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Two patients with placenta percreta underwent uterine artery embolization (UAE) for abnormally invasive placenta (AIP) in the first trimester. Patient 1 had a 9-week cervical ectopic, while Patient 2 had a 9-week cesarean scar pregnancy. Elective termination of pregnancy was performed in both patients. UAE was performed with tris-acryl gelatin microspheres as well as gelfoam until stasis and was repeated in cases of revascularization. Both patients were followed with US/MRI/MRA scans and β-hCG levels. Revascularization occurred in both patients following UAE, requiring multiple embolizations to achieve complete placental involution. Serial bland UAE may be an effective technique in the treatment of first-trimester AIP, with the distinct advantage of maintaining a patient's fertility., Level of Evidence: Level IV.

Purpose: To investigate the safety, efficacy and long-term results of bronchial artery embolization with microsphere particles (Embosphere ® Microspheres, BioSphere Medical, Rockland, MA) 700-900 µm in size for massive hemoptysis., Methods: One hundred and seventy-four patients (94 female, 80 male; mean age 39.4 ± 5.7) who had bronchial artery embolization for massive hemoptysis between January 2010 and October 2015 were incorporated in the study. Patients had hemoptysis with a mean volume of 525 ± 150 mL (median 500 mL, range 300-1200 mL) over a 24-h period. Underlying pathologies included bronchial artery hypertrophy due to bronchiectasis (56.3% [98/174]), lung cancer (29.9% [52/174]), tuberculosis (10.3% [18/174]) and the rest remained idiopathic (3.4% [6/174]). Mean bronchial artery diameter before the intervention was 3.8 ± 1.5 mm (median 4 mm, range 3.1-7.5 mm). Median follow-up period was 56 months (range 10-82 months). Primary objectives were the technical and clinical success., Results: Technical success was 100%. Clinical success for preventing massive hemoptysis was 91.9% (160/174). There was no procedure-related mortality or morbidities. Minor complications such as chest pain were observed in nine patients (5.0%). Recurrent hemoptysis (8.1%) was observed within 6 months in 14 patients, ten of whom were treated with a second embolization session and the remaining four with a total of three embolization sessions., Conclusion: Bronchial artery embolization for massive hemoptysis with Embosphere particles 700-900 µm in size is a safe and effective method with high technical and clinical success rates. Long-term results are excellent.

Purpose: To compare acute pain after uterine artery embolization (UAE) with tris-acryl gelatin microspheres (TAGM) versus gelatin sponge particles (GS) for leiomyoma., Materials and Methods: This was a single-institution, retrospective study. Between July 2008 and November 2016, 101 consecutive patients with symptomatic uterine leiomyoma underwent UAE with the same protocol for post-procedural pain. GS was employed with near-stasis endpoint for the first 49 patients, whereas TAGM was used with limited endpoint for the next 52 patients. Post-UAE pain levels were compared between both groups with a linear mixed model using visual analog scale (VAS) scores from 0 to 18 h as a repeat measure outcome. Peak VAS < 24 h or dose of drugs for analgesia and conscious sedation was compared by analysis of variance. Tumor infarction was assessed with post-procedural contrast-enhanced MRI., Results: Baseline demographics and most outcomes including tumor infarction were similar between both groups. The average VAS scores during the period <24 h were significantly lower in TAGM group (1.68, 95% CI 1.23-2.13) compared to GS group (3.28, 95% CI 2.82-3.74, p < 0.0001). The difference remained significant even after adjustment for other factors (p < 0.0001). The mean peak VAS < 24 h was also lower in TAGM group (3.89, 95% CI 3.25-4.53) than in GS group (5.90, 95% CI 5.20-6.53, p < 0.0001). The dose of drugs for analgesia and conscious sedation was significantly lower in TAGM group (p = 0.001, p = 0.004, respectively)., Conclusion: TAGM had an advantage over GS in UAE for leiomyoma in terms of less post-procedural pain <24 h, with lower doses of drugs for analgesia and conscious sedation.

