V Vidal1,2,3, J F Hak4,5,6, P Brige7,8, S Chopinet7,8,9, F Tradi10,7,8, M Bobot8,11,12, P Gach10,7,8, A Haffner13, G Soulez14, A Jacquier10, G Moulin10, J M Bartoli10, B Guillet8,12,15. 1. Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France. vincent.vidal@ap-hm.fr. 2. LIIE, Aix Marseille Univ, Marseille, France. vincent.vidal@ap-hm.fr. 3. CERIMED, Aix Marseille Univ, Marseille, France. vincent.vidal@ap-hm.fr. 4. Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France. jeanfrancois.hak@gmail.com. 5. LIIE, Aix Marseille Univ, Marseille, France. jeanfrancois.hak@gmail.com. 6. CERIMED, Aix Marseille Univ, Marseille, France. jeanfrancois.hak@gmail.com. 7. LIIE, Aix Marseille Univ, Marseille, France. 8. CERIMED, Aix Marseille Univ, Marseille, France. 9. Department of Digestive Surgery, University Hospital Timone APHM, Marseille, France. 10. Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France. 11. Department of Nephrology, University Hospital Conception APHM, Marseille, France. 12. INSERM 1263, INRA 1260, C2VN, Aix Marseille Univ, Marseille, France. 13. Department of Pathological Anatomy, University Hospital Timone APHM, Marseille, France. 14. Department of Radiology, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke East, Montreal, H2L 4M1, Canada. 15. Department of Radiopharmacy, APHM, Marseille, France.
Abstract
PURPOSE: Arterial embolization has been shown to be effective and safe for the management of bleeding, especially for postpartum and pelvic traumatic bleeding. We propose to evaluate the proof of concept of feasibility and effectiveness of arterial embolization with absorbable and non-absorbable sutures in a porcine model. MATERIALS AND METHODS: In the acute setting (n = 1), several different arteries (mesenteric, splenic, pharyngeal, kidney) were embolized using non-absorbable sutures (NAS): Mersutures™ braided sutures (polyethylene terephthalate). In the chronic setting (n = 3), only lower pole renal arteries were embolized. On the right side, NAS was used, whereas on the left side embolization was realized with absorbable suture (AS): Vicryl® braided suture (polyglactin 910). The chronic group was followed for 3 months. The pigs received contrast-enhanced CT the day before embolization (D-1), after the embolization (D0), at 1 month and 3 months after embolization (M1 and M3); digital subtraction angiography (DSA) was done at D0 and M3 and histological analysis at M3. RESULTS: All vascular targets were effectively embolized without any pre- or postoperative complications. Both DSAs and CTs at M3 showed a 100% recanalization rate for the AS embolization and a partial reversal rate for the NAS embolization. A renal hypotrophy in the embolized region was observed during both the M1 and M3 scans for both sutures (AS and NAS) with a clear hypotrophy for the NAS embolized kidney. CONCLUSION: Embolization by AS and NAS (FAIR-Embo) is a feasible and effective treatment which opens up the possibility of global use of this inexpensive and widely available embolization agent.
PURPOSE: Arterial embolization has been shown to be effective and safe for the management of bleeding, especially for postpartum and pelvic traumatic bleeding. We propose to evaluate the proof of concept of feasibility and effectiveness of arterial embolization with absorbable and non-absorbable sutures in a porcine model. MATERIALS AND METHODS: In the acute setting (n = 1), several different arteries (mesenteric, splenic, pharyngeal, kidney) were embolized using non-absorbable sutures (NAS): Mersutures™ braided sutures (polyethylene terephthalate). In the chronic setting (n = 3), only lower pole renal arteries were embolized. On the right side, NAS was used, whereas on the left side embolization was realized with absorbable suture (AS): Vicryl® braided suture (polyglactin 910). The chronic group was followed for 3 months. The pigs received contrast-enhanced CT the day before embolization (D-1), after the embolization (D0), at 1 month and 3 months after embolization (M1 and M3); digital subtraction angiography (DSA) was done at D0 and M3 and histological analysis at M3. RESULTS: All vascular targets were effectively embolized without any pre- or postoperative complications. Both DSAs and CTs at M3 showed a 100% recanalization rate for the AS embolization and a partial reversal rate for the NAS embolization. A renal hypotrophy in the embolized region was observed during both the M1 and M3 scans for both sutures (AS and NAS) with a clear hypotrophy for the NAS embolized kidney. CONCLUSION: Embolization by AS and NAS (FAIR-Embo) is a feasible and effective treatment which opens up the possibility of global use of this inexpensive and widely available embolization agent.