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DOI: 10.1055/s-0044-1786708
Temporary Embolic Agents
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Embolic agents and their use in therapeutic vascular occlusion have advanced considerably since the emergence of these procedures in the mid-1960s. The earliest embolic agents included muscle tissue and Gelfoam used for the treatment of traumatic carotid-cavernous fistula in 1965 and 1966, respectively.[1] [2] Other early embolizations employed permanent agents such as 1.5- and 3-mm stainless steel pellets administered for the treatment of arteriovenous malformation[3] and lead pellets for the treatment of spinal cord hemangioma, both in 1968.[4]
Pharmacologic agents such as epinephrine and propranolol were also being investigated for their occlusive effects by Czech radiologist, Dr. Josef Rösch in 1970.[5] These embolization procedures differed in that they capitalized on image guidance to identify and occlude distant vessels, specifically for the treatment of gastrointestinal hemorrhage. Rösch's ground-breaking publication prompted an editorial note in Gastroenterology titled “Turned Off Bleeders” which cautioned against unchecked enthusiasm for minimally invasive procedures,[6] [7] but early interventionalists were not swayed.
With influence from Rösch, American radiologist Dr. Charles Dotter administered an autologous clot to treat gastrointestinal hemorrhage shortly thereafter.[8] In the coming years, embolic agents for gastrointestinal hemorrhage were further explored in canine models with physical agents, like Gelfoam, outperforming pharmacologic vasoconstrictors.[9] By the 1980s, Gelfoam became the favored agent for temporary occlusion in gynecologic hemorrhage, presurgical devascularization, and hemoptysis.[10] [11] Other temporary embolic agents studied in animal models included Oxycel and Surgicel,[12] with polyvinyl alcohol (Ivalon), silicone, and cyanoacrylates rounding out the permanent embolic agents. As the application of therapeutic embolization grew, so did the arsenal of embolic agents, each with unique advantages and drawbacks. One of the major distinguishing factors for embolic agents is whether they provide temporary or permanent occlusion.
This review article will focus on the temporary embolic agents in use today, namely: Gelfoam, autologous blood clots (ABCs), and Avitene. Their preparation, indication, and specific limitations will be discussed in addition to advances in embolic bioengineering with the emergence of on-demand degradation, shape memory polymers (SMP), and drug-eluting beads.
Publikationsverlauf
Artikel online veröffentlicht:
10. Juli 2024
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References
- 1 Lang ER, Bucy PC. Treatment of carotid-cavernous fistula by muscle embolization alone: the brooks method. J Neurosurg 1965; 22 (04) 387-392
- 2 Ishimori S, Hattori M, Shibata Y, Shizawa H, Fujinaga R. Treatment of carotid-cavernous fistula by Gelfoam embolization. J Neurosurg 1967; 27 (04) 315-319
