Embolization in ENT – short note

Embolization

  • Non-surgical, minimally-invasive procedure performed by an interventional radiologist
  • Involves the selective occlusion of blood vessels by purposely introducing emboli

 Therapeutic applications in ENT

  • Pre operatively for vascular tumors to occlude blood supply
  • Occlude arteriovenous malformations (AVMs)
  • Cerebral aneurysm
  • Uncontrollable epistaxis
  • Surgical hemorrhage
  • JNA
  • ABC Maxilla, mandible
  • Glomus tumors
  • Carotid body tumors
  • Maxillary artery
  • Specific branch of maxillary artery
  • ECA

Procedure

  • Under LA
  • Access to the organ in question is acquired by means of a guidewire and catheter(s) entered thru femoral artery
  • Position of the correct artery or vein supplying the pathology in question is located by digital subtraction angiography (DSA)
  • These images are then used as a map for the radiologist to gain access to the correct vessel
  • Artificial embolus used is usually one of the following
    • Coils – Made of platinum or stainless steel with Dacron wool tails which induces clot
    • Polyvinyl alcohol Particles   50-1200 um in size
    • Gelfoam à temporary, dissolve in approx.. 5 wks
    • Plug
    • Detachable balloon
  • Once the artificial emboli have been successfully introduced, another set of DSA images are taken to confirm a successful deployment.

Mata’s test

  • In case occlusion of internal carotid artery is planned then collateral circulation to brain must be first tested by Endovascular Balloon Occlusion Test (Mata’s test) to prevent stroke

 Advantages

  • Minimally invasive
  • No scarring
  • Minimal risk of infection
  • No or rare use of general anesthetic
  • Faster recovery time
  • High success rate compared to other procedures
  • Preserves fertility and anatomical integrity

 Disadvantages

  • User dependent success rate
  • Risk of emboli reaching healthy tissue e.g. CVA, limb ischaemia
  • Increased chances of recurrence in JNA

 

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