Index

A embolization agent and preprocedure AAST. See American Association rupture , 99 for Surgery of Trauma (AAST) emergency situations , 99 Abdominopelvic tumors endovascular treatment , 99 adrenal , 423 extrahepatic proximal segment , 98 pelvic ( see Pelvic tumors) ischemic tolerance problems , 99 Adjuvant medications , 34 periarthritis nodosa/fi bro muscular AITP. See Autoimmune thrombocytopenic dysplasia , 100 purpura (AITP) technique , 98 American Association for Surgery visceral aneurysms , 99 of Trauma (AAST) and pseudoaneurysms abdominal visceral injuries , 357 catheterization , 161 “Baltimore” codifi cation , 360 indications , 161–162 grade I and II lesions , 360 outcomes , 162 grade IV and V , 358 visceral , 160–161 organ injury scale , 388 Angiomyolipoma (AML) parietal cephalic impacts diagnosis , 233 and abdominal pain, 375 preventive embolization , 234 splenic traumatic injury , 380 symptomatic , 233 AML. See Angiomyolipoma (AML) Antibiotic prophylaxis , 37–39 Amplatzer vascular plugs Aortography (AVPs) , 20, 21, 81 infrarenal , 316 Anesthesia and sedation ovarian arteries , 311 allergies , 34 vascularization, atonic uterus , 316 dosage , 35 Arteriovenous malformations (AVM) droperidol, propofol anesthesia , 408 and etomidate, 36 coaxial microcatheter , 408 intravascular injection , 34 embolization , 406 midazolam , 36 ethanol , 408 neuroleptanalgesia , 35 fl ow and type, malformation , 405 pain control , 36–37 hypoechoic serpiginous structures , plexus blocks , 35 406–407 sufentanil , 35–36 middle sacral , 408, 420 Aneurysms pulmonary pressure , 409 hepatic artery pulsatile mass , 406

P. Chabrot, L. Boyer (eds.), Embolization, 445 DOI 10.1007/978-1-4471-5182-1, © Springer-Verlag London 2014 446 Index

Autoimmune thrombocytopenic purpura embospheres , 326 (AITP) , 164 gynecological consultation , 327 AVM. See Arteriovenous malformations hospital length , 328 (AVM) multidisciplinary discussion , 330 AVPs. See Amplatzer vascular plugs (AVPs) pelvic MRI , 329 post-embolization syndrome , 326 pre-and post-procedural phases , 325 B pregnancy and fertility , 330–331 BA. See Bronchial artery (BA) re-intervention procedures , 328–329 Balloon-occluded retrograde transvenous success rate and complications , 327–328 obliteration (BRTO) therapeutic protocol , 325–326 vs. endoscopic sclerosis , 426 uterine reperfusion , 326 portacaval gastrorenal shunt , 425 CurUFE. See Curative uterine fi broid renal , 426 embolization (CurUFE) Barcelona Clinic Liver Classifi cation (BCLC) , 121, 123 BCLC. See Barcelona Clinic Liver D Classifi cation (BCLC) DEB. See Drug-eluting beads (DEB) Bronchial artery (BA) Double systemic arterial , 69 adenocarcinoma , 75–76 Drug-eluting beads (DEB) , 117, 122 anastomosis , 73 angio and embolization techniques , 65–66 aorta , 64 E arterial wall erosion , 63 Embolization complications , 67, 70 anastomotic network , 357 CT , 64 blood transfusions , 357 ectopic and aberrant BA , 71 catheterization pathway and occlusion systemic hemorrhages , 67 type , 31 BRTO. See Balloon-occluded retrograde head trauma , 378–379 transvenous obliteration (BRTO) hemodynamic collapse , 385–387 hepatic trauma (see Hepatic trauma) highway accident, limb fractures , 380–381 C hypogastric aneurysms , 215 CA. See Celiac artery (CA) imaging work-up , 356 Carotid artery, cancerology , 50–51, 56 initial assessment and resuscitation , 355 Carotid blowout syndrome , 51–52, 57 liver injury and blush , 371–372 Catheterization devices morphological assessment , 367–370 frequently used , 23, 24 non-aneurysmal hypogastric arteries , guide wires , 24 215–216 hydrophilic catheters , 23 parenchymal embolizations (see microcatheters , 23–24 Parenchymal embolizations) sheaths and catheters , 23 parietal cephalic impacts and abdominal Celiac artery (CA) , 195–196 pain , 375–377 Closure devices pelvic hematoma , 358 angiographic series , 25 polytrauma patients , 355 description , 25 renal traumatisms , 361–363 double-guided technique , 25–26 RPH , 357–358 Computed tomography (CT) scan , 81, 89–91, solid organs , 357 97, 100 splenic traumas (see Splenic traumas) Curative uterine fi broid embolization terminal organs , 356 (CurUFE) traumatic lesions , 356 catheterization diffi culties and spasms , 326 truncal embolizations , 31–32 contraindications and indications , 330 upper quadrant pain , 373–374 control angiography , 326 varicocele (see Varicoceles) Index 447

vascularization type , 31 G vessel occlusion , 357 Gastrointestinal (GI) tract hemorrhages Endocrine tumors (ET) , 124 arteriography , 182 Endoleaks. See Endovascular cholecystectomy , 185 abdominal aortic aneurysm chronic lymphoid leukemia , 183–184 repair (EVAR) coloscopy , 187 Endotension , 292 complications , 179–180 Endovascular abdominal aortic aneurysm embolization , 176–177 repair (EVAR) esogastroduodenal endoscopy , 174 aortic aneurysms , 291 fi broscopy , 189–190 arteriovenous malformations , 295 hematemesis , 181 blood pressure , 291 hepatic segmentectomy , 183 endoleaks classifi cation , 291–292 iodine , 174 end-stage renal failure , 297–300 lower hemorrhages , 178, 179 indications , 296 necrotico-hemorrhagic acute pancreatitis , infrarenal AAA , 302–305 186 optimal occlusion agent , 296 PHT , 173 radiological anatomy , 292 radiological anatomy , 174–175 reintervention rate , 295 rectum cancer , 190–193 type I endoleaks , 292–293 upper hemorrhages , 178, 179 type II endoleaks (see Type II endoleaks) urinary catheterization , 176 Epistaxes angiography , 48–49 anterior gauze plugging and endoscopic H electrocoagulation, 45 HCC. See Hepatocellular carcinoma (HCC) controlled hemorrhage, hemodynamic Hemarthrosis, knee arthroplasty instability , 48 conservative management , 429 description , 44 description , 428 endovascular treatment , 46–47, 55 synovectomy , 428 environment, indications and patient’s Hematological diseases situation , 47 AITP , 164 occlusion material , 47 myeloproliferative diseases , organic causes , 44 164–165 post-embolization neuropathies , 50 thalassemia , 165 refractory epistaxes etiologies , 44 Hematomas relevant radiological anatomy , anticoagulants , 259 45, 54 indications , 261–262 surgical treatment , 45–46 non-Hodgkin lymphoma , 266 systemic complications , 49 outcomes , 261 ET. See Endocrine tumors (ET) rectus sheath , 260 Ethylene vinyl alcohol (EVA) retroperitoneal hematoma , 263 instructions , 12 retroperitoneum and psoas , 260 onyx , 11–12 rhythmic cardiopathy , 264–265 technical characteristics , 11 Seldinger technique , 260–261 tumor neovascularizations , 12 ultrasound , 259–260 EVA. See Ethylene vinyl alcohol (EVA) Hemoptysis (H) EVAR. See Endovascular abdominal aortic aortogram, catheterization and post-embo aneurysm repair (EVAR) angiogram , 72 arterial bleeding (see Systemic arterial bleeding) F bronchial circulation , 63 Fanconi syndrome , 79 bronchial hypervascularization , 73–74 FLR. See Future liver remnant (FLR) celiac trunk (CT) , 64 Future liver remnant (FLR) , 135 description , 63 448 Index

