Vascular Embolization

This page is intended to provide information where selective embolization in combination with surgical glue indication is registered. It is not intended for use in USA, France and UK.
For complete information please refer to your local SPC
Vascular Embolization

Mastering polymerization time 1,2,3,4
for a better management of
Vascular Anomalies Embolization 5,6

Polymerization Time Adjustment
Visibility 1, 4 | Control 1, 4

VAE

Mastering polymerization time 1,2,3,4 for a better management of Vascular Anomalies Embolization 5,6

Polymerization Time Adjustment
Visibility 1, 4 | Control 1, 4

VE
(Vascular Embolization)

Vascular anomalies(7)

  • « Vascular tumours and vascular malformations are common vasculose anomalies characteristic for dissimilar clinical course, specific biological as well as immune cytological and histological properties.»
  • « In 80% of cases, hemangiomas are single lesions observed dominantly on body integuments with their most common location on the head (60%), trunk (25%) and limbs (15%).»

Example: Embolization of a left orbitonasal vascular malformation(8)
FIG 1. 55-year-old man was referred for preoperative embolization of a left orbital disfiguring mass FIG 2. Lateral view angiogram of the left external carotid artery shows large dilated anterior branches of the external carotid artery, some blush, and early venous drainage FIG 3. Lateral view angiogram of the left internal carotid artery injection reveals that a large dilated ophthalmic artery feeds the vascular
malformation and two intradural aneurysms at its origin (arrows)

VASCULAR ANOMALIES - FROM SIMPLE SKIN DISCOLORATIONS TO LARGE DEVASTATING DEFORMATIONS

Indication

Lipiodol® indication in vascular embolization

Selective embolization in combination with cyanoacrylate-based glue (particularly for arteriovenous malformation or aneurysms)

Vascular anomaly embolization

Embolic vascular occlusion may be performed at any level from large arteries or veins to capillary beds, it may be temporary or permanent for treating a wide variety of conditions

Used to treat a wide variety of conditions:
• To slow down or block blood flow
• To induce liver lobe hypertrophy

Vascular anomalies classification

  • International Society for the Study of Vascular Anomalies (ISSVA) Classification System(9)

Vascular (vasoproliferative) neoplasms (tumors)

Infantile hemangioma
Congenital hemangiomas
– RICH (rapidly involuting congenital hemangioma)
– NICH (noninvoluting congenital hemangioma)
Hemangioendothelioma
– Kaposiform hemangioendothelioma and tufted angioma
– Spindle cell hemangioendothelioma
– Epithelioid hemangioendotheliomas
Other rare hemangioendotheliomas
– Composite, retiform, and others
Angiosarcoma
Dermatologic acquired vascular tumors
– Pyogenic granuloma

Vascular malformations

Slow-flow vascular malformations
– Capillary malformation
– Venous malformation
– Lymphatic malformation
Fast-flow vascular malformations
– Arterial malformation
– Arteriovenous malformation (AVMs)
– Arteriovenous fistula
Combined vascular malformation
(various combinations of the above



VASCULAR ANOMALIES ARE COMPLEX AND NUMEROUS TABLES OF ISSVA CLASSIFICATION DOES NOT LIST EXHAUSTIVELY ALL VASCULAR ANOMALIES

Vascular Anomalies Embolization guidelines

Lipiodol® & N-butyl cyanoacrylate glue (NBCA) endorsed by international guidelines

« The optimal volume, injection speed, and ratio of the NBCA-Lipiodol® mixture should be determined to facilitate successful vascular embolization. […] NBCA is radiolucent, and therefore, is usually mixed with radiopaque materials such as Lipiodol ®…»

« Lipiodol® is an oily contrast medium. Its generic name is ethyl ester of iodinated poppy-seed oil fatty acids. In Japan, it has been used during hysterosalpingography and lymphangiography. When NBCA is mixed with Lipiodol®, the NBCA becomes radiopaque, and its polymerization time is increased…»

« Cyanoacrylate glue is a liquid that may be mixed with Lipiodol® , an oily contrast agent, before injection. Mixing cyanoacrylate glues with Lipiodol® slows the rate of solidification, […] It also allows visualization of the injected varix on fluoroscopy. Various ratios of glue and Lipiodol® are used, ranging from 1:1 to 1:1.6.»

