• Treatment: vessels embolization by using mixture of Lipiodol and absolute ethanol. • Follow- up CT after 10 months.[r]
(1)THE USE OF ABSOLUTE ETHANOL- LIPIODOL
MIXTURE AS AN INTRAVASCULAR EMBOLIC
AGENT IN INTERVENTIONAL RADIOLOGY
Technician: BUI VAN ĐOAI Technician: TRAN QUOC ĐAT
Doctor: NGUYEN NGOC CUONG Doctor: PHAM HONG CANH HANOI MEDICAL UNIVERSITY HOSPITAL
OVERVIEW
• A variety of embolic agents and approaches to embolize • A variety of embolic agents and approaches to embolize
hypervascular tumors and peripheral AVMs
• Novel embolic agents (eg Onyx, Coils, microspheres): effective but expensive
• Large benign hypervascular tumors require a great amount of embolic agent that costs money
(2)• Lipiodol/ethanol ratio : 1/5 - 1/2 • Total amount: 1.5 ml (0.4–7.1) • Technical successful rate: 93% • Clinical successful rate:100%
Embolic mechanism
1 Lipiodol
C t t t id th h f th i t
• Contrast agent guides the approach way of the mixture • Contribute to embolize vessels
2 Absolute ethanol
(3)ADVANTAGES
• The mixture is in fluid form that can embolize very
small vessels
• Only need a minor amount of the mixture to
embolize vessels of a tumor or an AVM effectively
•Reduce time of radiation dose exposure and contrast
agent injected to patient as it embolizes vessel more
quickly in comparion with other agents
Lower hospital cost
•Lower hospital cost
HOW TO MIX?
• Use syringes to suck ethanol and Lipiodol up
• Use syringes to suck ethanol and Lipiodol up.
• Use wireless three-pronged fork to mix them
together
• Lipiodol/ethanol ranging from 1:5-1:3
(4)Standard mixture
• The mixture is homogeneous
• The mixture is homogeneous.
• The mixture is in milky color
• Absence of separated lipiodol drops in the
mixture
(5)HOW TO PUMP THE MIXTURE INTO
VESSELS
• Super selective Microcatheter is passed through
the tumor’s vessels with DSA guided
the tumor s vessels with DSA-guided
• Pump the mixture into vessel by using a syringe
and control by DSA.
• Control the reflux and shunt with DSA
DISADVANTAGES
• To embolize tumors or AVM having large
shunts, use feeding- vessel balloon inflation
Microcatheter
• Cause pain after pumping the mixture into
vessels -> pain management
(6)COMPLICATIONS
It’s very rare:
• Hepatic vessels embolisation:
immflamation, induced liver functions
• Renal vessels embolization:
immflamation,induced kidney functions.
AVM embolization: pulmonary occlusion
• AVM embolization: pulmonary occlusion
At Hanoi Medical University Hospital
• 15 cases
– 10 cases of renal AML
– cases of pelvic AVM
(7)Case 1
• 42 yo male
• Diagnosis: left renal AML • Diagnosis: left renal AML
• Treatment: vessels embolization by using mixture of Lipiodol and absolute ethanol
• Follow- up CT after 10 months
(8)(9)Case 2
• 68yo female
• Diagnosis: Hepatic AML • Diagnosis: Hepatic AML
• Treatment: vessels embolisation by using mixture of Lipiodol and absolute ethanol
(10)Case 3
• 40yo male
• Diagnosis: AVM of a finger
(11)(12)CONCLUSION
• Available Applicable in hospitals having DSA machine • Available, Applicable in hospitals having DSA machine • Affordable
• High effectiveness • Very rare complications
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