Therapeutic Arterial Therapeutic Arterial Embolisation in UrologyEmbolisation in Urology
Embolisation for malignant Embolisation for malignant conditionsconditions
Embolisation for non-malignant Embolisation for non-malignant conditionsconditions
Embolisation for malignant Embolisation for malignant conditioncondition
Embolisation is the occlusion of Embolisation is the occlusion of arterial supply of the tumorarterial supply of the tumor
IschemiaIschemia Tumor necrosisTumor necrosis Arrest tumor growthArrest tumor growth
Embolisation- Intra arterial delivery of Embolisation- Intra arterial delivery of particular materials / sclerosantsparticular materials / sclerosants
Occlusion - collateral formationOcclusion - collateral formation
Closer the occlusion to tumor - less Closer the occlusion to tumor - less collateralcollateral
Embolic materials-Embolic materials- Autologous clot and Autologous clot and
tissuestissues EACAEACA Duramater Duramater Gelfoam Gelfoam Oxycel Oxycel Detachable ballonsDetachable ballons Metallic coils (stainless Metallic coils (stainless
steel, platinum)steel, platinum)
Poly vinyl alcohol Poly vinyl alcohol foamfoam
CyanoacrylatesCyanoacrylates Polymeric siliconePolymeric silicone Resin microspheresResin microspheres Microfibrillar collagenMicrofibrillar collagen Sod.tetadecyl Sod.tetadecyl
sulphatesulphate AlcoholAlcohol
Indications Indications 1.1. To control Hemorhage, Polycythemia, To control Hemorhage, Polycythemia,
Hypercalcemia, CHF – AV shunt, HTHypercalcemia, CHF – AV shunt, HT
2.2. Preoperatively – Facilitate surgeryPreoperatively – Facilitate surgery
3.3. Inhibit tumor growthInhibit tumor growth
4.4. PalliationPalliation
5.5. Decrease tumor bulk - Better chemo-effect on Decrease tumor bulk - Better chemo-effect on metsmets
Chemo EmbolisationChemo Embolisation Kato – 1981Kato – 1981 Combination of intra arterial infusion of Combination of intra arterial infusion of
chemotherapeutic agent & embolisationchemotherapeutic agent & embolisation
M/AM/A1.1. Prolongs transit timeProlongs transit time2.2. Anoxia - Increased tissue permeabilityAnoxia - Increased tissue permeability3.3. Higher concentration drugHigher concentration drug4.4. Decreased side effectsDecreased side effects
RENAL CARCINOMARENAL CARCINOMA
STAGESTAGE 5 YR 5 YR SURVIVALSURVIVAL
Stage IStage I 30%30% 60-65%60-65%
Stage II,IIIStage II,III 30-55%30-55%
Stage IVStage IV 25-57%25-57% 8-11%8-11%
SiteSite %% Survival (mo)Survival (mo)
Lung Lung 6969 66
Bone Bone 4343 1515
LiverLiver 1414 33
BrainBrain 77 2-52-5
LNLN 55
Stage I-III – Radical NephrectomyStage I-III – Radical Nephrectomy
Stage IV - Palliative nephrectomyStage IV - Palliative nephrectomy
Renal artery embolisationRenal artery embolisation1.1. Locoregionally advanced RCCLocoregionally advanced RCC2.2. Isolated metastasisIsolated metastasis3.3. Palliative embolisationPalliative embolisation
Embolisation in Embolisation in RCC with renal vein and RCC with renal vein and IVC thrombosisIVC thrombosis
Facilitates thrombectomy – Facilitates thrombectomy – decreasing the decreasing the bulk and extent of thrombusbulk and extent of thrombus
Surgery is done 24-48 hrs later – Surgery is done 24-48 hrs later – edematous rim around tumor facilitates edematous rim around tumor facilitates dissectiondissection
Embolisation agentEmbolisation agent
Peripheral embolisation – GelfoamPeripheral embolisation – Gelfoam
Central embolisation - CoilsCentral embolisation - Coils
Complications –Complications – Post embolisation syndrome Post embolisation syndrome (Flank pain, Fever, Leucocytosis & Raised (Flank pain, Fever, Leucocytosis & Raised
LDH)LDH) Paralytic ileusParalytic ileus HypertensionHypertension Renal failureRenal failure Unintentional embolisation – Lt colon Unintentional embolisation – Lt colon
necrosisnecrosis
Embolisation of Embolisation of skeletal mets-skeletal mets-
Bone mets – 30-45% Bone mets – 30-45% Lumbar and pelvis – MCLumbar and pelvis – MC Preoperative / palliative embolisationPreoperative / palliative embolisation
Embolisation for Non-Malignant Embolisation for Non-Malignant ConditionCondition
IndicationIndication
To control bleeding & treatment of To control bleeding & treatment of vascular malformationvascular malformation
Ablation of renal functionAblation of renal function
Control of BleedingControl of Bleeding AV FistulaAV Fistula AngiomyolipomaAngiomyolipoma HematuriaHematuria TraumaTrauma Renal artery aneurysmRenal artery aneurysm
Control of BleedingControl of Bleeding
AV Fistula –KidneyAV Fistula –Kidney
CongenitalCongenital - Cirsoid , rare , multiple - Cirsoid , rare , multiple communicating vessel.communicating vessel.
