Embolization: A Closer Look
With potential applications ranging from the head to the lower extremities, from liver cancer to pain relief, aneurysms to weight loss, the buzz surrounding therapeutic embolization continues to grow. It is vital that we match our enthusiasm with measured, objective evaluation, as well as continued improvement. As editors of this month’s edition of Endovascular Today, we focus on key questions across the broad spectrum of embolization applications.
Our feature opens with Ali Kord Valeshabad, MD; Jeffrey Kuwahara, MD; and Dr. Ray answering whether we are seeing a resurgence for Lipiodol (Guerbet LLC), as Lipiodol-based conventional transarterial chemoembolization shows favorable results as a transarterial therapy for hepatocellular carcinoma.
Prostate artery embolization (PAE) continues to draw interest for the nonsurgical treatment of symptomatic benign prostatic hyperplasia. Nigel Hacking, MBBS, and Sandeep Bagla, MD, each offer transatlantic perspectives on the current state of PAE, addressing whether the procedure is truly ready for prime time.
Osteoarthritis applications are also making headlines. Reviewing the available data in this nascent field, Masahiko Shibuya, MD, and Yuji Okuno, MD, identify the most suitable candidates for embolization using proper patient selection methods and identifying the appropriate procedural technique. We follow this ground-breaking experience with coverage of the early data from the first United States–based study of geniculate artery embolization, presented last month at SIR.
Next, Andrew C. Picel, MD, and Anne C. Roberts, MD, discuss the use of endovascular therapy in women with chronic pelvic pain. In conjunction, our Ask the Experts panel consisting of Michael Miller Jr, MD; Waleska Pabon-Ramos, MD; Meridith J. Englander, MD; and Miguel Angel de Gregorio, MD, each offer their thoughts on which veins they treat and when for pelvic congestion syndrome.
Erik Schadde, MD, and Prof. Binkert explain the development of double embolization for rapid liver hypertrophy as it evolved from the surgical associating liver partition and portal vein ligation for staged hepatectomy procedure.
Radiation segmentectomy has shown favorable early results in limited study. Derek Biederman, MD, and Edward Kim, MD, explore what is known to date and weigh this option against surgery, noting that no direct comparisons yet exist.
Hanno Hoppe, MD, and Sebastian Kos, MD, examine whether proximal or distal embolization is more appropriate for splenic artery embolization. Then, Seyed Ameli-Renani, MBBS; Vasileios Patsiogiannis, MD; and Robert A. Morgan, MBChB, discuss the indications, limitations, and outcomes for the use of liquid embolization of type I endoleaks.
Next, Vincent Vidal, MD, reviews the merits of hemorrhoidal artery embolization compared with other nonsurgical minimally invasive treatments available for this condition, describing longer-term outcomes in available cohorts.
Our cover features wrap up with a look at current weight loss expectations for patients undergoing bariatric embolization from Bin-Yan Zhong, MD; Godwin Abiola, BA; and Clifford R. Weiss, MD, who detail the available data in this experimental space.
Finally, our featured interview is with Isabelle Van Herzeele, MD, who highlights themes coming from the recent Dutch Society for Simulation in Healthcare conference and identifies ongoing studies evaluating simulation training technologies for endovascular interventions, among other topics.
As you can see, there is no shortage of exciting development in the field of embolotherapy. As clinicians, our mission continues to be the responsible exploration of new horizons while continuing to refine our more proven techniques. We hope this edition provides answers to some of today’s questions and better informs tomorrow’s.
Christoph A. Binkert, MD, FCIRSE, FSIR
Charles E. Ray Jr, MD, PhD, MS
Guest Chief Medical Editors