Download PDF
Semin intervent Radiol 2008; 25(3): 191-203
DOI: 10.1055/s-0028-1085925
© by Thieme Medical Publishers

Which Arteries Are Expendable? The Practice and Pitfalls of Embolization throughout the Body

Thomas R. Burdick2 , 3 , 5 , Eric K. Hoffer1 , Todd Kooy2 , Basavaraj Ghodke2 , 3 , 5 , Benjamin W. Starnes2 , 4 , 5 , Karim Valji2 , Steve Goldberg2 , Danial Hallam3 , 5 , R. Torrance Andrews2
  • 1Dartmouth-Hitchcock Medical Center Radiology, Lebanon, New Hampshire
  • 2Department of Radiology, University of Washington, Seattle, Washington
  • 3Department of Radiology, Seattle, Washington
  • 4Department of Surgery, Seattle, Washington
  • 5Harborview Medical Center, Seattle, Washington
Further Information

Publication History

Publication Date:
30 September 2008 (online)

Also available at
    Permissions and Reprints

ABSTRACT

This article outlines general concepts of, and strategies for, therapeutic embolization throughout the body, touching on all major arterial distributions. Clinical scenarios that allow or prevent safe embolization of vessels are presented. Specific agents are recommended where appropriate, as are alternate approaches when embolization is not an option. Pre-embolization precautions and adjunctive measures are described in high-risk areas.

