Endovascular treatment of intra- and extra cranial malformation

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Presentation transcript:

Endovascular treatment of intra- and extra cranial malformation S.Sirakov , assoc.prof. Penev, prof. Bosnjakovic

Embolization Embolization is a nonsurgical, minimally invasive procedure performed by an interventional radiologist and interventional neuroradiologist. It involves the selective occlusion of blood vessels or vascular territory by purposely introducing temporary or permanent agenst. Embolization is used to treat a wide variety of conditions affecting different organs of the human body.

Embolization The elegancy of the technique underscores the value of minimally invasive therapy. Since the first reported cases using autologous clot in 1972 embolization techniques have evolved with the use of many agents and devices to achieved impressive results.

The treatment is used to occlude: Arteriovenous malformation Cerebral aneurysm Gastrointestinal bleeding Epistaxis Primary post partum hemorrhage Surgical hemorrhage Uterine fibroids Kidney and liver lesions

Embolization The procedure is carried out as an endovascular procedure by a consultant radiologist in an interventional suite It is common for most patients to have the treatment carried out with little or no sedation, although this depends largely on the organ to be embolized.

Types of embolization agents: I . Permanent agent: Coils Detachable balloons Particles Acrylic gelatin microspheres PVA – polyvinyl alcohol Liquid embolic agent (NBCA, Onyx) II . Temporary Gelaspon Autologous clot

Which embolic agent? Is the vessel to be embolized a large or small vessel? Is the desired occlusion permanent or temporary? Is cellular or ( more specifically organ) death required ?

The aim of the procedure is by arterial or venous way to get area of interest (tumor, arteriovenous malformation, aneurysm and etc.) and using guidewires and catheters to apply embolic agent.

Carcinoma of basic crane (preoperative treatment)

Carcinoma of basic crane (preoperative treatment)

Metastatic lesion of vertebral body

Juvenile angiofibroma

Juvenile angiofibroma

Basocelular carcinoma (preoperative treatment)

Juvenile angiofibroma

Arteriovenous malformation

Arteriovenous malformation

Aneurysm of basilar artery

Spinal AV Fistula

Hepatocellular carcinoma

Advantages of embolization : Minimally invasive Minimal risk of infection No or rare use of general anesthetic Faster recovery time High success rate compared to other procedures

Disadvantages of embolization: User dependent success rate Risk of emboli reaching healthy tissue Not suitable for everyone Expencive devices Recurrence more likely

Thank You for you attention!