- 3 Doppman JL, Di Chiro G, Ommaya A. Obliteration of spinal-cord arteriovenous malformation by percutaneous embolisation. Lancet 1968; 1 (7540): 477
- 4 Newton TH, Adams JE. Angiographic demonstration and nonsurgical embolization of spinal cord angioma. Radiology 1968; 91 (05) 873-876 , passim
- 5 Clare NM, Ghidoni JJ, Brown MJ. Selective arterial embolization. JAMA 1978; 239 (22) 2338-2339
- 6 Donaldson Jr RM. “Turned off” bleeders. Gastroenterology 1970; 59 (03) 477-478
- 7 Rösch J, Keller FS, Kaufman JA. The birth, early years, and future of interventional radiology. J Vasc Interv Radiol 2003; 14 (07) 841-853
- 8 Rösch J, Dotter CT, Brown MJ. Selective arterial embolization. A new method for control of acute gastrointestinal bleeding. Radiology 1972; 102 (02) 303-306
- 9 Gold RE, Grace DM. Gelfoam embolization of the left gastric artery for bleeding ulcer: experimental considerations. Radiology 1975; 116 (03) 575-580
- 10 Jander HP, Russinovich NAE. Transcatheter Gelfoam embolization in abdominal, retroperitoneal, and pelvic hemorrhage. Obstet Gynecol Surv 1981; 36 (05) 274
- 11 Greenfield AJ. Transcatheter vessel occlusion: selection of methods and materials. Cardiovasc Intervent Radiol 1980; 3 (04) 222-228
- 12 Kunstlinger F, Brunelle F, Chaumont P, Doyon D. Vascular occlusive agents. AJR Am J Roentgenol 1981; 136 (01) 151-156
- 13 Wang CY, Hu J, Sheth RA, Oklu R. Emerging embolic agents in endovascular embolization: an overview. Prog Biomed Eng (Bristol) 2020; 2 (01) 012003
- 14 Medsinge A, Zajko A, Orons P, Amesur N, Santos E. A case-based approach to common embolization agents used in vascular interventional radiology. AJR Am J Roentgenol 2014; 203 (04) 699-708
- 15 Coldwell DM, Stokes KR, Yakes WF. Embolotherapy: agents, clinical applications, and techniques. Radiographics 1994; 14 (03) 623-643 , quiz 645–646
- 16 Brinckman M. Transcatheter embolization and therapy. Transcatheter Embolization Ther 2009; 41-50
- 17 Vaidya S, Tozer KR, Chen J. An overview of embolic agents. Semin Intervent Radiol 2008; 25 (03) 204-215
- 18 Katsumori T, Kasahara T. The size of gelatin sponge particles: differences with preparation method. Cardiovasc Intervent Radiol 2006; 29 (06) 1077-1083
- 19 Abada HT, Golzarian J. Gelatine sponge particles: handling characteristics for endovascular use. Tech Vasc Interv Radiol 2007; 10 (04) 257-260
- 20 Centra M, Ratych RE, Cao GL. et al. Culture of bovine pulmonary artery endothelial cells on Gelfoam blocks. FASEB J 1992; 6 (12) 3117-3121
- 21 Ierardi AM, Piacentino F, Pesapane F. et al. Basic embolization techniques: tips and tricks. Acta Biomed 2020; 91 (8-S): 71-80
- 22 Miyayama S, Yamakado K, Anai H. et al. Guidelines on the use of gelatin sponge particles in embolotherapy. Jpn J Radiol 2014; 32 (04) 242-250
- 23 Lopera JE. Embolization in trauma: review of basic principles and techniques. Semin Intervent Radiol 2021; 38 (01) 18-33
- 24 Cziperle DJ. Avitene™ microfibrillar collagen hemostat for adjunctive hemostasis in surgical procedures: a systematic literature review. Med Devices (Auckl) 2021; 14: 155-163
