About Peripheral Embolization

About Peripheral Embolization

Towards more targeted embolization

Embolotherapy

The field of embolotherapy is continuously expanding towards new indications, in the last decade towards benign prostate embolization ; more recently towards emborrhoids and muskuloskeletal embolization, with the consequence of making embolization technique more and more demanding.
Aim of embolization procedure is to deliver effective treatment while preserving adjacent tissues/structures. Among embolization principles, targeted and flow-directed embolization are fundamental ones.
The increasing use of microcatheters participated to not only improve targeted embolization but also to maintain maximum blood flow to foster embolics delivery1.
Still, the variability in vascularization anatomy associated to the variability of embolic material that may be used, can make delivery of those embolics a real challenge.

One of the challenges is to avoid Non-Target embolization (NTE) and preserve adjacent tissues. NTE may be minimized by cautious planning and being as targeted as possible. However, presence of small vessels proximal to the target vessel makes it very difficult to control especially when using microspheres that tend to reflux at the tip of the catheter2.

The challenge of Non-Target Embolization (NTE)

Complications

LIVER
  • Acute cholecystitis3, 4
  • Pancreatitis3
  • Liver infarction and parenchyma focal
    necrosis3, 4
BRONCHIAL
HEMOPTYSIS
  • Spinal cord ischemia (spinal arteries NTE)8
  • Dysphagia (esophageal branches NTE)8
  • Ischemic colitis8
FIBROIDS
  • Premature menopause (ovarian NTE)5
  • Buttock necrosis6
  • Labium minora ulceration (internal pudental artery)7
UP TO
28*%
An underestimated challenge
of tissue damages following chemo-embolization9
(*in a study examining 51 HCC patients)

read more
1
FATAL CASE
REPORT
Rarely symptomatic - but can be dramatic
Acute necrotizing pancreatitis following DEB-TACE for HCC10
read more
UP TO
39*%
Induce further patients’ follow up
of incomplete treatment after DEB-TACE11
(*in a study examining 44 HCC patients)

read more

Physicians talk about NTE

Play Video

By the time we can see (contrast) reflux, it is already too late
to prevent NTE

Jafar Golzarian (Minneapolis, MN, USA)

NTE is an under
diagnosed problem

 Irene Bargellini (Pisa, Italy)

Play Video
Play Video

Because embolics went off target to embolize the cystic artery,
the patient went to surgery for bilioma inside the peritunum

Thierry de Baere (Villejuif, France)

The patient had transient paraplegia so anti-reflux microcatheters would have
been helpful

Florian Wolf (Vienna, Austria)

Play Video

Deliver More12.
Reduce the risk of Non-Target Embolization
with SeQure®13, 14.

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Full length Physician videos

Prof. Jafar Golzarian (Minneapolis, MN, USA)
“Microspheres embolisation and flow dynamic: what do we know?”
https://youtu.be/cQhcagvjWIs

Prof. Irene Bargellini (Pisa, Italy)
“New microcatheters could help reduce the “everyday challenge” of non-target embolization”
https://youtu.be/pNJ5W6gPBVo

Prof. Thierry De Baere (Villejuif, France)
“Non-target embolization: from concept to clinical situation”
https://www.youtube.com/watch?v=F2gUDx_bcVE

Prof. Florian Wolf (Vienna, Austria)
“Clinical applications of Sequre® control reflux microcatheter”
https://www.youtube.com/watch?v=HBOaFBm42Qo

CLOSE

1 Transcatheter Embolization and Therapy, Techniques in Interventional Radiology, DOI 10.1007/978-1-84800-897-7_1, Springer-Verlag London Ltd. 2010, pp 3-10, http://bit.ly/2tY7rAg

2 Transcatheter Embolization and Therapy, Techniques in Interventional Radiology, DOI 10.1007/978-1-84800-897-7_3, Springer-Verlag London Ltd. 2010, pp 29-31, http://bit.ly/2tY7rAg

3 Safety Profile of Sequential Transcatheter Chemoembolization with DC Bead: Results of 237 Hepatocellular Carcinoma (HCC) Patients. Katerina Malagari, et al. Cardiovasc Intervent Radiol (2011) 34:774–785 DOI 10.1007/s00270-010-0044-3

4 Analysis of Nontarget Embolization Mechanisms During Embolization and Chemoembolization Procedures. Ruben Lopez-Benıtez. Et al. Cardiovasc Intervent Radiol (2009) 32:615–622 DOI 10.1007/s00270-009-9568-9

5 Contrast-enhanced sonography during uterine artery embolization for the treatment of leiomyomas. Marret, H.,et al. (2004) Ultrasound in Obstetrics and Gynecology, 23 (1), pp. 77-79.

6 Buttock necrosis after uterine artery embolization. Dietz, D.M et al. (2004) Obstetrics and Gynecology, 104 (5 PART 2), pp. 1159-1161.

7 Patient presentation and management of labial ulceration following uterine artery embolization. Gonsalves, C., et al. (2007) CardioVascular and Interventional Radiology, 30 (6), pp. 1263-1266

8 Bronchial and Nonbronchial Systemic Artery Embolization for lifethreatening Hemoptysis: A Comprehensive Review. Woong Yoon et al. RadioGraphics 2002; 22:1395–1409. Published online 10.1148/rg.226015180

9 Efficacy and Nontarget Effects of Transarterial Chemoembolization in Bridging of Hepatocellular Carcinoma Patients to Liver Transplantation: A Histopathologic Study. Ulrike Stampfl, MD, et al. J VascIntervRadiol2014;25:1018–1026

10 Acute necrotizing pancreatitis as a fatal complication following DC Bead transcatheter arterial chemoembolization for hepatocellular carcinoma: A case report and review of the literature. Takashi Yamaguchi et al. Molecular and Clinical Oncology 2018; 9: 403-407; DOI: 10.3892/mco.2018.1690

11 Transarterial chemoembolization with DC Bead LUMI™ radiopaque beads for primary liver cancer treatment: Preliminary experience. Aliberti et al. Future Oncology 2017, (25):2243-2252. doi: 10.2217/fon-2017-0364

12 Beads accumulation reports DR-1800178 & TR-026

13 Vessel Flow Dynamic Indication (Beads Reflux) Bench Test report TR-002

14 Usability, Safety and Efficacy of a Novel Microcatheter for Reducing Non-Target Embolization. Michael Tal et al. WCIO 2018 Poster. Animal study.

SEQURE® microcatheters are class IIb medical devices intended for use by interventional radiologists and interventional oncologists for the infusion of contrast media into all peripheral vessels and for drug infusion in intra-arterial therapy, and infusion of embolic materials. They should not be used in cerebral vessels.
For complete information about precautions and optimal usage conditions for these medical devices, we recommend consulting the instructions for use supplied with each device or with your local Guerbet representative(s). Information for use only in countries with applicable health authority registrations. Notified Body: MedCert 0482. Manufacturer: Accurate Medical Therapeutics Ltd. EC Rep: Guerbet. Document creation date: April 2020. SEQURE® microcatheters are registered trademarks of Guerbet Group or its affiliates.

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