« […] NBCA is a clear free flowing adhesive liquid that will polymerize on contact with any ionic solution. NBCA must be combined with ethiodized oil to reduce the polymerization time and to add radiopacity. The more ethiodized oil used the slower the polymerization time…»

LIPIODOL® & NBCA ENDORSED BY INTERNATIONAL GUIDELINES

Mixture preparation

Example of mixture

Tools necessary to obtain Lipiodol® and NBCA (n-Butyl cyanoacrylate) mixture:

• Three way stopcock
Non-ionic solution (10% dextrose) to flush the catheter

LIPIODOL® & NBCA MIXTURE EASY TO PREPARE

Lipiodol® & NBCA dilution ratios

Embolization’s clinical applications

1. Portal vein embolization using a NBCA/ Lipiodol® mixture before right liver resection(15)

A

« Placement of a pigtail catheter in the main portal
branch after CT-guided puncture of the left portal vein. »

B

« Catheterization of a right-sided portal branch via a microcatheter system. »

C

« Visualization of the entire embolized area of the right-sided portal branches. »

D

« Visualization of the entire embolized area of the right-sided portal branches. »

E

« Total occlusion of the right-sided portal venous system 30 days after embolization with Histoacryl/Lipiodol®. »

F

« The same patient 9 months after right-sided hemihepatectomy shows a massive hypertrophy of the residual liver. »

A
B
C
D
E
F

« Placement of a pigtail catheter in the main portal
branch after CT-guided puncture of the left portal vein. »

« Catheterization of a right-sided portal branch via a microcatheter system. »

« Visualization of the entire embolized area of the right-sided portal branches. »

« Visualization of the entire embolized area of the right-sided portal branches. »

« Total occlusion of the right-sided portal venous system 30 days after embolization with Histoacryl/Lipiodol®. »

« The same patient 9 months after right-sided hemihepatectomy shows a massive hypertrophy of the residual liver. »

A

« Placement of a pigtail catheter in the main portal branch after CT-guided puncture of the left portal vein. »

B

« Catheterization of a right-sided portal branch via a microcatheter system. »

C

« Visualization of the entire embolized area of the right-sided portal branches. »

D

« Visualization of the entire embolized area of the right-sided portal branches. »

E

« Total occlusion of the right-sided portal venous system 30 days after embolization with Histoacryl/Lipiodol®. »

F

« The same patient 9 months after right-sided hemihepatectomy shows a massive hypertrophy of the residual liver. »

Portal vein were embolized with a mixture of Histoacryl/Lipiodol® mean dilution ratio 1:4

LIPIODOL® & NBCA – FOR TREATMENT OF GASTRIC VARICES

2. Cyanoacrylate therapy for the treatment of gastric varices: a new method(16)

A

« Endoscopic view of fundal varix (gastroesophageal varices type 1) with active bleeding before treated with cyanoacrylate. »

B

« Endoscopic view of gastroesophageal varices 1 after cyanoacrylate therapy, showing stoppage of bleeding. »

C

« Abdominal X-ray examination showing a large amount of Lipiodol®-mixed cyanoacrylate remaining at the site of large fundal varix. »

D

« Computed tomography scan of thorax after Lipiodol®-diluted cyanoacrylate, showing normal pulmonary vessels. »

A
B
C
D

« Endoscopic view of fundal varix (gastroesophageal varices type 1) with active bleeding before treated with cyanoacrylate. »

« Endoscopic view of gastroesophageal varices 1 after cyanoacrylate therapy, showing stoppage of bleeding. »

« Abdominal X-ray examination showing a large amount of Lipiodol®-mixed cyanoacrylate remaining at the site of large fundal varix. »

« Computed tomography scan of thorax after Lipiodol®-diluted cyanoacrylate, showing normal pulmonary vessels. »

A

« Endoscopic view of fundal varix (gastroesophageal varices type 1) with active bleeding before treated with cyanoacrylate. »

B

« Endoscopic view of gastroesophageal varices 1 after cyanoacrylate therapy, showing stoppage of bleeding. »

C

« Abdominal X-ray examination showing a large amount of Lipiodol®-mixed cyanoacrylate remaining at the site of large fundal varix. »

D

« Computed tomography scan of thorax after Lipiodol®-diluted cyanoacrylate, showing normal pulmonary vessels. »

Patients with bleeding large gastric varices – Cyanoacrylate/Lipiodol® Dilution ratio 1:1

LIPIODOL® & NBCA – FOR TREATMENT OF GASTRIC VARICES

3. Clinical efficacy of transcatheter embolization of visceral artery pseudoaneurysms using NBCA(17)

A

« 26-year-old male patient with a pseudoaneurysm in the proximal jejunum: superior mesenteric arteriography showed focal contrast media collection in the proximal jejunum, indicating a pseudoaneurysm. »

