Hemangiomas and vascular malformations
Prem Puri in Newborn Surgery, 2017
Embolization involves the delivery of a substance, through a catheter to the AVM, to occlude blood flow and/or fill a vascular space. Reduced arteriovenous shunting and ischemia improve symptoms and may shrink the lesion. Embolization is used either as a preoperative adjunct to resection or as monotherapy for lesions not amenable to extirpation. Because the AVM is not removed, almost all lesions eventually will expand after treatment.71,86–89 Stage I AVM has a lower recurrence rate than higher-staged lesions. Most recurrences occur within the first year after embolization, and in an earlier era, 98.0% re-expanded within 5 years.88 Despite the high likelihood of re-expansion, embolization can effectively palliate an AVM by reducing its size, slowing expansion, and alleviating pain and bleeding. Preoperative embolization also reduces blood loss during extirpation. In recent years, embolization from the venous outflow approach, sometimes in combination with nidus embolization from the arterial side, has offered significantly improved outcomes. Long-term outcome data are not yet available, but there is significant optimism that this approach will allow earlier and more effective embolization.
Injury to the Liver
Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba in Acute Care Surgery and Trauma, 2016
Asencio et al. [47] showed a mortality benefit with HAE alone in NOM patients as well as an adjunct to operative management in a prospective study of patients with AAST Grades IV and V from both blunt and penetrating mechanisms of injury. Hagiwara et al. [44], in a case-control study, suggested that a combination of a CT scan Grades IV and V lesion and fluid requirements of >2000 mL/h to maintain normotension are indications for laparotomy. However, this study also revealed that many stable patients with high-grade injuries had bleeding on angiography regardless of the presence of a contrast blush on CT scan. Nearly half of Grade III injuries and nearly all Grade IV injuries had bleeding on HA. Furthermore, Monnin et al. [45] used a multidisciplinary approach (surgeon, interventional radiologist, and anesthetist) to perform HAE in unstable patients of high-grade injuries with hemorrhage control rate of 100% and only two HAE-related complications. They recommend this approach to avoid immediate surgery and consider embolization to be more effective to stop arterial bleeding than surgery without a concomitant increase in failure rate or mortality.
Interventional Techniques
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
Embolization is usually performed as an adjuvant to surgical resection. When surgery and/or radiotherapy are considered inappropriate, embolization may alone provide symptomatic relief by stabilizing tumour growth.52 The benefits of pre-operative embolization have been demonstrated in several single institution reports.53, 54 Murphy and Brackmann assessed the effects of per-operative embolization in a cohort of 35 glomus jugulare tumour patients, and found pre-operative embolization reduced the volume of operative blood loss and the duration of procedures but not the length of bed stay.55 Tikkakoski et al. reported that pre-operative embolization improved operating conditions with subjective benefits to surgical results if performed by superselective catheterization with effective devascularization of the tumour vascular bed.56
Preoperative adrenal artery embolization followed by surgical excision of giant hypervascular adrenal masses: report of three cases
Published in Acta Chirurgica Belgica, 2018
Ismail Cem Sormaz, Fatih Tunca, Arzu Poyanlı, Yasemin Giles Şenyürek
Preoperative management included medical treatment with α- and β-adrenergic blockers for blood pressure control. Three weeks before surgery, the patient was started on phenoxybenzamine 10 mg per day by mouth, which was gradually titrated up to 60 mg per day. The patient was also put on β-adrenergic blocker agent (propranolol-HCL) 40 mg per day concordant with gradual increasing doses of phenoxybenzamine. Preoperative adrenal artery embolization was planned for the right-sided adrenal mass in this patient. The main aim of the arterial embolization was to reduce hypervascularity and decrease troublesome bleeding during surgery. We also thought that TAE might help to prevent severe perioperative hypertensive attacks. The day before angiography and embolization, the average blood pressure and heart rate of the patient were 123/62 mm Hg and 65 bpm, respectively. Equipment for close hemodynamic monitoring and management of possible hypertensive attacks during angiography and embolization was maintained.
An expansive aneurysmal bone cyst of the maxillary sinus in an 8 year old child: Case report and review of literature
Published in Acta Oto-Laryngologica Case Reports, 2020
Milan Urík, Ivo Šlapák, Michaela Máchalová, Jana Jančíková, Soňa Šikolová, Denisa Pavlovská, Petr Jabandžiev, Marta Ježová
Traditionally, curettage and debridement of the bone have been regarded as the mainstays of treatment. In an attempt to decrease the rate of recurrence, some authors have promoted various adjuvants for treating ABC such as use of cryotherapy [3], polymethylmethacrylate cementation [4], phenol in the bone cavity [5], use of a high-speed burr [6] or percutaneous injection of alcohol [7] or other agents has been used to treat ABCs that are difficult to approach surgically. Radiation therapy has been used for lesions determined to be nonoperable [8]. Arterial embolization has been used before surgery to decrease intraoperative blood loss and also as a stand-alone treatment for unresectable lesions [9]. However, the use of adjuvants, although producing a lower recurrence rate, is not free from complications. The most frequent complications are: cutaneous fistula, abscesses, cellulitis, osteitis, hypopigmentation, hemolysis and necrosis and of course cosmetic defect. Krishna et al. describe their special biopsy method called curopsy [10]. It is a limited percutaneous curettage that is used to obtain material for histological examination. After curopsy, patients are followed up clinically and radiographically. Only if the lesion or symptoms progress do patients undergo additional treatment, mostly with curettage without adjuvants.
Synovitis in hemophilia: preventing, detecting, and treating joint bleeds
Published in Expert Review of Hematology, 2023
According to [anonymized] and Jimenez-Yuste, in hemophilia, the appearance of hemarthrosis secondary to a spontaneous periarticular aneurysm is rare [91]. In this circumstance, angiographic embolization can be a therapeutic and coagulation factor-saving option in hemarthroses that do not respond to replacement of coagulation factor. Angiographic embolization is not a remedy for all refractory hemarthroses in hemophilia. It is essential to bear in mind that despite its efficacy, arterial embolization is an invasive procedure with a published percentage of adverse events up to 25% (16% minor, 7% serious, 2% death) [65]. In 2013, Galli et al stated that selective angiographic embolization of knee and elbow arteries was a reasonable procedure that could avert repeated hemarthroses [92]. Figure 3 shows my recommended algorithm for the current management of CHS.