Purpose: The purpose of the study was to compare safety and efficacy outcomes following prostate artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with 100-300 versus 300-500 μm tris-acryl gelatin microspheres., Materials and Methods: Patients were prospectively treated between August 2011 and June 2013 to receive PAE with 100-300 μm (group A) or 300-500 μm (group B) tris-acryl gelatin microspheres. Patients were followed for a minimum of 12 months and were assessed for changes in International Prostate Symptom Score (IPSS), quality of life (QoL) index, prostate volume determined by magnetic resonance imaging, serum prostate specific antigen (PSA), and maximum urine flow rate (Qmax), as well as any treatment-related adverse events., Results: Fifteen patients were included in each group, and PAE was technically successful in all cases. Both groups experienced significant improvement in mean IPSS, QoL, prostate volume, PSA, and Qmax (p < 0.05 for all). The differences observed between the two groups included a marginally insignificant more adverse events (p = 0.066) and greater mean serum PSA reduction at 3 months of follow-up (p = 0.056) in group A., Conclusions: Both 100-300 and 300-500 μm microspheres are safe and effective embolic agents for PAE to treat LUTS-related to BPH. Although functional and imaging outcomes did not differ significantly following use of the two embolic sizes, the greater incidence of adverse events with 100-300 μm microspheres suggests that 300-500 μm embolic materials may be more appropriate.

Purpose: To describe first clinical experience with a directly image-able, inherently radio-opaque microspherical embolic agent for transarterial embolization of liver tumors., Methodology: LC Bead LUMI™ is a new product based upon sulfonate-modified polyvinyl alcohol hydrogel microbeads with covalently bound iodine (~260 mg I/ml). 70-150 μ LC Bead LUMI™ iodinated microbeads were injected selectively via a 2.8 Fr microcatheter to near complete flow stasis into hepatic arteries in three patients with hepatocellular carcinoma, carcinoid, or neuroendocrine tumor. A custom imaging platform tuned for LC LUMI™ microbead conspicuity using a cone beam CT (CBCT)/angiographic C-arm system (Allura Clarity FD20, Philips) was used along with CBCT embolization treatment planning software (EmboGuide, Philips)., Results: LC Bead LUMI™ image-able microbeads were easily delivered and monitored during the procedure using fluoroscopy, single-shot radiography (SSD), digital subtraction angiography (DSA), dual-phase enhanced and unenhanced CBCT, and unenhanced conventional CT obtained 48 h after the procedure. Intra-procedural imaging demonstrated tumor at risk for potential under-treatment, defined as paucity of image-able microbeads within a portion of the tumor which was confirmed at 48 h CT imaging. Fusion of pre- and post-embolization CBCT identified vessels without beads that corresponded to enhancing tumor tissue in the same location on follow-up imaging (48 h post)., Conclusion: LC Bead LUMI™ image-able microbeads provide real-time feedback and geographic localization of treatment in real time during treatment. The distribution and density of image-able beads within a tumor need further evaluation as an additional endpoint for embolization.

No systemic agents that are known to be effective for the treatment of solid-pseudopapillary neoplasm (SPN) are available. We report the prolonged and sustained control of metastatic pancreatic SPN to the liver using hepatic arterial embolization (HAE), where a total of 13 HAE sessions were performed over a 6-year period.

Purpose: This study was designed to undertake systematic review and meta-analysis of published comparative trials comparing embolic agents used in uterine artery embolisation (UAE) for uterine leiomyomata., Methods: Systematic literature searches were performed in MEDLINE, Embase, PubMed, and Cochrane Central databases from database inception to July 2012. Randomised and nonrandomised trials comparing two or more embolic agents used in UAE were included. Assessment included five widely used embolic agents: nonspherical polyvinyl alcohol (PVA) (Contour PVA, Boston Scientific or PVA Cook Medical); spherical PVA (Contour SE, Boston Scientific); acrylamido PVA (Beadblock, Biocompatibles, Terumo); tris-acryl gelatin microspheres (TAGM) (Embospheres, Merit Medical Inc); and polyzene-F hydrogel microspheres (Embozenes, CeloNova Biosciences). Outcomes assessed included: quality of life (QOL), assessment, magnetic resonance imaging (MRI), uterine and fibroid volumes and degrees of MRI fibroid enhancement and devascularisation. A total of 262 citations were reviewed with 5 randomised, controlled trials involving 295 women and 5 non-RCTs involving 617 women included., Results: No evidence of superiority of any embolic agent was demonstrated. Meta-analysis was performed between TAGM (Embospheres) and spherical PVA microspheres. Two RCTs found a trend toward greater uterine and dominant fibroid volume reductions with Embospheres but the combined differences were not statistically significant (p = 0.78 and p = 0.94 respectively). Embospheres demonstrated greater percentage fibroid devascularisation than spherical PVA (p = 0.039)., Conclusions: This study confirms that the current evidence demonstrates superiority of Embospheres over spherical PVA but no reported differences in outcomes between any of the other agents. Comparison of embolic agents was limited by lack of RCT data and further research is warranted.