B

« The microcatheter was advanced within the jejunal branch, and the pseudoaneurysm was confirmed. The 25% glue solution (histoacryl blue with Lipiodol®) was retained and confined within the jejunal branch. »

C

« After embolization, follow-up arteriography through the outer catheter confirmed a completely occluded pseudoaneurysm and preservation of the adjacent vessels. »

A
B
C

« 26-year-old male patient with a pseudoaneurysm in the proximal jejunum: superior mesenteric arteriography showed focal contrast media collection in the proximal jejunum, indicating a pseudoaneurysm. »

« The microcatheter was advanced within the jejunal branch, and the pseudoaneurysm was confirmed. The 25% glue solution (histoacryl blue with Lipiodol®) was retained and confined within the jejunal branch. »

« After embolization, follow-up arteriography through the outer catheter confirmed a completely occluded pseudoaneurysm and preservation of the adjacent vessels. »

A

« 26-year-old male patient with a pseudoaneurysm in the proximal jejunum: superior mesenteric arteriography showed focal contrast media collection in the proximal jejunum, indicating a pseudoaneurysm. »

B

« The microcatheter was advanced within the jejunal branch, and the pseudoaneurysm was confirmed. The 25% glue solution (histoacryl blue with Lipiodol®) was retained and confined within the jejunal branch. »

C

« After embolization, follow-up arteriography through the outer catheter confirmed a completely occluded pseudoaneurysm and preservation of the adjacent vessels. »

Patient with a pseudoaneurysm in the proximal jejunum NBCA/Lipiodol® dilution ratio 1:3

LIPIODOL® & NBCA – FOR EMBOLIZATION OF PSEUDOANEURYSMS

4. Endovascular embolization of a muscular symptomatic arteriovenous malformation (AVM) with NBCA(18)

A

«Arteriogram showing the mAVM, which is fed by multiple perforanting branches of the profunda femoris artery. »

B

« Embolization of the feeding branches with Glubran 2 and Lipiodol® after selective catheterization using a microcatheter. »

C

 « Post-embolization arteriogram shows the occlusion of all embolized branches with complete devascularization and thrombosis of the nidus. »

A
B
C

«Arteriogram showing the mAVM, which is fed by multiple perforanting branches of the profunda femoris artery. »

« Embolization of the feeding branches with Glubran 2 and Lipiodol® after selective catheterization using a microcatheter. »

 « Post-embolization arteriogram shows the occlusion of all embolized branches with complete devascularization and thrombosis of the nidus. »

A

«Arteriogram showing the mAVM, which is fed by multiple perforanting branches of the profunda femoris artery. »

B

« Embolization of the feeding branches with Glubran 2 and Lipiodol® after selective catheterization using a microcatheter. »

C

 « Post-embolization arteriogram shows the occlusion of all embolized branches with complete devascularization and thrombosis of the nidus. »

Patient with muscular symptomatic arteriovenous malformation Glubran 2/Lipiodol® dilution ratio 1:2.5

LIPIODOL® & NBCA – FOR AVM TREATMENT

5. Interventional treatment of pulmonary lymphatic anomalies(19)

« […] Percutaneous embolization of these abnormal pulmonary lymphatic vessels has been proven to be successful treatment
of these conditions with minimal complication rate […] »

A

« DCMRL of the patient with neonatal chylothorax, demonstrating abnormal pulmonary lymphatic flow toward lung parenchyma (white arrows). »

B

« Fluoroscopy image of the chest again demonstrating abnormal flow of the Lipiodol® injected through groin lymph nodes toward lung parenchyma (black arrows). »

A
B

« DCMRL of the patient with neonatal chylothorax, demonstrating abnormal pulmonary lymphatic flow toward lung parenchyma (white arrows). »

« Fluoroscopy image of the chest again demonstrating abnormal flow of the Lipiodol® injected through groin lymph nodes toward lung parenchyma (black arrows). »

A

« DCMRL of the patient with neonatal chylothorax, demonstrating abnormal pulmonary lymphatic flow toward lung parenchyma (white arrows). »

B

« Fluoroscopy image of the chest again demonstrating abnormal flow of the Lipiodol® injected through groin lymph nodes toward lung parenchyma (black arrows). »

