Embolization

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Editors
Pascal Chabrot, MD, PhD Louis Boyer, MD, PhD
Department of Radiology Department of Radiology
University Hospital of Clermont-Ferrand University Hospital of Clermont-Ferrand
Clermont-Ferrand Clermont-Ferrand
France France

ISBN 978-1-4471-5181-4 ISBN 978-1-4471-5182-1 (eBook)

DOI 10.1007/978-1-4471-5182-1
Springer London Heidelberg New York Dordrecht

Library of Congress Control Number: 2013946427

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To Our Wives
Foreword

Interventional radiology emerged in the 1960s, with Charles Dotter’s report of the
first percutaneous angioplasty. As it quickly appeared that an endovascular catheter
“could replace a scalpel,” interventional radiology soon became a valuable alterna-
tive to surgical management.
The first embolizations were realized in the 1970s: neuroradiological emboliza-
tions carried out in France by R. Djindjian and hemostasis embolizations to treat GI
tract hemorrhages by J. Rosch in the United States and to treat hemoptysis by
J. Remy in France.
Embolization has since become one of the pillars of interventional radiology, and
over the years considerable improvements have been made concerning catheters as
well as occlusion agents.
The indications of interventional radiology are constantly broadening: the most
remote anatomical areas are today within our range and a wider number of clinical
conditions are nowadays treated. Embolization allows not only vessel occlusion but
also in situ administration of various therapeutic agents, particularly drugs. In addi-
tion, it is no longer only restricted to symptomatic indications (e.g., hemostasis
embolization) but also more and more as a curative technique in many fields.
Specific training is required to acquire the mandatory anatomical, clinical, and
technical prerequisites for the realization of embolization. The radiologist is the
ideal candidate for this training as he has the essential background required. It is a
public health issue to train young interventional radiologists, to ensure a sufficient
number of operators likely to support this activity.
It is essential to maintain the attractiveness of this discipline among the young
radiologists and to ensure their training with inventive pedagogic methods so as to
compensate for the lesser know-how in endovascular navigation due to the blossom-
ing of the vascular cross-sectional imaging.
This book proposed by my friend Louis Boyer and his colleagues is a valuable
tool for the promotion and the development of embolization. This team’s experi-
ence in diagnostic and interventional vascular radiology, which was initiated by
Professor Pierre Viallet, one of the pioneers of vascular radiology in France, makes

vii
viii Foreword

Clermont-Ferrand one of the most important French centers of interventional

radiology and embolization.
This handbook which reviews and summarizes the key points of various emboli-
zation techniques and their indications will be particularly useful as a learning tool
for young radiologists. It can also be used by more experienced interventional radi-
ologists for a quick “refresher lesson” on a specific procedure.
I am convinced that all interventional radiologists should have this handy, practi-
cal daily reference tool, and I sincerely wish it has a great success.

Francis Joffre
President of the Interventional Radiology Federation
of the French Society of Radiology
Toulouse, France
Preface

The development of the embolization techniques, especially in oncology, led us

to propose this practical handy book as a teaching aid for the training of young
interventional radiologists which is now promoted in France as in the rest of
Europe.
The innovations in catheterization techniques and embolization agents have con-
siderably contributed to the development of endovascular occlusion techniques in
arterial and venous trunks as much as distal parenchymal capillary beds. Mini inva-
sive therapies, endovascular embolization, and chemo-embolization now constitute
major therapeutic alternatives in various fields: on a purely palliative or on a cura-
tive basis in oncology, traumatology, functional diseases, for the treatment of benign
tumors, or when dealing with postoperative complications.
Very in-depth and detailed books describing these techniques are ready available
for the specialists. Our ambition here is to provide a basic handbook for the young
vascular radiologists in training and a checklist for the more experienced vascular
radiologists by providing for each indication a synthetic approach of the technique
and of the expected results of constantly increasing embolization procedures in wid-
ening indications.
The first part of this book relates to the toolbox (the materials) and the procedure
techniques as well as the physiopathological requirements for carrying out emboli-
zation; the second part is an analytical description of the main situations and
anatomo-clinical strategies.
This book therefore does not have the ambition to appear in academic libraries,
but rather to be a readily available memory aid for clinical interventional radiolo-
gists, accessible in the multidisciplinary staff rooms and in angiography suites.
We express our sincere thanks and our friendship:
• To our teacher and boss Professor Jean François Viallet
• To all the coauthors
• To Danielle Sol for preparing the manuscript

ix
x Preface

• To Matthieu Dondey and Agaïcha Alfidja for their help in translating the French
version of the book into English
• To Mickaël Fontarensky for the preparation of the illustrations
• To all our team members for the years of joint work, which have enabled us to
develop our experience and to gather our radio-clinical cases

