Miscellaneous Indications for Embolization: Indications for Bleeding or for Decreasing Vascularity in Different Vascular
In this chapter, we discuss the various indications for vascular embolizations in different vascular beds. Some of these indications range from common conditions like epistaxis to rare conditions like myositis ossificans of the long bones. Embolization of
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Miscellaneous Indications for Embolization: Indications for Bleeding or for Decreasing Vascularity in Different Vascular Beds
Abstract In this chapter, we discuss the various indications for vascular embolizations in different vascular beds. Some of these indications range from common conditions like epistaxis to rare conditions like myositis ossificans of the long bones. Embolization of arteriovenous malformations in the head and neck present a technical challenge. Intra-abdominal bleeding due to pseudoaneurysms secondary to pancreatitis are also amenable for embolization. The indications, technical details, complications and outcomes of embolization for epistaxis, arteriovenous malformations and tumours are discussed here. Keywords Epistaxis • Myositis ossificans • Arterio-venous malformation • Pseudoaneurysm • Bleeding • Pancreatitis
Epistaxis Most cases of epistaxis are from an anterior source and can be treated with pressure, anterior nasal packing, or cautery. Intractable epistaxis is generally posterior in origin and the site is inaccessible requiring endoscopic cautery, posterior packing, surgical ligation, or embolization. Embolization has been used to treat epistaxis for more than 30 years and success rates have been reported in approximately 90 % of patients, with major complications occurring in approximately 2 %. These excellent results require thorough knowledge of the regional anatomy, familiarity with the equipment and various agents used to achieve this type of embolization, as well as attention to detail and meticulous technique. Several aspects of embolization need attention including the agent of choice, preferred size of the embolic material used, and the number of vessels to be embolized.
Historical Perspective Epistaxis is a Greek word meaning nosebleed and these records describe the use of the ashes of papyrus mixed with vinegar to treat nasal bleeds. Hippocrates said that pinching the nose “for some time” and asking the patient to breathe through the mouth stopped bleeding from the nose. In 1869, Pilz was the first person to treat © Springer International Publishing Switzerland 2017 K. Varghese, S. Adhyapak, Therapeutic Embolization, DOI 10.1007/978-3-319-42494-1_7
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Miscellaneous Indications for Embolization
epistaxis by surgically ligating the external carotid artery. Although in 1879 James Little and Carl Michel were the first to identify the vascular plexus in the anterior part of the nasal septum (“Little’s area”) as the common area from which nasal bleeding occurs, Wilhelm Kiesselbach’s 1884 paper describing the area has led to the common usage of “Kiesselbach plexus” to describe this common source of epistaxis. Seiffert described ligation of the internal maxillary artery (IMAX) through the maxillary antrum via the Caldwell-Luc approach to control epistaxis in 1929 [1]. Sokoloff et al. [2] in 1974 described the successful transcatheter embolization of epistaxis in two patients using Gelfoam (GF) (Gelfoam-Pharmacia and Upjohn Company, Kalamazoo, MI). Since that time a va
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