Embolization

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Therapeutic embolization is the artificial closure of blood vessels by the administration of z. B. liquid plastics, plastic beads or fibrin sponges via a catheter . It is usually carried out by a radiologist who specializes in interventional radiology in a so-called angiography suite under fluoroscopic control. A distinction is made between emergency embolization with an indication due to a life-threatening bleeding that is difficult to stop and an elective (planned) embolization in z. B. a vascular malformation or tumor treatment.

Emergency embolizations

Emergency embolization after pelvic trauma: Bleeding mostly from the fractured pelvic bone, the presacral venous plexus and branches of the internal iliac artery .

Emergency embolization organs:

  • Spleen: depending on the extent of the injury, conservative procedure under supervision, splenectomy (surgical removal of the spleen) or increasingly embolization therapy (usually central occlusion of the splenic artery )
  • Liver: the most dangerous organ for the patient. Therapy options are surgery (e.g. using what is known as surgical packing, where embolization can then be useful) and embolization
  • Kidney: depending on the extent of the injury, conservative procedure under supervision, surgery (organ-preserving procedure up to nephrectomy ) or increasingly embolization therapy in increasingly unstable patients, since too many patients lose the kidney completely
  • Gastrointestinal bleeding: A gastrointestinal bleeding (also initially HB-relevant) (e.g. bleeding from a gastric ulcer into the intestinal lumen) is an emergency, but most of this bleeding stops again under substitution (administration of blood reserves ). In the case of emergency surgery, there is a mortality of 15–40%, the mortality without immediate therapy is 10% (mostly old, often previously ill patients). Indications for embolization therapy for gastrointestinal bleeding are: (pseudo-) aneurysms (vasodilatations that can burst and then bleed), a bleeding stump after an abdominal operation, stomach ulcer, varices , erosive gastritis , tumors in the abdomen, Mallory-Weiss syndrome , in the child juvenile polyp and Meckel's diverticulum .
  • Duodenal ulcer bleeding : angiography is indicated if the endoscopic attempt has failed twice
  • Bronchial artery embolization: Indication for life-threatening bleeding which manifests itself as hemoptysis (coughing up blood) (> 250 ml hemoptysis / 24 h). The technical success of bronchial artery embolization is up to 100%, but in about 30% of the cases there is recurrent bleeding within 14 days (depending on the underlying disease).

Elective embolization treatment

  • Embolization of pulmonary AV fistulas
  • Embolization of AV malformations (e.g. on the extremities)
  • Embolization of hemangiomas (e.g. on the extremities)
  • Bone tumor embolization of the spine (usually preoperative before tumor removal; in individual cases as palliative therapy for pain treatment and tumor reduction): In tumors of the spine, the so-called lumbar arteries must be angiographically displayed at least two levels of the vertebral body above and below the tumor, as collateral connections between the tumor and the spine are essential and vessels nourishing the spinal cord must be excluded (risk of paraplegia and tetraplegia as a rare complication of embolization)
  • Bone tumor embolization on the extremities (mostly preoperative; in individual cases as palliative therapy to treat pain and reduce tumors)
  • Uterine fibroid embolization : a method of treating symptomatic uterine fibroids by injecting spherical microparticles into the uterine artery .

materials

Liquid embolisates are Histoacryl , Ethibloc , Ethylene-Vinyl Alcohol -Copolymer , Ethanol and Lipiodol . They are very effective in embolization and work regardless of the patient's coagulation status (very important if, for example, the patient has lost several liters of blood after a traffic accident and his coagulation does not work properly again despite mass transfusions). Some liquid embolizates have an increased risk of complications because they act like superglue in a flash.

Particulate embolizates are Gelfoam , polyvinyl alcohol (PVA) and newly developed spherical microparticles made of gelatine or plastic. In some cases they only have a temporary effect, the embolized vessels open up again. The spherical microparticles are available in multiple sizes (between 40 and 900 micrometers in increments of about 100 µm), making it possible to choose a suitable embolizate for the respective vessel or parenchymal organ.

Coils , interlocking detachable coils (IDC) and lattice-like locking systems are used as the metallic locking material . The coils and interlocking detachable coils are partially controllable, metallic micro-spirals with reconditioned thrombogenic threads. Microcoils and IDCs require a functioning coagulation in order to be able to effectively seal a large bleeding vessel.

See also

Individual evidence

  1. ↑ M. Krotz, KJ Pfeifer, M. Reiser , U. Linsenmaier: Radiological intervention in multiply injured patients. In: Radiologist. 45, 2005, pp. 1129-1145; quiz 1146
  2. ↑ A. Raikhlin, MO Baerlocher, MR Asch, A. Myers: Imaging and transcatheter arterial embolization for traumatic splenic injuries: review of the literature. In: Can J Surg. 51 (6), Dec 2008, pp. 464-472.
  3. ^ V. Monnin, C. Sengel, F. Thony, I. Bricault, D. Voirin, C. Letoublon, C. Broux, G. Ferretti: Place of arterial embolization in severe blunt hepatic trauma: a multidisciplinary approach. In: Cardiovasc Intervent Radiol. 31 (5), Sep-Oct 2008, pp. 875-882.
  4. ↑ HP Dinkel, H. Danuser, J. Triller: Blunt renal trauma: minimally invasive management with microcatheter embolization experience in nine patients. In: Radiology. 223 (3), Jun 2002, pp. 723-730.
  5. ↑ HH Wang, B. Bai, KB Wang et al. a .: Interventional therapy for acute hemorrhage in gastrointestinal tract. In: World J Gastroenterol. 12, 2006, pp. 134-136.
  6. ↑ F. Baltacıoğlu, NC Cimşit, K. Bostanci, M. Yüksel, N. Kodalli: Transarterial microcatheter glue embolization of the bronchial artery for life-threatening hemoptysis: Technical and clinical results. In: Eur J Radiol. 2008 Dec 12.
  7. ↑ B. Radeleff, M. Eiers, R. Lopez-Benitez, G. Noeldge, P. Hallscheidt, L. Grenacher, M. Libicher, F. Zeifang, PJ Meeder, GW Kauffmann, GM Richter: Transarterial embolization of primary and secondary tumors of the skeletal system. In: Eur J Radiol. 58 (1), Apr 2006, pp. 68-75.
  8. ↑ JP Pelage, WJ Walker, O. Le Dref, A. Laurent, R. Rymer: Treatment of uterine fibroids. In: Lancet. 357, 2001, p. 1530.