Clermont-Ferrand, France Louis Boyer, MD, PhD

Pascal Chabrot, MD, PhD
Contents

Part I Technical Bases

1 The Toolbox: Catheterization Devices

and Embolization Agents ...................................................................... 3
Pascal Chabrot, Vincent Vidal, and Louis Boyer
2 Vascular Occlusions and Parenchymal
Embolizations: Principles...................................................................... 29
Pascal Chabrot, Isabelle Brazzalotto, and Louis Boyer

Part II Situations and Strategies

3 Hemorrhages of the ENT Area ............................................................. 43

Arthur Varoquaux, Pierre Cassagneau, Vincent Vidal,
Alexis Jacquier, Frédéric Cohen, Cyril Muller,
Florian Desmots, Jean-Michel Bartoli, and Guy Moulin

Part III Situations and Strategies: Thorax

4 Massive Hemoptysis: Radiological Management ................................ 63

Louis Boyer, Lucie Cassagnes, Hélène Vernhet,
Jean-Marc Garcier, and Pascal Chabrot
5 Embolization of the Pulmonary Artery ............................................... 79
Louis Boyer, Lucie Cassagnes, Hélène Vernhet,
Jean-Marc Garcier, and Pascal Chabrot

Part IV Situations and Strategies: Liver

6 Hepatic Artery Embolizations .............................................................. 95

Louis Boyer, Emmanuel Buc, Denis Pezet,
Tan Duc Vo, and Pascal Chabrot
xi
xii Contents

7 Chemoembolizations and Hepatic

Intra-arterial Chemotherapies ............................................................. 115
Pascal Chabrot, Agaïcha Alfidja Lankoande, Eric Dumousset,
Armand Abergel, Denis Pezet, and Louis Boyer
8 Portal Vein Embolization ...................................................................... 135
Pascal Chabrot, Vincent Vidal, Laurent Poincloux, Le Thanh Dung,
Gérald Gahide, Louis Boyer, and Pierre Perreault

Part V Situations and Strategies: Abdomen and GI Tract

9 Splenic Arterial Embolizations ............................................................. 153

Pascal Chabrot, Marie-Aude Vaz Tourret, Rémy Guillon,
Anne Ravel, Denis Pezet, Jean-Marc Garcier,
and Louis Boyer
10 Gastrointestinal Tract Arterial Hemorrhages ..................................... 173
Louis Boyer, Denis Pezet, Grégory Favrolt,
Isabelle Brazzalotto, and Pascal Chabrot
11 True and Pseudoaneurysm of Visceral and Renal Arteries ............... 195
Louis Boyer, Amr Abdel Kerim, Antoine Petermann,
Mickaël Fontarensky, and Pascal Chabrot
12 Hypogastric Arteries: Aneurysms, Occlusions
Before Stent Grafting............................................................................. 213
Pascal Chabrot, Lucie Cassagnes, Mickaël Fontarensky,
Philippe Bourlet, and Louis Boyer

Part VI Situations and Strategies: Kidney,

Retroperitoneum, and Male Pelvis

13 Renal Arterial Embolizations ............................................................... 229

Louis Boyer, Laurent Guy, Anne Ravel, Lucie Cassagnes,
Rami Chemali, and Pascal Chabrot
14 Anticoagulant-Related Hematomas ..................................................... 259
Louis Boyer, Lucie Cassagnes, Agaïcha Alfidja Lankoande,
and Pascal Chabrot
15 Embolization of Varicoceles .................................................................. 269
Louis Boyer, Anne Ravel, Laurent Guy, Bruno De Fraissinette,
Jean-Marc Garcier, Rami Chemali, and Pascal Chabrot
16 Embolization of the Internal Pudendal Arteries
for High-Flow Priapism ......................................................................... 281
Louis Boyer, Anne Ravel, Laurent Guy, Romain Bellini,
Jean-Marc Garcier, and Pascal Chabrot
Contents xiii

17 Embolization of Endoleaks After Endovascular

Abdominal Aortic Aneurysm Repair (EVAR)..................................... 291
Pascal Chabrot, Gérald Gahide, Lucie Cassagnes,
Gilles Soulez, Louis Boyer, and Eric Therasse

Part VII Situations and Strategies: Female Pelvis

18 Postpartum Hemorrhages ..................................................................... 309

Pascal Chabrot, Abdoulaye Ndoye Diop, Denis Gallot,
Isabelle Brazzalotto, and Louis Boyer
19 Uterine Fibroid Embolization (UFE) ................................................... 323
Louis Boyer, Eric Dumousset, Agaïcha Alfidja Lankoande,
Nathalie Mazet, Anne Ravel, and Pascal Chabrot
20 Pelvi-perineal Venous Insufficiency ...................................................... 341
Louis Boyer, Agaïcha Alfidja Lankoande, Antoine Maubon,
Anne Ravel, Cristi Gageanu, Abdoulaye Ndoye Diop,
and Pascal Chabrot

