Department of Radiology, University of California, San Diego, Health Sciences, 200 W. Arbor Dr., San Diego, CA 92103-8756.
Department of Radiology, University of California, San Diego, Health Sciences, 200 W. Arbor Dr., San Diego, CA 92103-8756; Department of Radiology, Naval Medical Center, San Diego, California.
J Vasc Interv Radiol. 2020 Jun;31(6):986-992. doi: 10.1016/j.jvir.2020.01.005. Epub 2020 May 12.
To assess the feasibility, safety, and efficacy of balloon-assisted delivery of ethylene vinyl alcohol copolymer (EVOH) for a range of peripheral arterial applications.
Six academic medical centers entered retrospective data on 46 consecutive patients (27 men, 19 women; ages, 11-94 y; mean age, 50.3 y) who underwent 60 balloon-assisted EVOH procedures. The cohort was restricted to procedures involving peripheral, nonneural arteries 1-5.5 mm in diameter. Clinical indications included a wide range of vascular pathologic conditions (most commonly arteriovenous malformations [n = 20], renal angiomyolipomas [n = 8], and acute hemorrhage [n = 9]) and targeted visceral and musculoskeletal peripheral arteries. Data collected included sex, age, clinical indication, arterial pathology, arteries embolized, type of occlusion balloon microcatheter, type and concentration of EVOH agent, effectiveness as an embolic backstop, vessels protected, adequacy of EVOH cast penetration, catheter extraction, nontarget embolization, and complications.
Balloon occlusion prevented EVOH reflux in 59 of 60 procedures (98.3%). Nontarget EVOH embolization occurred in 2 procedures (3.3%). Adequate EVOH cast penetration and complete filling of the target pathologic structure were seen in 57 of 60 procedures (95%). Balloon deflation and uneventful extraction occurred in all procedures; small EVOH fragments detached into target arteries in 2 cases. One major (1.7%) and 2 minor (3.3%) complications occurred.
Balloon-assisted EVOH embolization of peripheral arteries is feasible, safe, effective, and versatile. The primary advantage of balloon-assisted EVOH embolization is the ability to apply more injection pressure to advance the EVOH cast assertively into the pathologic structure(s).
评估球囊辅助输送乙烯-乙烯醇共聚物（EVOH）在一系列外周动脉应用中的可行性、安全性和疗效。
六家学术医疗中心回顾性地记录了 46 例连续患者（27 名男性，19 名女性；年龄 11-94 岁；平均年龄 50.3 岁）的 60 例球囊辅助 EVOH 手术的数据。该队列仅限于直径为 1-5.5 毫米的外周非神经动脉的手术。临床适应证包括广泛的血管病理状况（最常见的是动静脉畸形[20 例]、肾血管平滑肌脂肪瘤[8 例]和急性出血[9 例]）和靶向内脏和肌肉骨骼外周动脉。收集的数据包括性别、年龄、临床适应证、动脉病理学、栓塞的动脉、闭塞球囊微导管的类型、EVOH 制剂的类型和浓度、作为栓塞阻挡物的有效性、保护的血管、EVOH 铸型渗透的充分性、导管提取、非靶向栓塞和并发症。
在 60 例手术中，有 59 例（98.3%）通过球囊闭塞防止了 EVOH 反流。有 2 例（3.3%）发生了非目标 EVOH 栓塞。在 60 例手术中有 57 例（95%）看到了足够的 EVOH 铸型渗透和完全填充目标病理结构。所有手术均成功地进行了球囊放气和无并发症的导管提取；在 2 例中，有小的 EVOH 碎片脱落进入目标动脉。发生了 1 例主要（1.7%）和 2 例次要（3.3%）并发症。
球囊辅助外周动脉 EVOH 栓塞是可行、安全、有效和多功能的。球囊辅助 EVOH 栓塞的主要优势是能够施加更高的注射压力，将 EVOH 铸型积极推进到病理结构中。
