Digestive Disease Interventions
DOI: 10.1055/s-0044-1782150
Review Article

Review of Commonly Used Embolics

1   Division of Interventional Radiology, Department of Radiology, Cleveland Clinic, Cleveland, Ohio
,
Jafar Golzarian
2   Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
› Author Affiliations

Abstract

As interventional radiology has progressed, endovascular embolization has become a cornerstone of the specialty, used in a wide range of clinical indications including vessel occlusion in acute hemorrhage, cancer and benign tumor treatment, vascular malformations, variceal obliteration, and endoleak management. Fundamental knowledge of the various categories of embolics is vital for interventional radiologists. This review aims to provide a brief summary of the most common embolic agents currently in use, including discussions of their advantages, shortcomings, and common indications of each.



Publication History

Received: 18 October 2023

Accepted: 02 February 2024

Article published online:
22 March 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Dawbarn RH, Derdeyn CP, Moran CJ, Cross DT, Dietrich HH, Dacey Jr RG. The starvation operation for malignancy in the external carotid area. Its failures and successes polyvinyl alcohol particle size and suspension characteristics. Jama Xliii 1904; (12) 792-795
  • 2 Hu J, Albadawi H, Chong BW. et al. Advances in biomaterials and technologies for vascular embolization. Adv Mater 2019; 31 (33) e1901071
  • 3 Speakman TJ. Internal occlusion of a carotid-cavernous fistula. J Neurosurg 1964; 21: 303-305
  • 4 Leyon JJ, Littlehales T, Rangarajan B, Hoey ET, Ganeshan A. Endovascular embolization: review of currently available embolization agents. Curr Probl Diagn Radiol 2014; 43 (01) 35-53
  • 5 Poursaid A, Jensen MM, Huo E, Ghandehari H. Polymeric materials for embolic and chemoembolic applications. J Control Release 2016; 240: 414-433
  • 6 Young S, Rostambeigi N, Golzarian J. The common but complicated tool: review of embolic materials for the interventional radiologist. Semin Intervent Radiol 2021; 38 (05) 535-541
  • 7 Sheth RA, Sabir S, Krishnamurthy S. et al. Endovascular embolization by transcatheter delivery of particles: past, present, and future. J Funct Biomater 2017; 8 (02) 12
  • 8 Abada HT, Golzarian J. Gelatine sponge particles: handling characteristics for endovascular use. Tech Vasc Interv Radiol 2007; 10 (04) 257-260
  • 9 Coulange L, Butori N, Loffroy R. et al. Uterine necrosis following selective embolization for postpartum hemorrhage using absorbable material. Acta Obstet Gynecol Scand 2009; 88 (02) 238-240
  • 10 Porcu G, Roger V, Jacquier A. et al. Uterus and bladder necrosis after uterine artery embolisation for postpartum haemorrhage. BJOG 2005; 112 (01) 122-123
  • 11 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
  • 12 Saad WE, Madoff DC. Percutaneous portal vein access and transhepatic tract hemostasis. Semin Intervent Radiol 2012; 29 (02) 71-80
  • 13 Chua GC, Wilsher M, Young MP, Manyonda I, Morgan R, Belli AM. Comparison of particle penetration with non-spherical polyvinyl alcohol versus trisacryl gelatin microspheres in women undergoing premyomectomy uterine artery embolization. Clin Radiol 2005; 60 (01) 116-122
  • 14 Pelage JP, Laurent A, Wassef M. et al. Uterine artery embolization in sheep: comparison of acute effects with polyvinyl alcohol particles and calibrated microspheres. Radiology 2002; 224 (02) 436-445
  • 15 Fuchs K, Duran R, Denys A, Bize PE, Borchard G, Jordan O. Drug-eluting embolic microspheres for local drug delivery - state of the art. J Control Release 2017; 262: 127-138
  • 16 Khankan AA, Osuga K, Hori S, Morii E, Murakami T, Nakamura H. Embolic effects of superabsorbent polymer microspheres in rabbit renal model: comparison with tris-acryl gelatin microspheres and polyvinyl alcohol. Radiat Med 2004; 22 (06) 384-390
  • 17 Lewis AL, Gonzalez MV, Lloyd AW. et al. DC bead: in vitro characterization of a drug-delivery device for transarterial chemoembolization. J Vasc Interv Radiol 2006; 17 (2, Pt 1): 335-342
  • 18 Vollherbst DF, Otto R, Do T. et al. Imaging artifacts of Onyx and PHIL on conventional CT, cone-beam CT and MRI in an animal model. Interv Neuroradiol 2018; 24 (06) 693-701
