Informed consent when using medical devices for indications not approved by the Food and Drug Administration

Patient information in the light of quality assurance

The relationship between patients and doctors has markedly changed over the last century. While until the turn of the 19th/20th century the patient was considered an object upon whom the doctor had the right to exert his art, the patient was then thought to have an integrity which the doctor could only legally injure with the consent of the patient. This was reflected in many court rulings, e.g. in Germany in 1894, requesting a doctor to inform the patient about therapy before performing surgery or even before giving medication, but also before performing invasive diagnostic procedures. The intensity of information required by law/court to be given to the patient varies also over time. Details of the implications to today's medical treatments are discussed.

The use of cyanoacrylate adhesives in peripheral embolization

Although liquid adhesives or glue have been used as embolic agents for nearly three decades, experience with them outside of neurointerventional indications is generally limited. Cyanoacrylates are the main liquid adhesives used in the vascular system and have an important role in managing vascular abnormalities, especially arteriovenous malformations. Vascular occlusion results as these agents polymerize on exposure to the ions in blood. A description of the properties, biologic interactions, techniques of use, and indications for acrylic embolization in the peripheral circulation is especially pertinent at this time because of the recent approval of n-butyl cyanoacrylate by the United States Food and Drug Administration.