Hemoptysis (H) (cont. ) chemoembolization, loaded double systemic arterial and pulmonary microspheres, 117 embolization, 69 cone beam CT , 119 multidetector CT (MDCT) , 64 HepaSphere microparticles , 118 percutaneous endovascular hepatic infusions, chemotherapy , embolization, 64 116–117 pulmonary arterial bleedings , 67–68 hepatic intra-arterial chemotherapy , 116 radiological anatomy , 64–65 inter-cure , 119 Hemorrhages, ENT lipiodol chemoembolization , 117 arterial embolization and hemorrhages , 43 Seldinger’s technique , 118 carotid blowout , 51–52, 57 randomized controlled trials , 121–122 epistaxes (see Epistaxes) TACE , 131 external carotid artery, cancerology , 50–51, technical variations and evolutions 56 drugs , 123 microcatheterism technique , 53 endovascular treatments , 123 Rendu-Osler disease , 52 radioembolization , 122–123 tumors , 52, 58 radiosensitization agents , 123 Hepatic artery embolizations treatment , 141 aneurysms , 98–100 Hereditary hemorrhagic telangiectasia arterial segmentation, liver , 104 (HHT), 79, 81 carcinoid secreting liver metastasis , 107 HHT. See Hereditary hemorrhagic CT , 104 telangiectasia (HHT) hypochondrium pain , 105–106 Hypersplenism liver traumatisms , 97–98 indications and outcomes , 163–164 liver tumors, hemorrhaging situations , PHT , 162 101–103 technique , 163 malignant pancreatic insulinoma , Hypogastric arteries 108–111 aneurysms , 213–214 radiological anatomy , 95–96 aortobifemoral bypass , 222–225 spontaneous hemoperitoneum , 100–101 aortoiliac aneurysms , 215–216 technique , 96–97 axial transverse , 218 vascular and traumatic disease , 95 embolization techniques , 214–215 Hepatic trauma endovascular techniques , 216 indications , 358–359 endovascular treatment , 213 morphological imaging , 359 iliac and hypogastric arteries , 219–221 mortality rate , 359 outcomes , 216 Hepatocellular carcinoma (HCC) radiological anatomy , 214 adjuvant treatment , 121 retrograde injection , 217 BCLC treatment algorithm , 121 and cholangiocarcinomas , 140 complication , 127 I contraindications , 120 ICBT. See Intercostobronchial CT , 126 trunk (ICBT) description , 115–116 IIA. See Internal iliac arteries (IIA) HepaSpheres , 121–122 ILA. See Iliolumbar artery (ILA) hepatic failure , 121 Iliolumbar artery (ILA) , 293–294 hepatic transplantation , 128–130 Intercostobronchial trunk (ICBT) , indications , 120 64, 65, 71 malignant liver tumors (see Malignant Internal iliac arteries (IIA) tumors) bilateral embolization , 311 mortality and morbidity , 121 division pattern , 310 nonindications , 119 ovarian arteries , 311 radiological anatomy and UA , 310 anthracyclines , 117 Internal . See Priapism Index 449

K Multidetector CT (MDCT) , 64 Knee replacement , 439–442 Musculoskeletal pathologies bone metastases , 427 hemarthrosis (see Hemarthrosis, knee L arthroplasty) Left varicoceles intra-arterial chemotherapy and primum movens , 270 chemoembolization, 426 renal ultrasound , 274 primary tumors (see Primary tumors) renal vein , 270 Myeloproliferative diseases , 164–165 scrotal pain , 278 symptomatic, exercise , 275 Liver traumatisms N caval/portal venous bleedings , 98 Nasopharyngeal fi broma , 52, 58 embolization , 97–98, 112 hemorrhage spontaneously amends , 97 hepatic arterial embolization , 98 O interventional radiology and surgery Occlusion agents treatment, 98 absorbable gelatin sponge Liver tumors instructions , 5 endocrine syndrome , 102 microspheres , 5 intra-arterial chemotherapy/ technical characteristics , 4–5 chemoembolization techniques, 101 coils liver abscess , 103 anchor, knitting and packing