Optimizing Embolization

By Marc Sapoval, MD, PhD, and Jafar Golzarian, MD
 

Today’s embolotherapy procedures span a wide range of applications, including potentially life-saving oncologic interventions, revisions of previous endovascular repairs, and relief from pain and other lifestyle-restricting conditions. Emerging potential applications include infertility and weight loss for morbid obesity, just to name a few. The continued enhancement of our more proven procedures and the fastidious evaluation being applied to tomorrow’s workhorse applications are testaments to the creativity and high standards of the current generation of physicians in this specialty. These patient-centered and highly tailored interventions not only aim to treat underlying vascular conditions, but also to improve the symptoms affecting the quality of our patients’ everyday lives.

This issue begins with an article by Shiro Miyayama, MD, and Osamu Matsui, MD, who review the use of superselective conventional transarterial chemoembolization to treat hepatocellular carcinoma tumors, including tips on best procedural techniques and a look at how this treatment might evolve going forward.

Next, Shamar Young, MD, and colleagues provide an evidence-based review of technical tips and recommendations for prostatic artery embolization (PAE) to treat lower urinary tract systems associated with benign prostatic hyperplasia, which can have a major impact on patients’ quality of life. Prof. Sapoval then talks with urologist Nicolas Thiounn, MD, about his approach to using PAE to treat benign prostatic hyperplasia, how the urologic and interventional radiology communities can work together for these patients, and issues pertaining to PAE that must be elucidated with further study.

Prashant Shrestha, MD, and colleagues then share their approach to balloon-occluded retrograde transvenous obliteration for bleeding gastric varices, including clinical evaluation and workup, procedural technique, postprocedural care, and alternative venous outflow occlusion strategies.

We asked Florian Wolf, MD; Michael Darcy, MD; Keigo Osuga, MD; Ricardo Garcia-Monaco MD, PhD; and Robert Morgan, MRCP, FRCR, EBIR, “How do you know when not to place another coil?” They each explain their decision-making process and how they know when they’ve achieved the best embolization result possible.

Lindsay Machan, MD, and Mark Nigro, MD, outline the indications and interventions for male factor infertility, including a step-by-step overview of the necessary diagnostic imaging and embolization procedure, and Mubin I. Syed, MD, and colleagues bring us up to date on the latest in bariatric embolization for weight loss in morbidly obese patients. Both procedures have shown promising results thus far but are still in the early stages of development and warrant continued study.

In addition to our embolization articles, we also have an overview of the current use of telestroke programs by Feras Akbik, MD, and Thabele M. Leslie-Mazwi, MD; detailed coverage of the recently presented landmark ATTRACT data and insights from members on the SIR meeting panel where they were presented; an article tracing the history of endovascular aneurysm repair to its current state, as contemplated by aortic operators at the 2016 VERVE Symposium in Sydney, Australia; and finally, an interview with Antonio Micari, MD, who shares his perspective on the use of drug-eluting therapies for infra­popliteal and below-the-knee disease.

Marc Sapoval, MD, PhD
Jafar Golzarian, MD

Guest Chief Medical Editors

 

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About Endovascular Today

Endovascular Today is a publication dedicated to bringing you comprehensive coverage of all the latest technology, techniques, and developments in the endovascular field. Our Editorial Advisory Board is composed of the top endovascular specialists, including interventional cardiologists, interventional radiologists, vascular surgeons, neurologists, and vascular medicine practitioners, and our publication is read by an audience of more than 22,000 members of the endovascular community.