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Superselective mesenteric embolization with microcoils in a porcine model
Anthony C Chin1, Marc A Singer, Michael Mihalov
1Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
Purpose:
There is a lack of data regarding the degree of ischemic change that may occur in small and large bowel after superselective arterial embolotherapy with platinum microcoils. The purpose of this study was to gain a clearer understanding of the ischemic complications of superselective embolization of peripheral mesenteric arteries with microcoils by gross and histologic examination of postembolectomy bowel specimens at several time intervals in an adult porcine model.
Methods:
Two-millimeter platinum microcoils with fibrils were superselectively deployed into six isolated mesenteric branch vessels in each of nine adult pigs. The animals were observed for two days (n = 3), one month (n = 3), or three months (n = 3) and then killed. At necropsy, intestines were examined for gross abnormalities. Sections of bowel containing microcoils were identified under fluoroscopy, resected, and evaluated histologically.
Results:
A total of 54 microcoils were deployed into the distal arterial mesentery supplying the jejunum (n = 14), ileum (n = 26), and colon (n = 14) of nine adult pigs. Each animal received six microcoils. There were no clinical complications, and all pigs gained weight during their observation periods. Gross examination of the intestines did not reveal any evidence of acute or chronic ischemia. The coils were found in the distal arterial vasculature of the intestine. Histologic examination revealed mild superficial necrosis of villous tips in several samples; however, this finding is likely related to a fixation artifact rather than ischemic injury. There was no other histologic evidence suggestive of ischemic injury.
Conclusions:
Gross and histologic findings after superselective arterial embolotherapy demonstrated minimal changes in the bowel, and there were no significant clinical consequences to the animals. We conclude that transcatheter arterial embolotherapy in pigs is safe and may be applicable in the control of massive lower gastrointestinal hemorrhage in humans.
Insights
Superselective arterial embolotherapy using platinum microcoils showed minimal bowel changes and no clinical complications in pigs. This transcatheter arterial embolization technique appears safe for treating gastrointestinal hemorrhage.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Vascular Surgery
Background:
- Superselective arterial embolotherapy with platinum microcoils is used for gastrointestinal hemorrhage.
- Data on ischemic complications in small and large bowel following this procedure is limited.
Purpose of the Study:
- To evaluate ischemic complications in the bowel after superselective arterial embolotherapy with platinum microcoils.
- To assess gross and histologic changes in postembolectomy bowel specimens in a porcine model.
Main Methods:
- Platinum microcoils were deployed into mesenteric arteries of nine pigs.
- Animals were observed for 2 days, 1 month, or 3 months post-embolization.
- Intestines were examined grossly and histologically for ischemic changes.
Main Results:
- 54 microcoils were deployed without clinical complications; all pigs gained weight.
- No gross evidence of acute or chronic ischemia was observed.
- Histologic examination showed minimal superficial villous tip necrosis, likely artifactual, with no other signs of ischemic injury.
Conclusions:
- Superselective arterial embolotherapy with microcoils resulted in minimal bowel changes and no significant clinical consequences in pigs.
- Transcatheter arterial embolization is a potentially safe and applicable method for controlling massive lower gastrointestinal hemorrhage.