Patient with neonatal chylothorax – NBCA/Lipiodol® ratio 1:2

LIPIODOL® & NBCA – FOR PULMONARY LYMPHATIC ANOMALIES

6. Infiltrated embolization of meningioma with dilute cyanoacrylate glue(20)

« […] a 13% n-butyl-cyanoacrylate (NBCA)-Lipiodol® mixture is injected extremely slowly from the middle meningeal artery (MMA) […] »

Patient with left convexity meningioma

LIPIODOL® & NBCA – FOR MENINGIOMA EMBOLIZATION

7. Varicocele embolization with N-butyl cyanoacrylate: experience in 41 patients(21)

« […] The mixture with Lipiodol® also modulates the polymerization rate. We have at all times used a Lipiodol®-N2BCA ratio of 1:1 […] »

« Color Doppler US examination. Pre-treatment (A, B) and 12 months post-embolization (C, D). At rest (A, C) and during Valsalva (B, D). Pampiniform plexus color Doppler signal during valsalva (B) that is no longer appreciated after the embolization (D). »

Patients with a diagnosis of varicocele – NBCA/Lipiodol® ratio 1:1

LIPIODOL® & NBCA – FOR VARICOCELE

8. Transcatheter Embolization of a Large Symptomatic Pelvic Arteriovenous Malformation with Glubran 2 Acrylic Glue(22)

« […] The glue needs to be mixed with lipiodol before use to enable its fluoroscopic visualization […] »

A

The preoperative angio-VCT demonstrates a large pAVM involving the urinary bladder and the distal part of the left ureter.

B

 The postembolization angio-VCT shows the complete devascularization of the pAVM.

A
B

The preoperative angio-VCT demonstrates a large pAVM involving the urinary bladder and the distal part of the left ureter.

 The postembolization angio-VCT shows the complete devascularization of the pAVM.

A

The preoperative angio-VCT demonstrates a large pAVM involving the urinary bladder and the distal part of the left ureter.

B

 The postembolization angio-VCT shows the complete devascularization of the pAVM.

Patient with pelvic arteriovenous malformation Glubran 2 acrylic glue / Lipiodol® ratio 1:2.5

LIPIODOL® & GLUBRAN 2 ACRYLIC GLUE – FOR PELVIC ARTORIOVENOUS MALFORMATION

9. Emergency case – Arterial Embolotherapy for Endoscopically Unmanageable Acute Gastroduodenal Hemorrhage: Predictors of Early Rebleeding(23)

« […] The glue needs to be mixed with lipiodol before use to enable its fluoroscopic visualization […] »

A

Bleeding Dieulafoy lesion in a 76-yearold man. (A and B) Extravasation of contrast medium from the left gastric artery at the celiac trunk (arrows) and selective angiography indicates continuing bleeding.

B

Bleeding Dieulafoy lesion in a 76-yearold man. (A and B) Extravasation of contrast medium from the left gastric artery at the celiac trunk (arrows) and selective angiography indicates continuing bleeding.

C

(C) After arterial microcatheterization, bleeding was controlled after embolization of the left gastric artery using a Glubran/ Lipiodol® (E-Z-EM) mixture (1:3) (arrows).

A
B
C

Bleeding Dieulafoy lesion in a 76-yearold man. (A and B) Extravasation of contrast medium from the left gastric artery at the celiac trunk (arrows) and selective angiography indicates continuing bleeding.

Bleeding Dieulafoy lesion in a 76-yearold man. (A and B) Extravasation of contrast medium from the left gastric artery at the celiac trunk (arrows) and selective angiography indicates continuing bleeding.

(C) After arterial microcatheterization, bleeding was controlled after embolization of the left gastric artery using a Glubran/ Lipiodol® (E-Z-EM) mixture (1:3) (arrows).

A

Bleeding Dieulafoy lesion in a 76-yearold man. (A and B) Extravasation of contrast medium from the left gastric artery at the celiac trunk (arrows) and selective angiography indicates continuing bleeding.

B

Bleeding Dieulafoy lesion in a 76-yearold man. (A and B) Extravasation of contrast medium from the left gastric artery at the celiac trunk (arrows) and selective angiography indicates continuing bleeding.

C

(C) After arterial microcatheterization, bleeding was controlled after embolization of the left gastric artery using a Glubran/ Lipiodol® (E-Z-EM) mixture (1:3) (arrows).

LIPIODOL® & GLUBRAN – FOR CONTROLLING BLEEDING FROM GASTRODUODENAL ULCERS

10. Emergency case – Postpartum Hemorrhage in Coagulopathic Patients: Preliminary Experience with Uterine Arterial Embolization with N-Butyl Cyanoacrylate(24)

Images of primary PPH caused by uterine atony after caesarean section in a 33-year-old woman.