KEYWORDS

Embolization - trauma - angiography

REFERENCES

  • 1 Mavroudis C, Backer C L, Rocchini A P, Muster A J, Gevitz M. Coronary artery fistulas in infants and children: a surgical review and discussion of coil embolization.  Ann Thorac Surg. 1997;  63(5) 1235-1242
    CrossrefPubMedSearch in Google Scholar
  • 2 Chambers C M, Curci J A. Treatment of nonaortic aneurysms in the endograft era: aneurysms of the innominate and subclavian arteries.  Semin Vasc Surg. 2005;  18(4) 184-190
    CrossrefPubMedSearch in Google Scholar
  • 3 Hirose H, Gill I S. Blunt injury of the innominate artery: a case report and review of literature.  Ann Thorac Cardiovasc Surg. 2004;  10(4) 218-223
    PubMedSearch in Google Scholar
  • 4 Johnston R H, Wall M J, Mattox K L. Innominate artery trauma: a thirty-year experience.  J Vasc Surg. 1993;  17(1) 134-139
    CrossrefPubMedSearch in Google Scholar
  • 5 Scalea T M, Sclafani S J. Angiographically placed balloons for arterial control: a description of a technique.  J Trauma. 1991;  31(12) 1671-1677
    CrossrefPubMedSearch in Google Scholar
  • 6 Marvasti M A, Parker Jr F B, Bredenberg C E. Injuries to arterial branches of the aortic arch.  Thorac Cardiovasc Surg. 1984;  32(5) 293-298
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Whitley D, Cherry Jr K J. Predictive value of carotid artery stump pressures during carotid endarterectomy.  Neuro Clin N Am. 1996;  7(4) 723-732
    PubMedSearch in Google Scholar
  • 8 McIntosh D L, Douglas G, Lee K, Allen J, Mahadevan M. External carotid artery blood supply to the orbit.  Int J Pediatr Otorhinolaryngol. 2007;  71(10) 1623-1626
    CrossrefPubMedSearch in Google Scholar
  • 9 du Toit D F, Leith J G, Strauss D C et al.. Endovascular management of traumatic cervicothoracic arteriovenous fistula.  Br J Surg. 2003;  90(12) 1516-1521
    CrossrefPubMedSearch in Google Scholar
  • 10 Mwipatayi B P, Jeffery P, Beningfield S J et al.. Management of extra-cranial vertebral artery injuries.  Eur J Vasc Endovasc Surg. 2004;  27(2) 157-162
    CrossrefPubMedSearch in Google Scholar
  • 11 Riesenman P J, Farber M A, Mendes R R et al.. Coverage of the left subclavian artery during thoracic endovascular aortic repair.  J Vasc Surg. 2007;  45(1) 90-94 discussion 94-95
    CrossrefPubMedSearch in Google Scholar
  • 12 Tehrani H Y, Peterson B G, Katariya K et al.. Endovascular repair of thoracic aortic tears.  Ann Thorac Surg. 2006;  82(3) 873-877 discussion 877-878
    CrossrefPubMedSearch in Google Scholar
  • 13 Orend K H, Zarbis N, Schelzig H et al.. Endovascular treatment (EVT) of acute traumatic lesions of the descending thoracic aorta–7 years' experience.  Eur J Vasc Endovasc Surg. 2007;  34(6) 666-672
    CrossrefPubMedSearch in Google Scholar
  • 14 Aggarwal S, Willinsky R, Montanera W, Terbrugge K, Wallace M C. Superselective angiography of a spinal dural arteriovenous fistula having a common segmental origin with the artery of Adamkiewicz.  Neuroradiology. 1992;  34(4) 352-354
    CrossrefPubMedSearch in Google Scholar
  • 15 Tanaka N, Yamakado K, Murashima S et al.. Superselective bronchial artery embolization for hemoptysis with a coaxial microcatheter system.  J Vasc Interv Radiol. 1997;  8(1 Pt 1) 65-70
    CrossrefPubMedSearch in Google Scholar
  • 16 White Jr R I. Bronchial artery embolotherapy for control of acute hemoptysis: analysis of outcome.  Chest. 1999;  115(4) 912-915
    CrossrefPubMedSearch in Google Scholar
  • 17 Uflacker R, Kaemmerer A, Neves C, Picon P D. Management of massive hemoptysis by bronchial artery embolization.  Radiology. 1983;  146(3) 627-634
    CrossrefPubMedSearch in Google Scholar
  • 18 Pump K K. Distribution of bronchial arteries in the human lung.  Chest. 1972;  62(4) 447-451
    CrossrefPubMedSearch in Google Scholar
  • 19 Chapman S A, Holmes M D, Taylor D J. Unilateral diaphragmatic paralysis following bronchial artery embolization for hemoptysis.  Chest. 2000;  118(1) 269-270
    CrossrefPubMedSearch in Google Scholar
  • 20 White Jr R I, Pollak J S, Wirth J A. Pulmonary arteriovenous malformations: diagnosis and transcatheter embolotherapy.  J Vasc Interv Radiol. 1996;  7(6) 787-804
    PubMedSearch in Google Scholar
  • 21 Gwon D I, Ko G Y, Yoon H K et al.. Inferior phrenic artery: anatomy, variations, pathologic conditions, and interventional management.  Radiographics. 2007;  27(3) 687-705
    CrossrefPubMedSearch in Google Scholar
  • 22 Shin S W, Do Y S, Choo S W et al.. Diaphragmatic weakness after transcatheter arterial chemoembolization of inferior phrenic artery for treatment of hepatocellular carcinoma.  Radiology. 2006;  241(2) 581-588
    CrossrefPubMedSearch in Google Scholar
  • 23 Syed M, Shaikh A, Neravetla S. Celiac artery aneurysm embolization by coil occlusion.  Ann Vasc Surg. 2005;  19(1) 113-119
    CrossrefPubMedSearch in Google Scholar
  • 24 Vaddineni S K, Taylor S M, Patterson M A, Jordan Jr W D. Outcome after celiac artery coverage during endovascular thoracic aortic aneurysm repair: preliminary results.  J Vasc Surg. 2007;  45(3) 467-471
    CrossrefPubMedSearch in Google Scholar
  • 25 Saito N, Kimura T, Toma M et al.. Endovascular repair of a thoracoabdominal aortic aneurysm involving the celiac artery and the superior mesenteric artery.  Ann Vasc Surg. 2006;  20(5) 659-663
