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Safety of extensive mesenteric embolization using quick-soluble gelatin sponge particles: an experimental canine
Ryo Deguchi1,2, Akira Yamamoto3, Ken Kageyama1
1Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan.
Purpose:
Transcatheter arterial embolization is an essential treatment for lower gastrointestinal bleeding; however, embolization of multiple vasa recta carries a substantial risk of bowel infarction. This study aimed to evaluate the safety of quick-soluble gelatin sponge particles (QS) compared with conventional gelatin sponge particles (GS) in a canine model of superior mesenteric artery branch embolization.
Materials And Methods:
This study planned to include 10 Beagle dogs. The entire ileocolic artery and its vasa recta were non-selectively embolized to create a stringent ischemic environment. DSA was performed at 15, 30, and 60 min after embolization and on days 1 and 7 post-embolization. Dogs were randomly assigned to receive QS (n = 5) or GS (n = 5). The primary outcome was 7-day survival. Secondary outcomes included angiographic recanalization, as well as macroscopic and histopathological evaluation of intestinal necrosis.
Results:
Given the first two mortality cases in the GS group, further enrollment in the GS group was halted. All five dogs in the QS group survived the 7-day observation period, demonstrating a significantly higher survival rate than the GS group (100% [5/5] vs. 0% [0/2]; P = 0.048). Sequential angiography showed progressive recanalization beginning within 15-30 min post-embolization in the QS group, whereas no recanalization occurred in the GS group. Macroscopic and histopathological examination demonstrated preservation of intestinal tissue in the QS group, whereas the GS group showed severe intestinal ischemia with widespread hemorrhagic necrosis.
Conclusion:
In this proof-of-concept canine study, extensive mesenteric embolization using QS appeared to facilitate rapid blood flow restoration and complete histopathological preservation of the bowel. These hypothesis-generating findings warrant confirmation in larger studies.
