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Embolization
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Embolization is defined as the "therapeutic introduction of various substances into the circulation to occlude vessels, either to arrest or prevent hemorrhaging, to devitalize a structure, tumor, or organ by occluding its blood supply, or to reduce blood flow to an arteriovenous malformation" (Stedman, 2000).
Uterine Artery Embolization, and the Treatment of Uterine Fibroids: Evolution, Science and Politics
New technologies can be categorized as being either ?sustaining? or ?disruptive.? Uterine artery embolization (UAE) is an example of a disruptive technology. As with any new technology, an extensive validation period was required before it was accepted into clinical practice. In this manuscript, we describe the UAE as a ?disruptive? technology, the science behind it and the politics involved. We conclude that it should now be considered a proven technology as well as the basis for ?sustaining? technologies. For the well-being of patients, we must keep an eye on the subtle and subversive political forces at play, particularly so-called turf wars.
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Embolic Protection ? Its Role in Carotid, Coronary and Renal Intervention
The end-organ consequences of arteriosclerosis, namely heart attack, stroke and renal failure, are the leading cause of mortality and morbidity in the western world. Advances in percutaneous interventional techniques have meant that a fair proportion of this disease burden can be dealt with by percutaneous and nonsurgical options. Coronary angioplasty is an established way of dealing with simple and increasingly complex coronary disease. Carotid and renal stenting are also gaining favor as the preferred treatment options, compared to either medical therapy or surgical treatment. Overall, the endovascular approach to treating increasingly complex arterial atherosclerosis is increasing. As the use of stenting increases, so the drive to reduce potential complications and improve success rates intensifies. Although embolization from local atheroma has long been recognized as a potential complication in vascular surgery, direct evidence of this phenomenon was also observed during saphenous vein graft angioplasty. There is also evidence that similar embolization also occurs during carotid and renal stenting, and in certain native coronary lesions with a high thrombus burden. This review examines the rationale for the use of embolic protection systems during endovascular intervention and the clinical evidence base for their use. We also describe the different types of embolic protection systems currently available, their relative merits and outline recommendations for the current use of these devices.
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Renal Sub-capsular Hemorrhage: Unique Imaging Findings and Role of Interventional Management
We present two patients with sub-capsular renal hemorrhage treated with arterial embolization. One patient developed the hemorrhage secondary to a presumed perforation of the renal cortex by a guidewire during renal artery stenting, while hemorrhage was spontaneous in the other patient. Anticoagulation was a common factor in both. Computer tomography (CT) of the abdomen with arterial phase scans was useful in defining the sites of hemorrhage and planning intervention. The radiological findings and intervention are discussed with review of the relevant literature. Key words: sub-capsular renal hemorrhage, guidewire perforation, interventional management
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Perforation of External Carotid Artery Branch Arteries during Endoluminal Carotid Revascularization Procedures: Consequences and Management
The purpose of this article is to describe several inadvertent perforations of external carotid artery branches that occurred in our laboratory during planned carotid artery stenting procedures. When known, the mechanism of the perforation is described. The treatment of these complications is discussed, along with a more general discussion of potential embolic materials. Perforation of branch arteries within the external carotid artery territory during planned carotid revascularization is an uncommon but potentially life-threatening complication. This complication can occur as a result of wire or catheter placement into these vessels. Early recognition of the perforation, prompt treatment of the bleeding, and control of the patient?s airway are necessary to avoid a potentially catastrophic outcome.
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A Review of the Prevention and Management of Catastrophic Complications During Renal Artery Stenting
Renal artery rupture, renal artery dissection or aortic dissection may follow stent deployment. Renal Artery Dissection The creation of a renal artery dissection during stenting that results in a change in management of the patient is unusual. Renal Artery Rupture Renal artery rupture is one of the most feared, though fortunately, rare complications with renal artery stenting with a reported incidence of only 0?1.7%.
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Dethrombosis of the Lower Extremities: Pharmacologic and Mechanical Techniques
Thrombus is widely present in the peripheral vasculature and its frequency depends on the patient?s clinical presentation. Thrombus is almost always present in acute critical limb ischemia (ALI) and is commonly found in patients with subacute presentations, chronic critical limb ischemia (CLI) and chronic occlusions. The approach to dethrombosing a vessel depends on multiple factors, including the age of the thrombus, but generally requires a combination therapy with chemical lysis and rheolytic thrombectomy, such as the use of Power-Pulse Spray (P-PS) technique, or atherectomy with dethrombosing capability such as the excimer laser. Surgery or chemical lysis as stand alone therapies carry very high rates of amputation and mortality. The role of embolic protection devices is still unclear but is promising, as embolization of atherothrombus continues to be a frequent occurrence during peripheral angioplasty. In this review, algorithms to treat thrombus in peripheral arterial disease are suggested.
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Ipsilateral Lumbar Artery Coil Embolization Made Possible by the Technology of a Novel Guide Catheter: A Case Report
Ipsilateral Lumbar Artery Coil Embolization Made Possible by the Technology of a Novel Guide Catheter: A Case Report Feature: Ipsilateral Lumbar Artery Coil Embolization Made Possible by the Technology of a Novel Guide Catheter: A Case Report - Gary M. Ansel, MD The patient is a 83-year old male with an infrarenal abdominal aortic aneurysm (AAA) and right iliac aneurysm. guided wire and coil transit catheter, the lumbar artery and aneurysm were reached and coiled (Figure 4). Repeat ...
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The CIS "Power-Pulse Spray" Technique
The CIS "Power-Pulse Spray" Technique Feature: The CIS "Power-Pulse Spray" Technique - David E. Allie, MD Introduction Thrombus is now accepted as playing a key role in patients with acute myocardial infarction (AMI), unstable angina, acute coronary syndromes (ACS), deep venous thrombosis (DVT), pulmonary embolus (PE), and acute limb ischemia (ALI). technique is a novel combination therapy simultaneously utilizing RT (AngioJet) and CT (UK or TNK) which recently received FDA market clearance ...
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Warfarin Therapy and Risk of Embolic Events in Elderly Stroke Patients with Aortic Atheroma
1,2Subhash Banerjee, MD, 3Richard Keber, MD, 3Mitchell Barnett, 1Pooja Banerjee, MD, 3Dinesh Jagasia, MD"> Warfarin Therapy and Risk of Embolic Events in Elderly Stroke Patients with Aortic Atheroma Original Contribution: Warfarin Therapy and Risk of Embolic Events in Elderly Stroke Patients with Aortic Atheroma - 1,2Subhash Banerjee, MD, 3Richard Keber, MD, 3Mitchell Barnett, 1Pooja Banerjee, MD, 3Dinesh Jagasia, MD Introduction Carotid artery stenosis and atrial fibrillation are the two ...
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Technical Considerations for Renal Artery Stenting
Renal artery stenosis (RAS) is the most common secondary cause of hypertension. It is associated with progressive renal failure. Percutaneous transluminal renal angioplasty and stenting (PTRAS) is associated with improved blood pressure control and preservation of renal function. PTRAS is associated with a high technical success rate and an acceptable adverse event and restenosis rate. Embolization and restenosis limit the benefit of this procedure, and are areas of future clinical research. After PTRAS, patients should be followed clinically and with duplex ultrasonography.
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