324

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. .

Peripheral

Embolization C. Beachley,

Jaime Tisnado,1 Michael and Marco Amendola

The for

Gianturco

stainless

permanent

attest

reports the

use

tions

of

the

coil

1 976

[2].

renal

the

use

of

material

and

Difficulties

[4].

any

was

were

One

reported

lodging

Wallace

the

the

feared

is the

material

of

by

most

of

et al.

arteries

in

was

complications

reflux particles

embolizing

denied

of emboliC in distal

embolization

femoral

artery

occurred

from

a coil

into

placed

into

the

the

distal

left

any

but

popliteal

the

left

legs

portion

of the

Filling

the

was a large

Virginia

Hospitals

with

claimed

had

present

relevant

symptoms.

been

enlarged

of

there

anteriorly

After taken

was

and

1 week, using

renal

opacification

Examination

not attached with

1 A).

of the

embolization

steel

coils.

a 7 French

left

other an-

kidney

Although

aorta

with

there

and

The

of the

left

renal

thin-walled

was

inferior

tumor

artery

Teflon

vena

was

was

catheter

The

under-

selectively

coils

deposited

into

the

coil,

was

enough

deposited (fig.

in a more

1 B).

left flank was

renal

of

after with

relative

confirmed

a stainless

Received

December

All authors: reprint

requests

AJR

133:324-326,

steel

coil

1 9, 1 978;

Department

the

artery

ease the

and

coil

than

was

desired

experienced blood

loss.

His-

did well. A pelvic film 1 week later and a history of ‘ ‘arthritis’ ‘ demonin the

accepted

of Radiology,

left

groin

after

Virginia

(fig.

revision

2A).

The

April

2. 1979.

Commonwealth

1979;

0361 -803X/79/

1332-0324

excellent. under

course

was

pulses

in the

local

strands uneventleft

leg.

$00.00;

of the

cath-

was

described

to of

complication

[5].

to embolize

developed

are that a major

it is a large

larger

only a few artery and

the chances [6]. Once the vessel to be embolized, it expands, wall of the vessel preventing its disembolization

into

against

main

catheter

the

disadvantages

used other

object,

are

have

different pointed

out

clinical

applications

case

in

they

which

artery the

minimal

the

ered

into

the

into

7 French and

Teflon

more

rigid

configuration. by Wallace

These disadvantages et al. [2] in a report

of the

steel

unable

to

catheter

The

hepatic

the opaque

a poor selective

the

coil.

catheter

that

is less

[1 , 2],

were

because steel

coil

it has shaped for

the

of

the

adequately

of been

ery

are

to place catheters

be

arteries

coil

the

They

deliver

then

and ‘

coil

during partially

was

‘ where

into

the

a the deliv-

protruding

intentionally it would

on

reported

the

recoiled

was

aorta

artery

coil.

memory, and it placement in

delivnot

cause

harm.”

We

patient

University,

well

used

[1 ]. Because

Medical

experienced

College

of Virginia

to J. Tisnado.

August

delay,

lodgment.

from

of hypernephnoma.

coil

peripheral

is placed

wedging

renal

Left nephrectomy

minimal

diagnosis

the

patient

by narcotics.

left

were

of the second

tip so that

of the renal

embolization,

was relieved

Postoperatively, the patient because of bilateral hip pain strated

part

catheter

coils

and are

steel

with

The

of the

1 A). Two

the delivery

was

placement

advantages of the device needed to permanently occlude

reflux

the coil

introduced

elongation

(fig.

During

of the

proximal

which

examination

artery.

recoil

Immediately

pain

accomplished

tologic

left

and

tumor

2B).

slight

is extremely important into the aorta. Reflux

The

are

cannot

huge

perfect

is a feared particles

it is radiopaque

the

as by stretching

for

that the Dacron

peripheral

distal

(fig.

removed

postoperative

of the

procedure,

Gianturco

arteries.

artery there

embolic

Gelfoam

renal

the

The

a right

in the

artery

surgically

of the coil revealed

restoration

material

when

toward

as well

femoral

was

via

but except

vessel to be embolized reflux of embolic material

than

supplying

coil

diminished.

at its bifurcation

noted,

left superficial

steel

bilaterally,

markedly

to be lodged

artery

were

extremities.

equal

arteniography

coil

in the

through a Mylar sheath. Selective placement of the catheter was complicated by the marked tortuosity and displacement of the aorta right,

coil

were

iliac

steel

femoral

to its tip.

excellent

Left

were

Discussion

she

denied

right.

preoperative

with

(fig.

of

evaluation,

of the

of the

anesthesia.

In any

which

She

.

of the lower

pulses

pulses

the

the

the

ful,

pedal

common

within

femoral

warm.