SpontaneousSpontaneous AcquiredAcquired - MC - MC
Acquired AV Fistula-Acquired AV Fistula-
MCMC Trauma, surgery, Renal biopsyTrauma, surgery, Renal biopsy Heals spontaneouslyHeals spontaneously C/F – CHF, Hematuria, C/F – CHF, Hematuria,
Retroperitoneal hemorrhage, HT - Retroperitoneal hemorrhage, HT - BruitBruit
Diagnosis – Doppler/AngiographyDiagnosis – Doppler/Angiography
TreatmentTreatment – Embolisation as distal as – Embolisation as distal as possiblepossible
Renal traumaRenal trauma
Bleeding is commonBleeding is common Fortunately-stops spontaneouslyFortunately-stops spontaneously Treated conservativelyTreated conservatively Selective embolisation Selective embolisation Venous bleeding cannot be controlledVenous bleeding cannot be controlled
Intractable bleeding from bladder Intractable bleeding from bladder and post prostatectomy bleeding- and post prostatectomy bleeding- EmbolisationEmbolisation
Ablation of Renal functionAblation of Renal function To achieve total renal infarction –To achieve total renal infarction –
alcoholalcoholIndicationsIndications Urinary fistulas – palliation in Urinary fistulas – palliation in
terminally ill patientsterminally ill patients To prevent excessive protein loss To prevent excessive protein loss
from failing kidneyfrom failing kidney Uncontrollable HTUncontrollable HT
VaricoceleVaricocele Incidence -10%Incidence -10% In infertile men – 30%In infertile men – 30%
MC – MC – Left sideLeft side --Incompetent valvesIncompetent valves – reflux down – reflux down
the Internal spermatic veinthe Internal spermatic vein --Proximal compressionProximal compression of left renal of left renal
vein Between SMA & Aorta vein Between SMA & Aorta
Engorged pampiniform plexus –Engorged pampiniform plexus –Raised scrotal temperatureRaised scrotal temperature
Abnormal sperm motilityAbnormal sperm motility Abnormal sperm morphologyAbnormal sperm morphology Oligospermia Oligospermia
Indication for Transcatheter Indication for Transcatheter EmbolisationEmbolisation
Varicocele with infertilityVaricocele with infertility Varicocele with testicular atrophyVaricocele with testicular atrophy Rec.varicoceleRec.varicocele
Femoral / Jugular approachFemoral / Jugular approach
Coils / Detachable ballonCoils / Detachable ballon
Common sites of coil placement –ISVCommon sites of coil placement –ISV Internal inguinal ringInternal inguinal ring Upper third of SI jointUpper third of SI joint 2 cm from left renal vein2 cm from left renal vein
ResultsResults 30-35% - Pregnancy rate30-35% - Pregnancy rate Simillar to surgical repairSimillar to surgical repair Less morbidLess morbid
PriapismPriapism Low flowLow flow – Venous – surgical – Venous – surgical
emergencyemergency High flowHigh flow – Arterial – Arterial
High flow priapismHigh flow priapism Caused by perineal traumaCaused by perineal trauma
TreatmentTreatment Mechanical compression and Mechanical compression and
pharmocological pharmocological
Surgery/ Trans catheter embolisationSurgery/ Trans catheter embolisation
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