post-embolization syndrome , 102–103 technique, 18 prophylactic antibiotic therapy , 103 instructions , 18–19 unique metastasis , 102 technical characteristics , 16–17 VEGF , 101 Tefl on-coated guides , 17 LM. See Lymphatic malformations (LM) embolization , 3 Lower hemorrhages, GI tract liquid agents indications , 178 EVA , 11–12 outcomes , 179 instructions , 10–11 Lymphatic malformations (LM) microcatheter , 10 description , 406 sclerosing agents (see Sclerosing Klippel-Trenaunay syndrome , 405 agents) macrocystic , 406, 413 technical characteristics , 9–10 sclerosing agents , 409 microparticles ultrasound and fl uoroscopic guidance , 408 aggregation and dilutions , 7 uni/multiloculate cysts , 406 catheter internal lumen , 7, 8 composition , 6 distal parenchymal devascularization , 5 M elasticity and rigidity , 6 Malignant tumors hepatic transplantation , 9 adenocarcinoma , 232 instructions , 8–9 liver interactions, adjacent parenchyma , 7 embolization and chemoembolization , plugs 124 atrial septum/ductus arteriosus , 20 ET , 124 AVP , 20, 21 metastases , 124–125 instructions , 21 TACE , 124 technical characteristics , 20 palliative embolization , 232–233 temporary and permanent MDCT. See Multidetector CT (MDCT) agents , 4 Menometrorrhagia thrombin , 22 effi cacy, progestin treatment, 334–339 thrombogenic materials , 3–4 poly-myomatous uterus , 332–333 Osteolytic metastases , 430–435 450 Index

P FLR , 135 PAHT. See Pulmonary arterial hypertension gelfoam , 138 (PAHT) glue , 138 Parenchymal embolizations HCC , 142 associated proximal occlusions , 33 hepatectomies , 135 distal embolization agent , 33 hepatic volume and operability , fl ow, afferent vessels, and collateral 139–140 networks , 32–33 indications , 140 strategy , 32, 33 ipsilateral approach , 136 PCS. See Pelvic congestion syndrome (PCS) plugs , 138–139 Pelvic congestion syndrome (PCS) radiological anatomy , 136 chronic pelvic pain , 342 synchronous liver metastases , 145–147 indications , 345–346 therapeutic associations , 141 multiparous women , 345 Post-embolization syndrome , 119 nutcracker syndrome , 342 Postpartum hemorrhage (PPH) premenstrual phase , 342 amniotic sac , 319–321 radiological anatomy , 342–343 aortography , 316 radiological suspicion , 348–350 atonic uterus , 316–317 successes rates and morbidity , 345 bleeding , 309 techniques , 343–344 gynecological and obstetrical Pelvic lytic bony metastases , 436–438 follow-up , 312 Pelvic traumas hysterectomy , 312 car accident , 382–384 indications , 313 indications , 365 left uterine artery injection , 317 mortality rate and complication , 365 placenta accreta , 314 technique , 363–364 radiological anatomy , 310 therapeutic gold , 364 surgical ligation , 309–310 Pelvic tumors technique , 311 benign prostatic hyperplasia , 425 UA , 315 bladder , 424 uterine atony/cervico-vaginal tear , 312 genitourinary hemorrhages and , 424 vaginal delivery , 318 IIA , 424 PPVI. See Pelvi-perineal venous insuffi ciency intra-arterial chemotherapy , 424 (PPVI) terminal branches , 424 Preoperative embolizations (PreopUFE) uterine cancers , 425 embolization agents and analgesics , 327 Pelvi-perineal venous insuffi ciency (PPVI) , hysterectomies , 329 346–347 indications , 331 PHT. See Portal hypertension (PHT) myomas , 329 Placenta accreta , 314 PreopUFE. See Preoperative embolizations Portal hypertension (PHT) (PreopUFE) hypersplenism , 162 Priapism varicose complications and nonabsorbable BRTO , 425 agents , 283 ethanolamine oleate , 426 duplex Doppler ultrasound , 282 femoral venous access , 425 highway motorcycle accident , 287 portacaval shunts , 426 indications , 283–284 rebleeding rate , 426 “perineal compression” , 281 TIPS , 425 persistent priapism, car Portal vein embolization accident, 288 agents , 138 radiological anatomy , 282 cholangiocarcinoma , 144 spinal cord injury , 281 coils and spherical microparticles , 138 sustained , 285–286 contraindications , 140 symptoms , 281 contralateral approach , 137 technique , 282–283 Index 451

Primary tumors renal tumor, liver metastases , 243–244 aneurysmal cysts , 428 techniques , 230–231 giant-cell tumors , 428 traumatic injury, kidney , 249 osteosarcomas , 427–428 treatment, anticoagulation , 246 Pulmonary arterial (PA) bleedings vascular murmur, lumbar fossa , 251–252 description , 67 vena cava and lung metastases , 242 indications , 68 Renal traumatisms recanalizations , 68 AAST grades , 363 technique , 68 complications and embolization , 362 vaso-occlusion , 68 delayed hemorrhages , 362 Pulmonary arterial hypertension (PAHT) , 13 emergency embolizations , 361–362 Pulmonary arteriovenous malformations parenchymal loss , 362 (PAVMs) renal infarction , 363 bronchial cancer , 85 secondary period , 362 CT scan , 81, 89–91 Rendu-Osler-Weber syndrome , 79, 86–88, 207 diagnosis , 80 Retroperitoneal hematoma (RPH) , 357 embolic accidents , 81 RPH. See Retroperitoneal hematoma (RPH) Fanconi syndrome , 79 hemoptysis and hemothorax , 80, 84 HHT , 79 S indications , 82 “Sandwich” technique , 51 posttraumatic false aneurysm , 82 Sclerosing agents radiological anatomy , 80 absolute alcohol Rasmussen’s aneurysm , 82 and detergents , 12 Rendu-Osler-Weber syndrome , 79, 86–88 instructions , 13–14 technique , 80–81 PAHT , 13 Pulmonary embolization , 69 systemic toxicity , 13 technical characteristics , 13 detergents R instructions , 15 Renal arterial aneurysms liquid and foam , 15 endovascular treatment , 237 technical characteristics , 14 therapeutic indications , 238 hypertonic saline and glycerol , 12 Renal arterial embolizations Sclerotherapy and embolization techniques adenocarcinoma , 240 AVM , 408–409 AML , 233–234 LMs , 408 angiomyolipoma , 245 VM ( see Vascular malformations (VM)) anticoagulants , 234 Splenic arterial embolizations arteriography , 248 AAST , 170 description , 229 analgesia , 154–155 functional exclusions , 238–239 aneurysm , 156 heart failure , 254 “Baltimore” , 159–160, 170 hematuria , 231 catheter , 155 hemodynamic collapsus , 247 catheterization techniques , 153 hypertension , 231 HCC , 168 infection , 231–232 HVC cirrhosis , 169 intermittent recurrent hematuria , 253 hyperleukocytosis , 156 intrarenal communications , 236–237 hypersplenism , 154 kidney transplantation , 250 indications and technique , 159 malignant tumors (see Malignant tumors) liver cirrhosis , 167–168 pain , 231 liver function , 156 radiological anatomy , 229–230 morphological follow-up , 157 refractory hypertension , 255 parenchymal embolizations , 156 renal failure , 231 proximal agents , 155 452 Index

Splenic arterial embolizations (cont. ) indications , 394 radiological anatomy , 153–154 motorcycle accident , 401–402 red blood cells , 156 techniques , 392–393 technical complications , 157–158 Truncal embolizations , 31–32 traumatisms, spleen , 158–159 Type I endoleaks trunk and hilum , 156 durable exclusion , 296 Splenic traumas type IA , 292–293 Baltimore classifi cation , 389 type IB , 293 catheterization diffi culties and Type II endoleaks complications, 360–361 embolization agents , 295 indications , 359–360 endovascular approach , 293–294 Spontaneous hemoperitoneum , 100–101 recurrence rate , 295 Systemic arterial bleeding strategy, embolization , 294 angio and embolization techniques , 65–66 transparietal approach , 294 catheterism/identifi cation, spinal cord branch , 66 complications , 67 U indications , 67 UA. See Uterine arteries (UA) Uterine arteries (UA) anastomoses , 310 T femoral access , 319 TACE. See Transarterial chemoembolization and IIA , 310 (TACE) ligation , 313 TACI. See Transarterial chemo-infusion resorbable gelatin sponge , 319 (TACI) UFE. See Uterine fi broid embolization (UFE) TAE. See Transarterial embolization (TAE) Upper hemorrhages, GI tract Thalassemia , 165 indications , 178 Tibiofi bular open fracture , 394–400 outcomes , 179 TIPS. See Transjugular intrahepatic Uterine fi broid embolization (UFE) portosystemic shunt (TIPS) black women , 323 Transarterial chemoembolization (TACE) , CurUFE ( see Curative uterine fi broid 119, 122, 124 embolization (CurUFE)) Transarterial chemo-infusion (TACI) , 117 description , 323 Transarterial embolization (TAE) , 116 preopUFE , 327 Transjugular intrahepatic portosystemic shunt radiological anatomy , 324–325 (TIPS) esophageal varices , 425 gastric varices , 426 V varicose veins , 425 Varicoceles venous hemorrhagic complications , 173 and deferential varicose vein , 270 Traumatic/iatrogenic lesions description , 269 acute phase , 234–235 embolization and complications , 272 bis-malformative arteriovenous fi stulas , etiological factors , 269 236 fertility , 272 late complications , 236 indications , 273 secondary period , 235 left ( see Left varicoceles) Traumatisms, limbs left scrotal pain , 278–279 arterial and venous lesions , 391 lumbar occlusion , 272 clinical suspicion , 392 pain and scrotal swelling , 272 concomitant injuries , 394 pampiniform venous plexus , 269 diagnosis , 392 radiological anatomy , 270 embolization , 393 selective catheterization , 276 endovascular treatment , 393 spermatic venography , 274 external/internal bleedings , 391 symptomatic, exercise , 275 Index 453

symptomatic left varicocele , 277 endovascular navigation , 30–31 technique , 270–272 lesion , 29 Vascular endothelial growth factor (VEGF) , post-procedural follow-up , 39 101 VEGF. See Vascular endothelial growth factor Vascular malformations (VM) (VEGF) AVM and AVF , 405 Venous femoral access , 348 indications , 410–411 Visceral and renal arteries interventional radiology , 406 aortography , 207–208 Klippel-Trenaunay syndrome , 405 arteriography , 203 left hemiface , 406, 412 CA , 195–196 lip, AVM , 406, 415–416 hypertension , 209 microcystic lymphangioma , 406, 415 indiations , 198–199 Parkes-Weber syndrome , 405 microcatheter , 202 patient follow-up , 410 outcomes , 198 sclerotherapy and embolization techniques pancreatic arcades , 205 ( see Sclerotherapy and embolization pancreatitis , 210 techniques) parent artery occlusion , 196–197 voluminous macrocystic lymphangioma , prepyelic renal , 205 406, 413–414 pseudoaneurysms , 195 voluminous perineal AVM , 406, 417 radiological anatomy , 196 Vascular occlusions Rendu-Osler Weber’s disease , 207 adjuvant medications , 34 renovascular hypertension , 208 anesthesia and sedation , 34–37 splenic artery false aneurysm , 201 antibiotic prophylaxis , 37–39 splenic parenchyma , 203–204 embolization techniques (see stents placement , 197–198 Embolization) techniques , 196 initial morphological assessment thrombin injection , 197 clinical condition , 29–30 VM. See Vascular malformations (VM)