Subsequently,

artery.

College

abdomen,

preliminary

caliber

the

Medical

years.

tumor

displacement

toward

stainless

catheterized

20

appropriate .5 cm

1 -1

the

in the

about

a hypervascular

arteries

no invasion, cava

to

mass

for

After

revealed

admitted

and revealed

left

defects

embolic woman

T:

-..

common

Report

A 50-year-old

.

to ischemia

the

equally

approach

avoid

giography

were

femoral

eter

Case

.

Coil

referable

symptoms

examination,

were

peripheral vessels [5]. To the best of our knowledge, distal embolization of a steel coil has not previously been descnibed in the English literature. We report a case in which peripheral

Steel

On physical The

placement

occlude

of the

embolic

in 1975 [1 ]. Many [2, 3]. As complica-

in selective

.

Cho,

introduced

undesirable

to permanently

reported

Shao-Ru

of large arteries use of the device

increased,

artery

Failure

recently

coil

appear.

in the

coil

successful

steel

to

steel occlusion

to the

began

the

of

embolic

of a Stainless

-

© American

Roentgen

Ray Society

a similar

Hospital,

problem

Box 728,

during

Richmond,

placement

VA 23298.

of

Address

AJR:133,

August

Fig.

1 -A,

riogram.

CASE

1979

Selective

Huge

left

renal

hypervascular

REPORTS

325

aCe-

hyperne-

phroma occupies entire left hemiabdomen. Marked enlargement and stretching of renal artery and main branches. B,

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Left renal arteriogram clusion. Two coils

after steel coil ocin proximal part of main renal artery (arrows). Contrast refluxed into markedly tortuous and displaced aorta.

.

‘

t;:?

,.

I. A

B

A

B

Fig. 2.-A, Pelvis. Steel coil overlies left ischial tuberosity. B, Left iliac arteriogram. 5teel coil lodged in distal common femoral artery and into origin of superficial

femoral

coil

represent

artery.

opacification

femoral

the

Filling

fibrin of

defects

thrombi.

superficial

within

Excellent and

deep

arteries.

second

at the proximal

was of the ulation

coil

when

moment

of the

position

inadvertently second of the

than

tip of the catheter recoiled slightly delivery, placing the coil in a more

alone small

intended.

in

the

clamped

At surgery

and ligated

coil. During clamping of the kidney, the coil was apparently

the renal artery into the aorta. Fortunately, were ligated into the stump of the renal coil

alone

the

distal

was

embolized.

Embolization

renal

artery

to the location artery or manipextruded from

the Dacron fibers artery, so that the of

the

bare

coil

did not occlude fibnin clots formed

the

damage

arteniogram

the femoral on the coil

(fig.

to the vessel

2B).

wall

that

vessels because [1 , 6], as demonstrated

However,

due

to

may

with

an embolized

occur

the

only rapid

coil, immediate surgical removal of required to prevent potentially serious A more desireable system consisting

the misplaced sequelae. of a smaller

coil

can

polyethylene

catheter

be delivered

is now

available.

through This

a 5 French catheter

is more

easily

coil

manipulated

is that

CASE

326

and is shaped system should

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addition,

the

route

for

tuous

vessels.

for placement in very tortuous reduce difficulties in catheter axillary

approach

catheterization

and

may

vessels. placement.

be used

embobization

This In

as an alternate of markedly

tor-

REPORTS

539-545,

ACKNOWLEDGMENTS

tanial

Everett

assistance

Jhaveni

in the

preparation

and Wanda of this

Cunningham

for secre5.

manuscript.

1978. Greenfield Transcatheter

REFERENCES 1 . Gianturco

arterial

6. C, Anderson occlusion. AJR

JH, Wallace 124:428-435,

5: Mechanical 1975.

devices

for

1979

1976.

HS,

occlusion

Tompkins

August

2. Wallace 5, Gianturco C, Anderson JH, Goldstein HM, Davis U, Bree RU: Therapeutic vascular occlusion utilizing steel coil technique: clinical applications. AJR 127:381-387, 1976. 3. Goldstein HM, Wallace 5, Anderson JH, Bree RL, Gianturco C: Transcatheter occlusion of abdominal tumors. Radiology 1 20: 4.

We thank

AJR:133,

Gerlock

in

a case

AJ,

AJ Jr, of

Athanasoulis embolization:

Ekelund

hypernephroma.

L: Failure of steel AJR 130:556-557,

CA, Waltman AC, LeMoure ER: prevention of embolic reflux using

balloon catheters. AJR 1 31 : 651 -655, 1978. Barth KH, Strandberg JO, Kaufman SU, White culan reactions to steel coil occlusion devices. 458,

1978.

coil

RI: Chronic vasAJR 131 :455-