Purpose: To investigate the effectiveness and safety of periurethral injections (PIs) of polyacrylamide hydrogel (PAHG, Bulkamid(®)) for the treatment of female stress urinary incontinence (SUI)., Methods: This double-centre prospective study included 82 female patients with SUI who were treated with PIs of PAHG between January 2008 and December 2010 in outpatient setting. The International Consultation on Incontinence Questionnaire short form (ICIQ-SF) and the Patient Global Improvement Impression (PGI-I) were used to assess incontinence and patient satisfaction after treatment. The impact of incontinence on quality of life (QoL) was investigated using the Incontinence Impact Questionnaire (IIQ-7)., Results: All patients were discharged on the same day of treatment and there was no intraoperative complication. At 1-year follow-up, the efficacy of PIs of PAHG (subjective success rate) was 74.4 %. The subjective responder rate was 86.6 %, 8.5 % of patients had no change and no patient reported worsening of symptoms. The mean number of episodes of urine leakage/24 h and the mean leakage/24 h significantly decreased after treatment. At 1-year follow-up, the IIQ-7 results were significantly improved compared with baseline. 25.6 % of patients had adverse events (mainly urinary tract infections and injection site pain)., Conclusion: This study demonstrates that PIs of PAHG are effective and safe and cause significant improvement of the QoL at 1-year follow-up. PIs of PAHG can be safely performed in an ambulatory setting and patients may be discharged on the day of the procedure.

Objective: To evaluate the efficacy of acrylamido polyvinyl alcohol microspheres (a-PVAM) as an embolic agent for uterine artery embolization (UAE) compared with Tris-acryl gelatin microspheres (TAGM)., Design, Setting, Participants: Prospective randomized double-blind noninferiority trial. Conducted at two sites both with regional UAE practices. Forty-six women with symptomatic leiomyomas., Intervention: UAE procedure was performed with either of the two embolic agents. Either 700-900-μm a-PVAM or 500-700-μm TAGM was used., Main Outcome Measures: Changes in leiomyoma perfusion, overall uterine volume, and dominant leiomyomas volume measured by contrast-enhanced magnetic resonance imaging at 1 week, 3 months, and 6 months after UAE by a reader blinded to the embolic agent used. Changes in Uterine Fibroid Symptoms and Quality of Life questionnaire scores were measured at 3, 6, and 12 months after UAE., Results: Forty-six patients were randomized and treated under the study protocol (a-PVAM n=22, TAGM n=24). There were no procedure-related complications. Two patients were excluded from analysis (one technical failure of the procedure, one withdrawal from study). Successful (>90%) leiomyoma devascularization was observed in 81% of subjects at 1 week after UAE, 97% at 3 months after UAE, and 95% at 6 months after UAE. No significant differences were observed in 14 of 15 outcome measurements, consistent with noninferiority. TAGM was slightly superior to a-PVAM on one comparison (overall quality of life at 3 months after UAE).

Hepatic encephalopathy is considered a contraindication to hepatic artery embolization. We describe a patient with a well-differentiated neuroendocrine tumor metastatic to the liver with refractory hepatic encephalopathy and normal liver function tests. The encephalopathy was refractory to standard medical therapy with lactulose. The patient's mental status returned to baseline after three hepatic artery embolization procedures. Arteriography and ultrasound imaging before and after embolization suggest that the encephalopathy was due to arterioportal shunting causing hepatofugal portal venous flow and portosystemic shunting. In patients with a primary or metastatic well-differentiated neuroendocrine tumor whose refractory hepatic encephalopathy is due to portosystemic shunting (rather than global hepatic dysfunction secondary to tumor burden), hepatic artery embolization can be performed safely and effectively.