- 25 Kumar AJ, Kaufman SL, Patt J, Posey JB, Maxwell DD, White Jr RI. Preoperative embolization of hypervascular head and neck neoplasms using microfibrillar collagen. AJNR Am J Neuroradiol 1982; 3 (02) 163-168
- 26 Kim KR, Shin JH, Song HY. et al. Treatment of high-flow priapism with superselective transcatheter embolization in 27 patients: a multicenter study. J Vasc Interv Radiol 2007; 18 (10) 1222-1226
- 27 Numan F, Cantasdemir M, Ozbayrak M. et al. Posttraumatic nonischemic priapism treated with autologous blood clot embolization. J Sex Med 2008; 5 (01) 173-179
- 28 Malone LJ, Stanfill RM, Wang H, Fahey KM, Bertino RE. Effect of intraparenchymal blood patch on rates of pneumothorax and pneumothorax requiring chest tube placement after percutaneous lung biopsy. AJR Am J Roentgenol 2013; 200 (06) 1238-1243
- 29 Maybody M, Muallem N, Brown KT. et al. Autologous blood patch injection versus hydrogel plug in CT-guided lung biopsy: a prospective randomized trial. Radiology 2019; 290 (02) 547-554
- 30 Aoki M, Tokue H, Miyazaki M, Shibuya K, Hirasawa S, Oshima K. Primary postpartum hemorrhage: outcome of uterine artery embolization. Br J Radiol 2018; 91 (1087): 20180132
- 31 Zhang XQ, Chen XT, Zhang YT, Mai CX. The emergent pelvic artery embolization in the management of postpartum hemorrhage: a systematic review and meta-analysis. Obstet Gynecol Surv 2021; 76 (04) 234-244
- 32 Camacho A, Ahn EH, Appel E. et al. Uterine artery embolization with Gelfoam for acquired symptomatic uterine arteriovenous shunting. J Vasc Interv Radiol 2019; 30 (11) 1750-1758
- 33 Vilos AG, Vilos GA, Hollett-Caines J. et al. Uterine artery embolization for symptomatic uterine myomas using Gelfoam pledgets alone vs. Embospheres plus Gelfoam pledgets: a randomized comparison. Gynecol Surg 2016; 13 (04) 409-414
- 34 Ini' C, Distefano G, Sanfilippo F. et al. Embolization for acute nonvariceal bleeding of upper and lower gastrointestinal tract: a systematic review. CVIR Endovasc 2023; 6 (01) 18
- 35 Faiella E, Santucci D, Vertulli D. et al. Preoperative embolization of vertebral metastasis: comprehensive review of the literature. Diseases 2023; 11 (03) 109
- 36 Jha R, Sharma R, Rastogi S, Khan SA, Jayaswal A, Gamanagatti S. Preoperative embolization of primary bone tumors: a case control study. World J Radiol 2016; 8 (04) 378-389
- 37 Kedra A, Dohan A, Biau D. et al. Preoperative arterial embolization of musculoskeletal tumors: a tertiary center experience. Cancers (Basel) 2023; 15 (09) 1-13
- 38 Cazejust J, Bessoud B, Le Bail M, Menu Y. Preoperative portal vein embolization with a combination of trisacryl microspheres, Gelfoam and coils. Diagn Interv Imaging 2015; 96 (01) 57-64
- 39 Pei R, Yang M, Wang J, Tong X, Wang G, Zou Y. Efficacy and safety of preoperative internal maxillary arterial embolization with Gelfoam for nasopharyngeal angiofibroma. Eur Arch Otorhinolaryngol 2019; 276 (03) 865-869
- 40 Salama NM, Tabashy RH, Mahmoud IH, El Rahman AERMA, Mohamed DNE, El Kassas H. Does Gelfoam slurry embolization post-pulmonary biopsy reduce risk of pneumothorax? A prospective randomized control study. Egypt J Radiol Nucl Med 2023; 54 (01) DOI: 10.1186/s43055-022-00950-6.
