Embolization
Therapeutic embolization is the artificial occlusion of blood vessels by administration of eg liquid plastics, plastic beads or Fibrinschwämmen via a catheter. It is performed usually by a specialized interventional radiology radiologist in a so-called angiography suite under fluoroscopic control. A distinction is made between Notfallembolisationen with a indication due to a difficult insatiable, life-threatening bleeding and an elective ( planned ) embolization in such as a vascular malformation or tumor treatment.
Notfallembolisationen
Notfallembolisation after pelvic trauma: bleeding mostly from the fractured pelvic bone, the presacral venous plexus and branches of the internal iliac artery.
Notfallembolisation organs:
- Spleen: conservative, depending on the extent of the injury procedure under surveillance, splenectomy (surgical removal of the spleen ) or increasingly embolization (usually central lock the splenic artery )
- Liver: For patients, the most dangerous organ. Options for therapy are the operation (eg, by means of the so-called surgical packing, where after embolization may be useful ) and embolisation
- Kidney: conservative, depending on the extent of the injury procedure under surveillance operation ( end organ preservation approach through to nephrectomy ) or, increasingly, embolization therapy in increasingly unstable patients because surgery to many patients lose the kidney but completely
- Gastrointestinal bleeding: A (also initial HB- relevant ) gastrointestinal bleeding (eg, bleeding from a gastric ulcer in the intestinal lumen ) is indeed an emergency, but most of these bleeding suspend again under substitution ( administration of blood products ). In an emergency surgery there is a mortality of 15-40 %, the mortality without immediate treatment is 10% ( mostly old, often vorerkrankte patients). Indication for embolization therapy in gastrointestinal hemorrhage are: ( pseudo) aneurysms ( vasodilation, which burst and then can bleed ), a bleeding visible vessel after abdominal surgery, gastric ulcer, varices, erosive gastritis, tumors in the abdomen, Mallory- Weiss syndrome, the child juvenile polyp and Meckel 's diverticulum.
- Bleeding duodenal ulcer: the indication for angiography exists when the endoscopic attempt has failed twice
- Bronchialarterienembolisation: indication for a life -threatening bleeding, as hemoptysis ( coughing up blood ) is expressed (> 250 ml Hämoptyse/24 h). The technical success of Bronchialarterienembolisation is up 100 %, but it comes in about 30 % of cases of recurrent bleeding within 14 days (depending on the underlying disease ).
Elective Embolisationsbehandlung
- Embolization of pulmonary AV fistulas
- Embolization of AV malformations ( eg the extremities)
- Embolization of hemangiomas (eg the extremities)
- Knochentumorembolisation the spine ( usually pre-operatively before tumor removal, in individual cases, as palliative therapy to relieve pain and tumor reduction ): For tumors of the spine, the so-called lumbar arteries must be above at least two vertebral levels and to angiographically below the tumor, as necessarily Kollateralverbindungen between the tumor and the spinal must be excluded and the spinal cord nutritive vessels (risk of paraplegia and quadriplegia as a rare Embolisationskomplikation )
- Knochentumorembolisation on the extremities (usually pre-operatively, in individual cases, as palliative therapy to relieve pain and tumor reduction )
- Uterine fibroid embolization: a method to treat symptomatic uterine fibroids by means of the injection of spherical microparticles in the uterine artery.
Materials
Liquid Embolisate are Histoacryl, Ethibloc, ethylene- vinyl alcohol copolymer, ethanol, and lipiodol. They are very effective in embolization and function independently of the coagulation status of the patient ( very important if the patient has after a traffic accident lost several liters of blood, for example, and its coagulation despite mass transfusions not yet returned to work adequately ). Some liquid Embolisate have an increased risk of complications, as they act like one seconds adhesive quickly.
Particulate Embolisate are Gelfoam, polyvinyl alcohol (PVA) and newly developed spherical microparticles made of gelatin or plastic. You have a partly only temporary effect, the embolized vessels open up again. The spherical microparticles offer through their presence in multiple grades of size ( 40-900 microns in increments of about 100 microns ) the possibility to choose a suitable embolizate for the respective vessel or parenchymal organ.
As metallic sealing material used coils, Interlocking detachable coils (IDC ) and latticed shutters. The Interlocking detachable coils and coils are partially controllable, metallic micro-inserts using reclaimed thrombogenic filaments. Microcoils and IDCs need a functioning clotting to effectively occlude a large bleeding vessel can.