DOI QR코드

DOI QR Code

Evaluation of Arterial Impairment after Experimental Gelatin Sponge Embolization in a Rabbit Renal Model

  • Oh, Jung Suk (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Hae Giu (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Chun, Ho Jong (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Choi, Byung Gil (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Choi, Yeong Jin (Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2014.05.12
  • Accepted : 2014.10.15
  • Published : 2015.02.01

Abstract

Objective: Arterial stenosis is a major obstacle for subsequent interventional procedures. We hypothesized that the stenosis is caused by gelatin sponge embolization and performed an experimental study in a rabbit renal model. Materials and Methods: A total of 24 rabbits were embolized with porcine gelatin sponge particles injected into the renal arteries. Four rabbits were sacrificed on 1 day, 4 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after embolization. Microscopic evaluations were performed on hematoxylin-eosin and smooth muscle actin immunohistochemical stained sections. Results: Gelatin sponge particles were mainly observed in the segmental and interlobar arteries. Transmural inflammation of the embolized arterial wall and mild thickening of the media were observed 1 week after embolization. Resorption of the gelatin sponge and organization of thrombus accompanied by foreign body reactions, were observed from 2 to 4 weeks after embolization. Microscopic images of the 3 weeks group showed vessel lumens filled mostly with organized thrombi, resulting in severe stenosis. Additionally, vessels showed a thickened intima that contained migrating smooth muscle cells and accompanying interruption of the internal elastic lamina. The migrating smooth muscle cells were distributed around the recanalized arterial lumen. Conclusion: Gelatin sponge embolization may induce arterial stenosis by causing organized thrombus and intimal hyperplasia, which consists of migrating smooth muscle cells and intimal collagen deposits.

