SIR 2024
Embolization
Christopher Zoppo, MD Candidate
Medical Student
UMASS Medical School
Disclosure information not submitted.
Alex Newbury, MD (he/him/his)
Radiology Resident
UMass Memorial Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Percutaneous transgluteal arterial access is an alternative access option that may be considered in cases where traditional access proves difficult or undesirable (hostile anatomy, groin site infection, iliac occlusive disease, etc). However, literature on the topic is lacking with only a few published case reports {1-4}. We aim to report the safety and efficacy of this approach for arterial embolization in a small cohort at a single institution.
Materials and methods:
Patients who underwent arterial embolization using a transgluteal approach at a single tertiary care center were identified. Chart review was performed to identify demographics, details of the cases, underlying pathology, and complications.
Results:
11 patients (median age 81) who underwent 12 embolizations were identified over a four-year period. All procedures were performed by a board-certified interventional radiologist with 10 years of experience. The decision to proceed with transgluteal access was made after discussion with the referring physician, in most cases a vascular surgeon (n=9). Either the superior (n=10) or inferior gluteal artery was accessed using MAK-NV (Merit Medical) introducer system. Access was obtained under ultrasound (n=6), fluoroscopy (n=2), or a combination (n=4). Cone beam CT was used in 9 of the cases for procedural planning. The embolizations were performed for a variety of pathologies including aortic endoleak repair (n=3), common (n=2) and internal (n=4) iliac aneurysms, and pseudoaneurysm of the aorta and renal artery. Hemostasis was obtained using either Surgifoam (n=8) or TRUFILL n-BCA glue as the catheter was withdrawn. No complications such as hematoma or buttock claudication were identified on chart review and follow up. In one case, a type III endoleak repair, embolization was not performed due to an inability to find the leak, leading to technical failure.
Conclusion:
In this small cohort, percutaneous transgluteal arterial access was safe and effective for embolizations in variety of locations and clinical scenarios. It should be considered in situations where traditional access is not desirable or possible. Care must be taken to achieve adequate hemostasis as the location is not amenable to manual compression. Additional research on the topic is necessary to support the small body of case reports described in the literature.