Arterial embolization with conformable embolic – pictorial case series

Learning Objectives: - Understand shear-thinning mechanism of action of a conformable embolic material
- Describe its microcatheter compatibility across product companies
- Discuss its use in different blood vessel sizes and different clinical conditions (elective and urgent/emergent)

Background:

Vascular embolization materials typically include solid (e.g. coils, plugs) and liquid (e.g. cyanoacrylate glue, ethylene vinyl alcohol) products. Obsidio (Boston Scientific; Marlborough MA) is a new pre-mixed conformable embolic with both soft-solid and aqueous characteristics. It is a cohesive material that flows like a liquid when force is applied; returning to a soft solid state when force is removed {1}. 

Clinical Findings/Procedure Details:

Case 1: Pt with hemobilia, melena, repeated PRBC transfusions s/p PTC. Left hepatic artery pseudoaneurysm along biliary drain tract and feeding artery embolized. Microcatheter reused for angiography after ex vivo removal of excess embolic material from catheter.

Case 2: Pt with endophytic left renal mass undergoing pre-ablation embolization. Intraprocedural imaging from embolization, cryoablation (measured ice ball), and follow-up post-ablation imaging to be provided.

Case 3: Pt with exophytic renal AML. Pre-, intra-, and post-embolization images provided.

Case 4: Pt with bleeding duodenal ulcer despite endoscopic clipping. Images from GDA embolization via SMA/pancreaticoduodenal arcade due to biphasic flow in GDA at site of endoscopic clip. Same microcatheter used to embolize two sites.

Case 5: Pt with HCC undergoing pre-Y90 mapping. Images from embolization of an extra-hepatic branch within planned treatment field prior to administration of Tc99m MAA (re-using same microcatheter); SPECT/CT imaging showing lack of non-target MAA distribution provided.

Case 6: Pt with splenic laceration undergoing proximal splenic artery embolization.

Conclusion and/or Teaching Points: A conformable embolic can safely and effectively be used across a variety of anatomic/clinical conditions and through a variety of microcatheters (Table 1). It provides rapid and durable vascular occlusion in both emergent and elective settings; often requiring small volume administration.