Keywords

References

  1. Doyon D, Mouzon A, Jourde AM, Regensberg C, Frileux C. [Hepatic, arterial embolization in patients with malignant liver tumours (author's transl)]. Ann Radiol (Paris) 1974;17:593-603
  2. Goldstein HM, Wallace S, Anderson JH, Bree RL, Gianturco C. Transcatheter occlusion of abdominal tumors. Radiology 1976;120:539-545 https://doi.org/10.1148/120.3.539
  3. Katsumori T, Kasahara T. The size of gelatin sponge particles: differences with preparation method. Cardiovasc Intervent Radiol 2006;29:1077-1083 https://doi.org/10.1007/s00270-006-0059-y
  4. Yamada R, Sato M, Kawabata M, Nakatsuka H, Nakamura K, Takashima S. Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology 1983;148:397-401 https://doi.org/10.1148/radiology.148.2.6306721
  5. Erinjeri JP, Salhab HM, Covey AM, Getrajdman GI, Brown KT. Arterial patency after repeated hepatic artery bland particle embolization. J Vasc Interv Radiol 2010;21:522-526 https://doi.org/10.1016/j.jvir.2009.12.390
  6. Sueyoshi E, Hayashida T, Sakamoto I, Uetani M. Vascular complications of hepatic artery after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. AJR Am J Roentgenol 2010;195:245-251 https://doi.org/10.2214/AJR.08.2301
  7. Maeda N, Osuga K, Mikami K, Higashihara H, Onishi H, Nakaya Y, et al. Angiographic evaluation of hepatic arterial damage after transarterial chemoembolization for hepatocellular carcinoma. Radiat Med 2008;26:206-212 https://doi.org/10.1007/s11604-007-0216-5
  8. Sahara S, Kawai N, Sato M, Tanaka T, Ikoma A, Nakata K, et al. Prospective evaluation of transcatheter arterial chemoembolization (TACE) with multiple anti-cancer drugs (epirubicin, cisplatin, mitomycin c, 5-fluorouracil) compared with TACE with epirubicin for treatment of hepatocellular carcinoma. Cardiovasc Intervent Radiol 2012;35:1363-1371 https://doi.org/10.1007/s00270-012-0352-x
  9. Brown DB, Pilgram TK, Darcy MD, Fundakowski CE, Lisker-Melman M, Chapman WC, et al. Hepatic arterial chemoembolization for hepatocellular carcinoma: comparison of survival rates with different embolic agents. J Vasc Interv Radiol 2005;16:1661-1666 https://doi.org/10.1097/01.RVI.0000182160.26798.A2
  10. Katsumori T, Nakajima K, Mihara T, Tokuhiro M. Uterine artery embolization using gelatin sponge particles alone for symptomatic uterine fibroids: midterm results. AJR Am J Roentgenol 2002;178:135-139 https://doi.org/10.2214/ajr.178.1.1780135
  11. Davies MG, Hagen PO. Pathobiology of intimal hyperplasia. Br J Surg 1994;81:1254-1269 https://doi.org/10.1002/bjs.1800810904
  12. Clowes AW. Intimal hyperplasia and graft failure. Cardiovasc Pathol 1993;2:179S-186S https://doi.org/10.1016/1054-8807(93)90058-A
  13. Liu MW, Roubin GS, King SB 3rd. Restenosis after coronary angioplasty. Potential biologic determinants and role of intimal hyperplasia. Circulation 1989;79:1374-1387 https://doi.org/10.1161/01.CIR.79.6.1374
  14. Carrel A, Guthrie CC. Anastomosis of blood vessels by the patching method and transplantation of the kidney. 1906 [classical article]. Yale J Biol Med 2001;74:243-247
  15. Waltham M, Harris J. Intimal hyperplasia: the nemesis of cardiovascular intervention. ANZ J Surg 2004;74:719-720 https://doi.org/10.1111/j.1445-1433.2004.03174.x
  16. Strauss BH, Wilson RA, van Houten R, van Suylen RJ, Murphy ES, Escaned J, et al. Late effects of locally delivered mitomycin C on formation of neointima and on vasomotor response to acetylcholine. Coron Artery Dis 1994;5:633-641 https://doi.org/10.1097/00019501-199407000-00012
  17. Richard HM 3rd, Silberzweig JE, Mitty HA, Lou WY, Ahn J, Cooper JM. Hepatic arterial complications in liver transplant recipients treated with pretransplantation chemoembolization for hepatocellular carcinoma. Radiology 2000;214:775-779 https://doi.org/10.1148/radiology.214.3.r00mr31775
  18. Siskin GP, Dowling K, Virmani R, Jones R, Todd D. Pathologic evaluation of a spherical polyvinyl alcohol embolic agent in a porcine renal model. J Vasc Interv Radiol 2003;14:89-98 https://doi.org/10.1097/01.RVI.0000052296.26939.4c
  19. Stampfl S, Bellemann N, Stampfl U, Radeleff B, Lopez-Benitez R, Sommer CM, et al. Inflammation and recanalization of four different spherical embolization agents in the porcine kidney model. J Vasc Interv Radiol 2008;19:577-586 https://doi.org/10.1016/j.jvir.2008.01.011
  20. Kawai N, Sato M, Minamiguchi H, Ikoma A, Sanda H, Nakata K, et al. Clinical evaluation of transcatheter arterial chemoembolization with 2-day-soluble gelatin sponge particles for hepatocellular carcinoma-comparison with insoluble gelatin sponge particles. J Vasc Interv Radiol 2013;24:1383-1390 https://doi.org/10.1016/j.jvir.2013.03.013
  21. Takasaka I, Kawai N, Sato M, Sahara S, Minamiguchi H, Nakai M, et al. A new soluble gelatin sponge for transcatheter hepatic arterial embolization. Cardiovasc Intervent Radiol 2010;33:1198-1204 https://doi.org/10.1007/s00270-010-9866-2

Cited by

  1. Indications for embolization in a French level 1 trauma center vol.153, pp.4, 2015, https://doi.org/10.1016/j.jviscsurg.2016.04.010
  2. Two cases of debulking surgery for lower limb diffuse plexiform neurofibroma with transcatheter arterial embolisation vol.55, pp.None, 2015, https://doi.org/10.1016/j.ijscr.2019.01.018
  3. Characterization of Calibrated Gelatin Sponge Particles in a Rabbit Renal Embolization Model vol.42, pp.8, 2015, https://doi.org/10.1007/s00270-019-02224-7
  4. Creation of an ex-vivo bovine kidney flow model for testing embolic agents: work in progress vol.4, pp.1, 2015, https://doi.org/10.1186/s42155-021-00210-0