    CrossrefPubMedSearch in Google Scholar
  • 26 Sato K, Lewandowski R J, Bui J T et al.. Treatment of unresectable primary and metastatic liver cancer with yttrium-90 microspheres (TheraSphere): assessment of hepatic arterial embolization.  Cardiovasc Intervent Radiol. 2006;  29(4) 522-529
    CrossrefPubMedSearch in Google Scholar
  • 27 Covey A M, Brody L A, Maluccio M A, Getrajdman G I, Brown K T. Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients.  Radiology. 2002;  224(2) 542-547
    CrossrefPubMedSearch in Google Scholar
  • 28 Haan J M, Biffl W, Knudson M M et al.. Splenic embolization revisited: a multicenter review.  J Trauma. 2004;  56(3) 542-547
    CrossrefPubMedSearch in Google Scholar
  • 29 Sclafani S J, Shaftan G W, Scalea T M et al.. Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis.  J Trauma. 1995;  39(5) 818-825 discussion 826-817
    CrossrefPubMedSearch in Google Scholar
  • 30 Schwalke M A, Crowley J P, Spencer P et al.. Splenic artery ligation for splenic salvage: clinical experience and immune function.  J Trauma. 1991;  31(3) 385-388
    PubMedSearch in Google Scholar
  • 31 Koconis K G, Singh H, Soares G. Partial splenic embolization in the treatment of patients with portal hypertension: a review of the English language literature.  J Vasc Interv Radiol. 2007;  18(4) 463-481
    CrossrefPubMedSearch in Google Scholar
  • 32 Mozes M F, Spigos D G, Pollak R et al.. Partial splenic embolization, an alternative to splenectomy–results of a prospective, randomized study.  Surgery. 1984;  96(4) 694-702
    PubMedSearch in Google Scholar
  • 33 Shah R, Mahour G H, Ford E G, Stanley P. Partial splenic embolization. An effective alternative to splenectomy for hypersplenism.  Am Surg. 1990;  56(12) 774-777
    PubMedSearch in Google Scholar
  • 34 Yoshioka H, Kuroda C, Hori S et al.. Splenic embolization for hypersplenism using steel coils.  AJR Am J Roentgenol. 1985;  144(6) 1269-1274
    PubMedSearch in Google Scholar
  • 35 Yoshida H, Mamada Y, Taniai N, Tajiri T. Partial splenic embolization.  Hepatol Res. 2008;  38(3) 225-233
    CrossrefPubMedSearch in Google Scholar
  • 36 Park J H, Kang K P, Lee S J et al.. A case of a ruptured pheochromocytoma with an intratumoral aneurysm managed by coil embolization.  Endocr J. 2003;  50(6) 653-656
    CrossrefPubMedSearch in Google Scholar
  • 37 Kawashima A, Sandler C M, Ernst R D et al.. Imaging of nontraumatic hemorrhage of the adrenal gland.  Radiographics. 1999;  19(4) 949-963
    PubMedSearch in Google Scholar
  • 38 Gonzalez Valverde F M, Balsalobre M, Torregrosa N et al.. Spontaneous retroperitoneal hemorrhage from adrenal artery aneurysm.  Cardiovasc Intervent Radiol. 2007;  30(2) 307-309
    CrossrefPubMedSearch in Google Scholar
  • 39 Baccot S, Tiffet O, Bonnot P, Perrot L, Cuilleret J. Bilateral post-traumatic adrenal hemorrhage. Report of a case with acute adrenal insufficiency.  Ann Chir. 2000;  125(3) 273-275
    CrossrefPubMedSearch in Google Scholar
  • 40 Guichelaar M M, Leenen L P, Braams R. Transient adrenocortical insufficiency following traumatic bilateral adrenal hemorrhage.  J Trauma. 2004;  56(5) 1135-1137
    PubMedSearch in Google Scholar
  • 41 Igwilo O C, Sulkowski R J, Shah M R, Messink W F, Kinnas N C. Embolization of traumatic adrenal hemorrhage.  J Trauma. 1999;  47(6) 1153-1155
    PubMedSearch in Google Scholar
  • 42 Abbara S, Nikolic B, Pelage J P, Banovac F, Spies J B. Frequency and extent of uterine perfusion via ovarian arteries observed during uterine artery embolization for leiomyomas.  AJR Am J Roentgenol. 2007;  188(6) 1558-1563
    CrossrefPubMedSearch in Google Scholar
  • 43 Brotman S, Soderstrom C A, Oster-Granite M et al.. Management of severe bleeding in fractures of the pelvis.  Surg Gynecol Obstet. 1981;  153(6) 823-826
    PubMedSearch in Google Scholar
  • 44 Yasumura K, Ikegami K, Kamohara T, Nohara Y. High incidence of ischemic necrosis of the gluteal muscle after transcatheter angiographic embolization for severe pelvic fracture.  J Trauma. 2005;  58(5) 985-990
    PubMedSearch in Google Scholar
  • 45 Suzuki T, Shindo M, Kataoka Y et al.. Clinical characteristics of pelvic fracture patients with gluteal necrosis resulting from transcatheter arterial embolization.  Arch Orthop Trauma Surg. 2005;  125(7) 448-452
    PubMedSearch in Google Scholar
  • 46 Gourlay D, Hoffer E, Routt M, Bulger E. Pelvic angiography for recurrent traumatic pelvic arterial hemorrhage.  J Trauma. 2005;  59(5) 1168-1173 discussion 1173-1164
    PubMedSearch in Google Scholar
  • 47 Ramirez J I, Velmahos G C, Best C R, Chan L S, Demetriades D. Male sexual function after bilateral internal iliac artery embolization for pelvic fracture.  J Trauma. 2004;  56(4) 734-739 discussion 739-741
    CrossrefPubMedSearch in Google Scholar
  • 48 Henriet J P. Sapheno-femoral venous confluence and the external pudendal network: anatomical data and new statistics.  Phlebologie. 1987;  40(3) 711-735
    PubMedSearch in Google Scholar

Thomas R BurdickM.D. 

Assistant Professor, Radiology, University of Washington, Director of Interventional Radiology, Harborview Medical Center

Department of Radiology Box 359728, 325 9th Avenue Seattle, WA 98104

Email: vasculopath@gmail.com