A

Right internal iliac arteriogram shows a beaded, dilated ascending branch of the uterine artery (arrow).

B

Delayed-phase right internal iliac arteriogram shows contrast agent extravasation (arrow) in the uterine body.

C

« After embolization, follow-up arteriography through the outer catheter confirmed a completely occluded pseudoaneurysm and preservation of the adjacent vessels. »

D

Right internal iliac arteriogram obtained to confirm treatment outcome 5 minutes after UAE shows a recanalized uterine artery (arrow) and recurrent extravasation (arrowhead) in the uterine body during the delayed phase.

E

Right internal iliac arteriogram obtained immediately after embolization of the ascending branch of the right uterine artery with a 0.5-mL bolus of a 1:1 mixture of NBCA and Lipiodol shows retained Lipiodol® (arrow) and no extravasation.

A
B
C
D
E

Right internal iliac arteriogram shows a beaded, dilated ascending branch of the uterine artery (arrow).

Delayed-phase right internal iliac arteriogram shows contrast agent extravasation (arrow) in the uterine body.

« After embolization, follow-up arteriography through the outer catheter confirmed a completely occluded pseudoaneurysm and preservation of the adjacent vessels. »

Right internal iliac arteriogram obtained to confirm treatment outcome 5 minutes after UAE shows a recanalized uterine artery (arrow) and recurrent extravasation (arrowhead) in the uterine body during the delayed phase.

Right internal iliac arteriogram obtained immediately after embolization of the ascending branch of the right uterine artery with a 0.5-mL bolus of a 1:1 mixture of NBCA and Lipiodol shows retained Lipiodol® (arrow) and no extravasation.

A

Right internal iliac arteriogram shows a beaded, dilated ascending branch of the uterine artery (arrow).

B

Delayed-phase right internal iliac arteriogram shows contrast agent extravasation (arrow) in the uterine body.

C

« After embolization, follow-up arteriography through the outer catheter confirmed a completely occluded pseudoaneurysm and preservation of the adjacent vessels. »

D

Right internal iliac arteriogram obtained to confirm treatment outcome 5 minutes after UAE shows a recanalized uterine artery (arrow) and recurrent extravasation (arrowhead) in the uterine body during the delayed phase.

E

Right internal iliac arteriogram obtained immediately after embolization of the ascending branch of the right uterine artery with a 0.5-mL bolus of a 1:1 mixture of NBCA and Lipiodol shows retained Lipiodol® (arrow) and no extravasation.

LIPIODOL® & NBCA – FOR EMERGENT POSTPARTUM HEMORRHAGE

Lipiodol® Ultra Fluid in vascular anomalies embolization

Documentation

You are welcome to consult and read the following online version of our brochures, bibliography and CCDS