- 41 Grange R, Di Bisceglie M, Habert P. et al. Evaluation of preventive tract embolization with standardized gelatin sponge slurry on chest tube placement rate after CT-guided lung biopsy: a propensity score analysis. Insights Imaging 2023; 14 (01) 212
- 42 Koh S, Kwon H, Hwangbo L, Kim CW, Kim S, Hong SB. Decreased bleeding-related adverse events using track embolization with gelatin sponge slurry after percutaneous liver biopsy: a propensity score-matched study. J Vasc Interv Radiol 2023; 34 (12) 2128-2136
- 43 Chen B, Isa A, Ngeow J, Greben C. Utility of routine tract embolization for percutaneous liver biopsy. J Vasc Interv Radiol 2017; 28 (02) S66
- 44 Gaba RC, Kobayashi KR, Bui JT. et al. Liver track embolization after islet cell transplant: comparison of two techniques. AJR Am J Roentgenol 2017; 208 (05) 1134-1140
- 45 Siskin GP, Englander M, Stainken BF. et al Embolic agents used for uterine fibroid embolization. AJR Am J Roentgenol 2000; 175 (03) 767-773
- 46 Barth KH, Strandberg JD, White Jr RI. Long term follow-up of transcatheter embolization with autologous clot, oxycel and gelfoam in domestic swine. Invest Radiol 1977; 12 (03) 273-280
- 47 Sniderman KW, Sos TA, Alonso DR. Transcatheter embolization with Gelfoam and Avitene: the effect of Sotradecol on the duration of arterial occlusion. Invest Radiol 1981; 16 (06) 501-507
- 48 Doucet J, MacDonald K, Lee C, Hana RA, Soulez G, Boyd D. The feasibility of degradable glass microspheres as transient embolic medical devices. J Biomater Appl 2021; 35 (06) 615-632
- 49 Yang H, Lei K, Zhou F. et al. Injectable PEG/polyester Thermogel: a new liquid embolization agent for temporary vascular interventional therapy. Mater Sci Eng C 2019; 102 (April): 606-615
- 50 Jiang Y, Zhang Y, Lu Z. et al. Liquid embolic agents for interventional embolization. ChemPhysMater 2022; 1 (01) 39-50
- 51 Verret V, Pelage JP, Wassef M. et al. A novel resorbable embolization microsphere for transient uterine artery occlusion: a comparative study with trisacryl-gelatin microspheres in the sheep model. J Vasc Interv Radiol 2014; 25 (11) 1759-1766
- 52 Bengtsson J, Cwikiel W, Sundgren PC, Karlstam E, Gavier-Widén D, Keussen I. The effects of uterine artery embolization with a new degradable microsphere in an experimental study. Acta Radiol 2017; 58 (11) 1334-1341
- 53 Barnett BP, Gailloud P. Assessment of EmboGel – a selectively dissolvable radiopaque hydrogel for embolic applications. J Vasc Interv Radiol 2011; 22 (02) 203-211
- 54 Choi H, Choi B, Yu B. et al. On-demand degradable embolic microspheres for immediate restoration of blood flow during image-guided embolization procedures. Biomaterials 2021; 265 (March 2020): 120408
- 55 Wong YS, Salvekar AV, Zhuang KD. et al. Bioabsorbable radiopaque water-responsive shape memory embolization plug for temporary vascular occlusion. Biomaterials 2016; 102: 98-106
- 56 Wang Y, Molin DGM, Sevrin C. et al. In vitro and in vivo evaluation of drug-eluting microspheres designed for transarterial chemoembolization therapy. Int J Pharm 2016; 503 (1-2): 150-162
- 57 Choi JW, Park JH, Cho HR. et al. Sorafenib and 2,3,5-triiodobenzoic acid-loaded imageable microspheres for transarterial embolization of a liver tumor. Sci Rep 2017; 7 (01) 554
- 58 Yamada K, Jahangiri Y, Li J. et al. Embolic characteristics of imipenem-cilastatin particles in vitro and in vivo: implications for transarterial embolization in joint arthropathies. J Vasc Interv Radiol 2021; 32 (07) 1031-1039.e2
- 59 Correa MP, Motta-Leal-Filho JM, Lugokeski R, Mezzomo M, Leite LR. GAUCHO - trial genicular artery embolization using imipenem/cilastatin vs. microsphere for knee osteoarthritis: a randomized controlled trial. Cardiovasc Intervent Radiol 2022; 45 (07) 903-910
- 60 Kung S, Chou M, Yang K, Hsu Y. Intra-arterial infusion of temporary embolic agent as a new treatment in a patient with osteoarthritis of the fingers. Asia Pacific Journal of Pain 2022; (747) 1-6
- 61 Okuno Y, Shibuya M. Possibility of embolic treatment for medial epicondylitis. Cardiovasc Intervent Radiol 2022; 45 (02) 205-206