopathy and/or myelopathy were randomized prospectively under 3 separate investigational device exemption pivotal trials to undergo ACDF with plate or artificial disc placement. The 3 arthroplasty systems evaluated were the Bryan cervical disc, Kineflex/C disc, and Discover cervical disc. The patients were evaluated with pre- and postoperative serial neurological examinations, radiographs, and clinical outcome indices at 1, 3, 6, 12, 24, 36, 48, and 60 months. Results Ninety-eight patients were treated at the authors' single investigational site. Fifty-seven of these patients underwent cervical arthroplasty and 41 underwent ACDF. A minimum 24-month follow-up was available for 90 patients (92%; 53 in the combined arthroplasty group and 37 in the combined ACDF group) with a follow-up duration ranging from 24 to 67 months (mean 38 months). Clinical success, defined as a composite measure consisting of 5 separate components, was significantly higher in the combined arthroplasty group (85%) compared with the combined ACDF group (70%; p = 0.035). The Neck Disability Index and visual analog scale patient self-report measures were evaluated at 3–24-months follow-up, and all groups showed excellent clinical outcomes. All groups (Bryan, Kineflex/C, Discover, and ACDF) showed statistically significant improvement from the preoperative period to a minimum 2-year follow-up (p < 0.0001). Overall, angular motion was improved by 0.91° in the combined arthroplasty group and reduced by 7.8° in the combined ACDF group (p < 0.0001). In the ACDF group there was a fusion rate of 97% (36 of 37 cases). In the arthroplasty group there was a 5.6% incidence of bridging heterotopic ossification (3 cases). There were a total of 4 reoperations (7.5%) in the combined arthroplasty group with 1 (1.9%) at the adjacent level. There were 3 reoperations (8.1%) in the ACDF group, all at the adjacent level. Conclusions The prospective, intermediate-term (average follow-up > 3 years) results of cervical TDR at the authors' site are encouraging. Patients treated with the artificial discs showed significantly better clinical results, maintained motion at the treated level, and trended toward less adjacent-level disease.

scholarly journals Ultraselective transcatheter arterial embolization with small-sized microcoils for acute lower gastrointestinal bleeding

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Mitsuhiro Kinoshita ◽  
Hiroshi Kondo ◽  
Suguru Hitomi ◽  
Takuya Hara ◽  
Ryusei Zako ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
Lower Gastrointestinal Bleeding ◽  
Recurrent Bleeding ◽  
Major Complications ◽  
Vasa Recta

Abstract Purpose To evaluate the clinical outcome of ultraselective transcatheter arterial embolization (TAE) with small-sized microcoils for acute lower gastrointestinal bleeding (LGIB). Materials and methods The subjects were 17 consecutive patients (mean age, 69 years) with LGIB who were treated with ultraselective TAE using small-sized microcoils between December 2013 and December 2019. Ultraselective TAE was defined as embolization of one or both of the long or short branches of the vasa recta. The etiologies of bleeding were colonic diverticulosis in 16 patients (94%) and malignancy in one patient (6%). The bleeding foci were in the ascending colon in 11 patients (65%), transverse colon in 2 patients (12%), and sigmoid colon in 4 patients (23%). A total of 18 branches (diameter: range 0.5–1.5 mm, mean 1.1 mm) of the vasa recta in 17 patients were embolized with small-sized microcoils (size range 1–3 mm, mean combined lengths of all microcoils 7.6 cm). The mean follow-up period was 19 months (range 1–80 months). The technical and clinical success rate, recurrent bleeding rate, major complications and long-term clinical outcomes were retrospectively evaluated. Results Technical and clinical success was achieved in all patients (17/17). The rates of early recurrent bleeding (within 30 days of TAE) and major complications were 0% (0/17). Recurrent bleeding occurred in one patient at 2 months after TAE, but was stopped with conservative treatment. There were no other bleeding episodes or complications in the follow-up period. Conclusion Ultraselective TAE with small-sized microcoils is a highly effective and safe treatment modality for LGIB.

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