Part VIII Situations and Strategies: Traumatisms

21 Embolization of Abdominal and Pelvic Trauma ................................. 355

Louis Boyer, Agaïcha Alfidja Lankoande, Cristi Gageanu,
Isabelle Brazzalotto, Marie-Aude Vaz Tourret, Stéphane Boisgard,
and Pascal Chabrot
22 Traumatisms of the Limbs .................................................................... 391
Louis Boyer, Antoine Roche, Lucie Cassagnes, Grégory Favrolt,
Hatem Gobara, and Pascal Chabrot
23 Management of Vascular Malformations ............................................ 405
Gilles Soulez and Josée Dubois
24 Miscellaneous/Marginal/Evolving Indications
(Other Abdominopelvic Tumors, Portal Hypertension-Related
Varicose Veins, Osteoarticular Pathologies) ........................................ 423
Louis Boyer, Agaïcha Alfidja Lankoande, Mickaël Fontarensky,
and Pascal Chabrot

Index ................................................................................................................ 445

Contributors

Armand Abergel, MD, PhD Department of Hepatogastroenterology,

University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
Amr Abdel Kerim, MD Department of Radiology,
University of Alexandria, Alexandria, Egypt
Agaïcha Alfidja Lankoande, MD Department of Radiology,
University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
Jean-Michel Bartoli Department of Radiology, Assistance Publiqúe,
Hôpitaux de Marseille, Marseille, France
Romain Bellini, MD Department of Radiology, Jean Perrin Cancer Centre,
Clermont-Ferrand, France
Stéphane Boisgard, MD, PhD Department of Orthopedic Surgery,
University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
Philippe Bourlet, MD Department of Radiology, Riom Hospital,
University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
Louis Boyer, MD, PhD Department of Radiology, University Hospital
of Clermont-Ferrand, Clermont-Ferrand, France
Isabelle Brazzalotto, MD Department of Anesthesia, University Hospital
of Clermont-Ferrand, Clermont-Ferrand, France
Emmanuel Buc, MD, PhD Department of Abdominal Surgery,
University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
Pierre Cassagneau Department of Radiology, Assistance Publiqúe,
Hôpitaux de Marseille, Marseille, France
Lucie Cassagnes, MD Department of Radiology, University Hospital
of Clermont-Ferrand, Clermont-Ferrand, France
Pascal Chabrot, MD, PhD Department of Radiology, University Hospital
of Clermont-Ferrand, Clermont-Ferrand, France
xv
xvi Contributors

Rami Chemali, MD Department of Radiology, Saint Georges Hospital,

Beyrouth, Lebanon
Frédéric Cohen Department of Radiology, Assistance Publiqúe,
Hôpitaux de Marseille, Marseille, France
Bruno De Fraissinette, MD Department of Radiology,
Clinique La Chataigneraie, Beaumont, USA
Department of RadiologyUniversity Hospital of Clermont-Ferrand,
Clermont-Ferrand, France
Florian Desmots Department of Radiology, Assistance Publiqúe,
Hôpitaux de Marseille, Marseille, France
Abdoulaye Ndoye Diop, MD Department of Radiology, University Hospital,
Dakar, Senegal
José Dubois, MD, MSc Department of Radiology, University Hospital Sainte
Justine, Montréal, QC, Canada
Eric Dumousset, MD Department of Radiology, University Hospital
of Clermont-Ferrand, Clermont-Ferrand, France
Le Thanh Dung, MD Department of Radiology,
Viet Duc University Hospital, Hanoï, Hanoï, Viet Nam
Grégory Favrolt, MD Department of Radiology, Clinique de Fontaine,
Dijon, France
Mickaël Fontarensky Department of Radiology,
University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
Cristi Gageanu, MD Department of Radiology, Issoire Hospital,
University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
Gérald Gahide, MD, PhD Department of Radiology,
Sherbrooke University Hospital, Sherbrooke, QC, Canada
Denis Gallot, MD, PhD Department of Obstetrics and Gynecology,
University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
Jean-Marc Garcier, MD, PhD Department of Anatomy and Radiology,
University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
Hatem Gobara, MD Department of Radiology, Riom Hospital,
University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
Rémy Guillon, MD Department of Radiology, Clinique Saint Roch,
Montpellier, France
Laurent Guy, MD, PhD Department of Urology, University Hospital
of Clermont-Ferrand, Clermont-Ferrand, France