  • 19 Vollherbst DF, Sommer CM, Ulfert C, Pfaff J, Bendszus M, Möhlenbruch MA. Liquid embolic agents for endovascular embolization: evaluation of an established (Onyx) and a novel (PHIL) embolic agent in an in vitro AVM model. AJNR Am J Neuroradiol 2017; 38 (07) 1377-1382
  • 20 Pedicelli A, Lozupone E, Valente I. et al. Pre-operative direct puncture embolization of head and neck hypervascular tumors using SQUID 12. Interv Neuroradiol 2020; 26 (03) 346-353
  • 21 Schmitt N, Floca RO, Paech D. et al. Imaging artifacts of liquid embolic agents on conventional CT in an experimental in vitro model. AJNR Am J Neuroradiol 2021; 42 (01) 126-131
  • 22 Koçer N, Hanımoğlu H, Batur Ş. et al. Preliminary experience with precipitating hydrophobic injectable liquid in brain arteriovenous malformations. Diagn Interv Radiol 2016; 22 (02) 184-189
  • 23 Goh GS, Goodwin MD, Huang JF, Kavnoudias H, Holden A. A pilot first-in-human study of embrace, a polyethylene glycol-based liquid embolic agent, in the embolization of malignant and benign hypervascular tumors. J Vasc Interv Radiol 2022; 33 (06) 660-667
  • 24 Gaba RC, Ansari SA, Roy SS, Marden FA, Viana MA, Malisch TW. Embolization of intracranial aneurysms with hydrogel-coated coils versus inert platinum coils: effects on packing density, coil length and quantity, procedure performance, cost, length of hospital stay, and durability of therapy. Stroke 2006; 37 (06) 1443-1450
  • 25 Liebig T, Henkes H, Fischer S. et al. Fibered electrolytically detachable platinum coils used for the endovascular treatment of intracranial aneurysms. Initial experiences and mid-term results in 474 aneurysms. Interv Neuroradiol 2004; 10 (01) 5-26
  • 26 White JB, Ken CG, Cloft HJ, Kallmes DF. Coils in a nutshell: a review of coil physical properties. AJNR Am J Neuroradiol 2008; 29 (07) 1242-1246
  • 27 Ahuja AA, Hergenrother RW, Strother CM, Rappe AA, Cooper SL, Graves VB. Platinum coil coatings to increase thrombogenicity: a preliminary study in rabbits. AJNR Am J Neuroradiol 1993; 14 (04) 794-798
  • 28 Sethi H, Peddu P, Prachalias A. et al. Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis. Hepatobiliary Pancreat Dis Int 2010; 9 (06) 634-638
  • 29 Bechara CF, Weakley SM, Kougias P. et al. Percutaneous treatment of varicocele with microcoil embolization: comparison of treatment outcome with laparoscopic varicocelectomy. Vascular 2009; 17 (Suppl. 03) S129-S136
  • 30 Lopera JE. The Amplatzer Vascular Plug: review of evolution and current applications. Semin Intervent Radiol 2015; 32 (04) 356-369
  • 31 Wang W, Li H, Tam MD, Zhou D, Wang DX, Spain J. The Amplatzer Vascular Plug: a review of the device and its clinical applications. Cardiovasc Intervent Radiol 2012; 35 (04) 725-740
  • 32 Pech M, Kraetsch A, Wieners G. et al. Embolization of the gastroduodenal artery before selective internal radiotherapy: a prospectively randomized trial comparing platinum-fibered microcoils with the Amplatzer Vascular Plug II. Cardiovasc Intervent Radiol 2009; 32 (03) 455-461
  • 33 Pech M, Mohnike K, Wieners G. et al. Advantages and disadvantages of the Amplatzer Vascular Plug IV in visceral embolization: report of 50 placements. Cardiovasc Intervent Radiol 2011; 34 (05) 1069-1073
  • 34 Jardinet T, Bonne L, Oyen R, Maleux G. Initial experience with the microvascular plug in selective renal artery embolization. Vasc Endovascular Surg 2020; 54 (03) 240-246
  • 35 Giurazza F, Corvino F, Cavaglià E. et al. Arterial embolizations with microvascular plug in extracranial and intracranial districts: technical results. Radiol Med (Torino) 2018; 123 (03) 236-243
  • 36 Giurazza F, Ierardi AM, Contegiacomo A, Corvino F, Carrafiello G, Niola R. Embolization with MVP (Micro Vascular Plug®): experience on 104 patients in emergent and elective scenarios. CVIR Endovasc 2021; 4 (01) 59
  • 37 Hughes P, Brennan I, Ryan JM. Use of the Hourglass peripheral embolisation device: early experiences. Eur Radiol Exp 2018; 2 (01) 4
  • 38 Jessen SL, Friedemann MC, Ginn-Hedman AM. et al. Microscopic assessment of healing and effectiveness of a foam-based peripheral occlusion device. ACS Biomater Sci Eng 2020; 6 (05) 2588-2599