Purpose: To compare the cost and effectiveness of the two most popular forms of eye care in intensive care, ocular lubricant (Lacrilube) and polyacrylamide hydrogel dressings (Geliperm); for the prevention of exposure keratopathy in the critically ill., Methods: A prospective randomised contralateral eye study was conducted at the Intensive Care Unit (ICU), Royal London Hospital, London, UK. Eighty eyes of 40 patients were recruited. Each patient received both Lacrilube and Geliperm allocated at random to different sides. A daily ophthalmology ward round was conducted. The outcome measures included the greatest palpebral aperture length, conjunctival oedema, and any exposure keratopathy., Results: There was no statistically significant difference in the maximum corneal exposure score between the eyes treated with Lacrilube and Geliperm (P = 0.38). No significant difference in degree of chemosis or palpebral aperture was identified., Conclusions: Our data suggest that Geliperm is as effective as Lacrilube in the prevention of exposure keratopathy in the critically ill. We also note that nursing staff must be fully trained in its application for eye care.

We report the case of a 31-year-old woman with mediastinal Castleman's disease of the hyaline vascular type. This large tumor was safely resected after arterial embolization. We describe the steps of this interventional procedure and discuss related necessary precautions.

Purpose: To evaluate trisacryl-gelatin microspheres (40-120 microm) for acute and chronic tissue embolization in mini-pig livers., Methods: Thirteen animals were divided into four groups: group 1 (n = 3), total arterial bed occlusion with acute procedure; groups 2 to 4, chronic superselective embolization with follow-up of 1 week (group 2, n = 1), 4 weeks (group 3, n = 4) or 14 weeks (group 4, n = 5). Key endpoints were homogeneity and particle distribution in acute embolizations (group 1) and necrosis and inflammation in chronic embolizations (groups 2-4) as assessed microscopically and angiographically., Results: After liver embolization, parenchymal necrosis did not occur; only signs of vessel wall disintegration were evident. The bile ducts remained intact. A distinct foreign body reaction with sparse leukocytic infiltration and giant cells was found at 14 weeks, but no signs of major inflammation were found. Particles were seen at the presinusoidal level, but no particle transportation into the sinusoids was observed., Conclusions: Embolization in mini-pig livers, using small trisacryl-gelatin microspheres, results in vessel fibrosis without parenchymal or bile duct necrosis. The most likely explanation for preservation of the parenchyma is portal inflow. Small trisacryl-gelatin microspheres may be ideal as an adjunct for chemoembolization.

A prospective study of 70 patients with life-threatening hemoptysis who had bronchial and systemic artery embolization with tris-acryl linked microspheres was performed over 15 months. The procedure was technically successful in 90% of patients and at 24 hr after the procedure (87%). Recurrent hemoptysis occurred in 13% of patients within the first week. Chest pain was experienced following embolization in 7% of patients. The mortality was 10% due to the inclusion of patients with pulmonary metastases. Bronchial artery embolization using microspheres is an effective and well-tolerated treatment for patients with life-threatening hemoptysis who are not surgical candidates.

We performed a retrospective analysis of 46 patients with histologically confirmed hepatocellular carcinoma (HCC) who were treated with transarterial embolization (TAE) of the hepatic arteries. To induce permanent embolization, microspheres (Embosphere; 100 to 700 micron) and a mixture of ethiodized oil (Lipiodol Ultrafluide) with cyanoacrylate (Glubran) was injected. A total of 106 TAE procedures were performed. Cumulative survival rates were calculated. No patient died during embolization or within the first 24 hours. Severe procedure-related complications were observed in 2 patients. At the time of analysis, 38 of 46 patients were alive. The 180-, 360-, 520-, and 700-day cumulative survival rates for the total study population were 80.6%, 70.7%, 70.7%, and 47.1%, respectively, with a median survival of 666 days. TAE with the use of microspheres and Lipiodol and cyanoacrylate for unresectable HCC is a feasible treatment modality. Bland embolization with the use of microspheres can be used in patients for whom chemoembolization is not desired.

