[Capillary embolization. Part II. Occlusion of the entire arterial system of experimentally induced renal tumors ]

Control of Hepatic Tumor Hemorrhage by Transcatheter Embolization with Ethibloc

Two patients with abdominal hemorrhage from a hepatic tumor underwent transcatheter embolization using Ethibloc. The hemorrhage ceased rapidly in both patients. No complications related to the embolization procedure were observed. One patient is doing well after 4 years. The second patient died of extensive metastatic disease eleven weeks after embolization. Control angiography after 14 months and 2 weeks, respectively, demonstrated persistent occlusion of the embolized hepatic arteries. Ethibloc offers the advantage of permanent vascular occlusion and appears to be a safe and effective embolization material for partial occlusion of the hepatic arteries.

[Palliative therapy of primary liver tumors]

In Europe and North America, primary liver tumors are rare. Resection is the only means of cure, but is possible in only 20-30% of the patients affected, so that in all other patients, i.e. the vast majority, only palliative treatment is possible. In a retrospective analysis we investigated the 68 patients we had treated for hepatocellular or cholangiocellular carcinoma of the liver. In 14 patients resection was possible, while 28 patients were treated by chemoembolization and 26 by intraarterial regional chemotherapy to the liver. There was no difference in tumor stage between the two groups receiving different palliative treatments. The patients in whom resection was performed, in contrast, mostly had less advanced tumors. For chemoembolization we used a mixture of Ethibloc, mitomycin, Adriamycin and cisplatin. Up to 1986, the intraarterial chemotherapy was performed with mitomycin and 5-FU. Since 1986 we have used Adriamycin and cisplatin. The overall median survival time was 8 months: after resection 17 months, after chemoembolization 6.5 months, and after intraarterial chemotherapy 6.5 months. There was a significant difference in survival between patients with tumor stage II and those with tumor stages III and IV. On comparing the survival time achieved with our treatments and that ensuing in the natural course of patients with liver tumor we found no improvement.

Prolonged survival following palliative renal tumor embolization by capillary occlusion

Nine patients with renal cell carcinoma and severe hematuria were palliatively treated with a new type of angioocclusion: the concept of capillary embolization. The so-called occlusion gel Ethibloc was used as embolizing agent. Each patient was followed up until death or for at least 4 years. All patients had a stage T3 or T4 tumor, 3 patients had metastases to multiple organs, 3 had lung metastases, and 3 were free of metastatic disease. In all cases, very high volumes (14-40 ml) of the embolizing agent were necessary to achieve total occlusion of the entire arterial compartment. Patients without metastatic disease had a mean survival time of 6 years and 4 months, all of them without signs of malignant disease. Patients with metastases had a mean survival time of 3 years. Compared with the natural history of renal cell carcinoma treated otherwise, this represents a substantial prolongation of survival time. Contrary to other angioocclusive treatment modalities, the concept of capillary occlusion with Ethibloc seems to achieve total tumor destruction.

Homologous controlled-viscosity fibrin for endovascular embolization. Part II: catheterization technique, animal experiments

Part I of the present paper described the development of a substance for endovascular embolization from homologous fibrinogen, aprotinin, thrombin, metrizamide and CaCl2. Part II deals with the applicability of a controlled-viscosity fibrin mixture via different types of arterial catheters. In a flow-dynamic model the embolizing medium injected via a double syringe was shown to block a blood flow corresponding approximately to the flow encountered in cerebral angioma vessels. In the course of animal experiments the embolization of mesenteric arteries of rabbits showed the distribution of the embolizing medium to be dependent on its viscosity; the action of an embolizing medium applied by means of a double syringe was studied in the femoral arteries of rabbits. Scintigraphy was used to study the distribution of the substance in the body of the experimental animal after intravenous (i.v.) application; long-term studies of embolized auricular arteries in rabbits revealed parchment-like necroses after 5 to 10 days and the presence of radiopaque substances in the ear stumps after 6 weeks.