LIPIODOL® ULTRA-FLUID. Composition: Ethyl esters of iodized fatty acids of poppy seed oil 10 mL, corresponding to an iodine content of 480 mg/mL. Indications (**): In diagnostic radiology – Hysterosalpingography – Ascending urethrography – Lymphography – Sialography – Fistulography and exploration of abscesses – Exploration of frontal sinuses – Pre and post-operative cholangiography.
In interventional radiology – Visualisation and localization (by selective intra-arterial use during CT) of liver lesions in adults with known or suspected hepatocellular carcinoma – Visualisation, localization and vectorisation during Trans-Arterial Chemo-Embolisation (TACE) of hepatocellular carcinoma at intermediate stage, in adults – Selective embolization in combination with Histoacryl glue (particularly for arteriovenous malformation or aneurysms) – Selective injections of LIPIODOL ULTRA-FLUID into the hepatic artery for diagnostic purposes where a spiral CT scan is not practical. In endocrinology – Prevention of severe cases of iodine deficiency. Posology and method of administration (*): have to be adapted according to the type of examination, the territories explored, the age and weight of the patient. The volume to be administered depends on the particular requirements of the technique and the size of the patient. Contraindications: Hypersensitivity to LIPIODOL ULTRA-FLUID – Confirmed hyperthyroidism – Patients with traumatic injuries, recent haemorrage or bleeding – Hysterosalpingography during pregnancy or acute pelvic inflammation – Bronchography. In interventional radiology (Trans-Arterial Chemo-Embolization), Administration in liver areas with dilated bile ducts unless drainage has been performed. Special warnings and special precautions for use (*): There is a risk of hypersensitivity regardless of the dose administered. Lymphography: Pulmonary embolism may occur immediately or after few hours to days from inadvertent systemic vascular injection or intravasation of LIPIODOL ULTRA-FLUID: Perform radiological monitoring during LIPIODOL ULTRA-FLUID injection and avoid use in patients with severely impaired lung function, cardiorespiratory failure or right-sided cardiac overload. Hypersensitivity: all iodinated contrast agents can lead to minor or major hypersensitivity reactions, which can be life-threatening. These hypersensitivity reactions are of an allergic nature (known as anaphylactic reactions if they are serious) or a non-allergic nature. They can be immediate (occurring within 60 min) or delayed (not occurring until up to 7 days later). Anaphylactic reactions are immediate and can be fatal. They are dose-independent, can occur right from the first administration of the product, and are often unpredictable: avoid use in patients with a history of sensitivity to other iodinated contrast agents, bronchial asthma or allergic disorders because of an increased risk of a hypersensitivity reaction to LIPIODOL ULTRA-FLUID. Thyroid: can cause hyperthyroidism in predisposed patients. Lymphography saturates the thyroid with iodine for several months and thyroid exploration should be performed before radiological examination. Chemo-Embolization: Trans-Arterial Chemo-Embolization is not recommended in patients with decompensated liver cirrhosis (Child-Pugh ≥8), advanced liver dysfunction, macroscopic invasion and/or extra-hepatic spread of the tumour. Renal insufficiency must be prevented by correct rehydration before and after the procedure. Oesophageal varices must be carefully monitored. Hepatic intra-arterial treatment can progressively cause an irreversible liver insufficiency in patients with serious liver malfunction and/or undergoing close multiple sessions. The risk of superinfection in the treated area is normally prevented by administration of antibiotics. Embolization with glue: An early polymerisation reaction may exceptionally occur between LIPIODOL ULTRA-FLUID and certain surgical glues, or even certain batches of glue. Before using new batches of LIPIODOL ULTRA-FLUID or surgical glue, the compatibility of LIPIODOL ULTRA-FLUID and the glue must be tested in vitro. Interaction with other medicinal products and other forms of interaction (*): Metformin, Beta blockers, vasoactive substances, angiotensin-converting enzyme inhibitors, angiotensin-receptor antagonists, Diuretics, Interleukin II. Fertility, pregnancy and lactation (*): LIPIODOL ULTRA-FLUID must only be used in pregnant women if absolutely necessary and under strict medical supervision. Breastfeeding should be discontinued if LIPIODOL ULTRA-FLUID must be used – Effects on ability to drive and use machines: The effects on ability to drive and to use machines have not been investigated – Undesirable effects (*): Most adverse effects are dose-related and dosage should therefore be kept as low as possible :hypersensitivity, anaphylactic reaction, anaphylactoid reaction, vomiting, diarrhea, nausea, fever, pain, dyspnea, cough, hypothyroidism, hyperthyroidism, thyroiditis, pulmonary embolism, cerebral embolism, retinal vein thrombosis, lymphoedema aggravation, hepatic vein thrombosis, granuloma. Overdose (*): The total dose of LIPIODOL ULTRA-FLUID administered must not exceed 20 mL – Pharmacodynamic properties (*): Pharmacotherapeutic group: X-ray contrast media, iodinated; ATC code: V08A D01. Water-insoluble iodinated contrast medium. Presentation (**): 10 mL glass ampoule. Marketing authorization holder (*): Guerbet – BP 57400 – F-95943 Roissy CdG cedex – FRANCE. Information: tel: 33 (0) 1 45 91 50 00. Revision: April 24th, 2018.

(*) For complete information please refer to the local Summary of Product Characteristics (SPC).

(**) Indications, volumes and presentations may differ from country to country.

Reporting of suspected adverse reactions is important as it helps to continuously assess the benefit-risk balance. Therefore, Guerbet encourages you to report any adverse reactions to your health authorities or to our local Guerbet representative.

Countries in which selective embolization in combination with surgical glue is registered: France, Cambodia, Iran, Morocco, Tunisia, India, Vietnam, Peru, Chile, Colombia, Argentina, Luxembourg, Uruguay, Taiwan, Turkey.
Country in which adjustment of drugs or medical devices is registered: Japan.
For complete information please refer to country’s local SPC.
For a copy of the SPC, please contact a member of Guerbet.

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