Purpose: A French multicenter registry was set up to confirm the safety and efficacy of large calibrated tris-acryl gelatin microspheres for embolization of symptomatic fibroids., Methods: Technical recommendations included embolization using large microspheres (>500 microm) with no secondary embolization agent. Postprocedural pain, clinical improvement and adverse events were prospectively evaluated during a follow-up period of at least 6 months., Results: Eighty-five women complaining of fibroid-related symptoms entered the study. In seven women, a secondary embolization agent was used in addition to microspheres. Complete resolution of menorrhagia was achieved in 84% of women at 24 months and significant uterine and fibroid volume reductions were noted after 6 months (37% and 73%, respectively). Three women experienced definitive amenorrhea (4%) and two women required hysteroscopic resection of a fibroid. Eight women were treated by hysterectomy because of treatment failure. In seven of these women, treatment failure was explained by an additional cause of symptoms including diffuse adenomyosis, endometrial hyperplasia or ovarian artery supply to the fibroids., Conclusion: Limited uterine artery embolization using large microspheres has good clinical success rate with low postprocedural pain and complications. Women can expect excellent midterm results with a high level of symptom control and significant fibroid volume reduction. Confidence in the end-point recommended here may require the experience of several cases.

The aim of this study was to compare the efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles (PVA) in the preoperative embolization of bone neoplasms, on the basis of intraoperative blood loss quantified by the differences in preoperative and postoperative hematic levels of hemoglobin, hematocrit and erythrocytes count. From January 1997 to December 2002, preoperative embolization of bone tumors (either primary or secondary) was carried out in 49 patients (age range 12/78), 20 of whom were treated with trysacril gelatin microspheres (group A) and 29 with PVA particles (group B). The delay between embolization and surgery ranged from 1 to 13 days in group A and 1 to 4 days in group B. As used in international protocols, we considered hematic levels of hemoglobin, hematocrit and erythrocytes count for the measurement of intraoperative blood loss then the differences in pre- and postoperative levels were used as statistical comparative parameters. We compared the values of patients treated with embospheres (n = 10) and PVA (n = 18) alone, and patients treated with (group A = 10; group B = 11) versus patients treated without other additional embolic materials in each group (group A = 10; group B = 18). According to the Student's t-test ( p < 0.05), the difference of hematic parameters between patients treated by embospheres and PVA alone were significant; otherwise there was no significant difference between patients treated with only one embolic material (embospheres and PVA) versus those treated with other additional embolic agents in each group. The patients treated with microspheres had a minor quantification of intraoperative blood loss compared to those who received PVA particles. Furthermore, they had a minor increase of bleeding related to the delay time between embolization and surgery. The use of additional embolic material did not improve the efficacy of the procedure in either group of patients.

Reflux esophagitis was successfully produced in all rats operated on by total gastrectomy and esophagojejunostomy. Its histopathological features comprised erosion and ulceration associated with inflammatory cell infiltration, with hyperplasia of the mucosal epithelium in some animals. These rats were dosed with sodium polyacrylate for protecting the mucosal surface, underwent jejunal diversion for preventing the reflux of digestive juice, or were treated with both in combination, to observe the repairing status of the esophageal ulcer, using the ratio of the length of the regenerated epithelium in the ulcer to the length of the ulcer as the index for the degree of repair. The oral ingestion of 5% sodium polyacrylate solution in drinking water proved the most effective means of administration of this agent. The repair was more improved greater in the group undergoing jejunal diversion, and was greatest in the group receiving both in combination. From these findings, oral administration of a mucosal surface protector, sodium polyacrylate, is an effective therapeutic regiment in mild cases of reflux esophagitis following total gastrectomy, as well as elimination of the cause by diversion of the route in severe cases. The combination of the two therapies will probably by the most effective therapeutic means for this disease.

A case of allergic contact dermatitis following the use of a Plexidur finger splint is reported. The allergen was acrylonitrile, one of the original constituents of the polymer Plexidur.