Therapeutic Arterial

Embolisation in Urology
Embolisation for malignant
conditions
Embolisation for non-malignant
conditions
Embolisation for malignant
condition

Embolisation is the occlusion of
arterial supply of the tumor

Ischemia
Tumor necrosis
Arrest tumor growth
Embolisation- Intra arterial delivery of
particular materials / sclerosants

Occlusion - collateral formation

Closer the occlusion to tumor - less
collateral

Embolic materials-
Autologous clot and
tissues
EACA
Duramater
Gelfoam
Oxycel
Detachable ballons
Metallic coils (stainless
steel, platinum)

Poly vinyl alcohol
foam
Cyanoacrylates
Polymeric silicone
Resin microspheres
Microfibrillar collagen
Sod.tetadecyl
sulphate
Alcohol


Indications
1. To control Hemorhage, Polycythemia,
Hypercalcemia, CHF AV shunt, HT

2. Preoperatively Facilitate surgery

3. Inhibit tumor growth

4. Palliation

5. Decrease tumor bulk - Better chemo-effect on
mets
Chemo Embolisation
Kato 1981
Combination of intra arterial infusion of
chemotherapeutic agent & embolisation

M/A
1. Prolongs transit time
2. Anoxia - Increased tissue permeability
3. Higher concentration drug
4. Decreased side effects
RENAL CARCINOMA
STAGE 5 YR
SURVIVAL
Stage I 30% 60-65%
Stage II,III 30-55%
Stage IV 25-57% 8-11%
Site % Survival (mo)
Lung 69 6
Bone 43 15
Liver 14 3
Brain 7 2-5
LN 5
Stage I-III Radical Nephrectomy

Stage IV - Palliative nephrectomy


Renal artery embolisation
1. Locoregionally advanced RCC
2. Isolated metastasis
3. Palliative embolisation
Embolisation in RCC with renal vein and
IVC thrombosis

Facilitates thrombectomy decreasing the
bulk and extent of thrombus

Surgery is done 24-48 hrs later
edematous rim around tumor facilitates
dissection
Embolisation agent

Peripheral embolisation Gelfoam

Central embolisation - Coils


Complications

Post embolisation syndrome
(Flank pain, Fever, Leucocytosis & Raised
LDH)
Paralytic ileus
Hypertension
Renal failure
Unintentional embolisation Lt colon
necrosis
Embolisation of skeletal mets-

Bone mets 30-45%
Lumbar and pelvis MC
Preoperative / palliative embolisation

Embolisation for Non-Malignant
Condition
Indication

To control bleeding & treatment of
vascular malformation

Ablation of renal function
Control of Bleeding
AV Fistula
Angiomyolipoma
Hematuria
Trauma
Renal artery aneurysm
Control of Bleeding
AV Fistula Kidney

Congenital - Cirsoid , rare , multiple
communicating vessel.
Spontaneous
Acquired - MC
Acquired AV Fistula-

MC
Trauma, surgery, Renal biopsy
Heals spontaneously
C/F CHF, Hematuria,
Retroperitoneal hemorrhage, HT -
Bruit
Diagnosis Doppler/Angiography

Treatment Embolisation as distal
as possible
Renal trauma

Bleeding is common
Fortunately-stops spontaneously
Treated conservatively
Selective embolisation
Venous bleeding cannot be controlled
Intractable bleeding from bladder
and post prostatectomy bleeding-
Embolisation
Ablation of Renal function
To achieve total renal infarction
alcohol
Indications
Urinary fistulas palliation in
terminally ill patients
To prevent excessive protein loss
from failing kidney
Uncontrollable HT
Varicocele
Incidence -10%
In infertile men 30%

MC Left side
-Incompetent valves reflux down
the Internal spermatic vein
-Proximal compression of left renal
vein Between SMA & Aorta
Engorged pampiniform plexus
Raised scrotal temperature

Abnormal sperm motility
Abnormal sperm morphology
Oligospermia
Indication for Transcatheter
Embolisation

Varicocele with infertility
Varicocele with testicular atrophy
Rec.varicocele
Femoral / Jugular approach

Coils / Detachable ballon

Common sites of coil placement ISV
Internal inguinal ring
Upper third of SI joint
2 cm from left renal vein
Results
30-35% - Pregnancy rate
Simillar to surgical repair
Less morbid
Priapism
Low flow Venous surgical
emergency
High flow Arterial

High flow priapism
Caused by perineal trauma

Treatment
Mechanical compression and
pharmocological

Surgery/ Trans catheter embolisation



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