Transcatheter vessel occlusion: selection of methods and materials

Transcatheter vessel occlusion (TCVO) is increasingly used for control of hemorrhage, palliative and preoperative tumor embolization, organ function ablation, and obliteration of arteriovenous fistulae and malformations. Methods for TCVO include transcatheter electrocoagulation, "staining" with contrast, the use of balloon-tipped catheters, and embolization. The choice of method and material depends on whether proximal occlusion of feeding vessels or arteriocapillary occlusion is desired, the vascular anatomy of the lesion, the safety with which the lesion can be embolized, and the type of lesion being treated. Embolization is the most frequently employed modality. Available materials include autologous tissue, absorbable hemostatics, synthetic particulates, and liquid polymers. Each material has advantages and disadvantages that make it desirable in certain situations and less useful in others. Complications of TCVO may be disastrous, but can be avoided with careful attention to detail. The specific features of the lesion determine the choice of materials and techniques.