SIR 2024
Embolization
Colin Standifird, BS
M2, Student
Kirk Kerkorian School of Medicine at UNLV
Financial relationships: Full list of relationships is listed on the CME information page.
Aaron S. Peterson, BA
M2 Student
Kirk Kerkorian School of Medicine at UNLV
Disclosure information not submitted.
Marvi A. Moreno, B.S.
Medical Student
Kirk Kerkorian School of Medicine at UNLV
Disclosure information not submitted.
Aaron T. Peterson, MD
Vascular Interventional Radiology and Diagnostic Radiology
Red Rock Radiology Associates
Disclosure information not submitted.
Provide a background on bariatric arterial embolization (BAE). Describe its use as a minimally invasive interventional radiology procedure and compare its weight loss outcomes with other surgical and pharmacological treatments of obesity.
Background:
Adult obesity is a significant worldwide health issue associated with a 30% increase in overall mortality.{1} With the average body mass index (BMI) increasing globally, this population has a growing need for treatment.{2} Surgical, endoscopic, and pharmacologic methods are widely used bariatric interventions, but not all patients qualify, and most come with significant side effects or complications.{3-5} Early observations of weight loss after artery embolizations led to FDA-approved BAE procedures.{7} Using image guidance, an interventional radiologist embolized the gastric fundus using embolic microspheres to induce localized ischemia.{7} The fundus of the stomach produces the hormone ghrelin, an appetite-inducing hormone.{8} This embolization decreases ghrelin levels and leads to weight loss.{9-14} The femoral or radial artery approach is used to gain the celiac artery. The participant's vascular anatomy is assessed using angiography. The left gastric artery, and in some cases the gastroepiploic artery, are embolized using 300-500µm Embosphere microspheres with embolization taken to stasis.{11,13} The excess weight loss (EWL) was measured at 10.6- 13.9% during multiple human trials.{9-14} The bariatric surgery options have higher EWL ranging from 19%-34% with a concurrent increase in complications, and not all patients qualify.{3} The pharmacologic options have smaller EWL ranges, 5.1-10.5%, and have a high number of side effects.{4} Endoscopic options have EWL that have a wide range, 8.9% - 54%, with success varying by up to 40%.{5} Bariatric artery embolization has been shown to decrease EWL in obese patients.{9-14} With the addition of this minimally invasive, well-tolerated, low-complication procedure, more individuals can decrease their weight and significantly decrease their morbidity and mortality rates.
Clinical Findings/Procedure Details:
Conclusion and/or Teaching Points: