Use of Phil Embolic Agent for Bleeding in Non-Neurological Interventions

Abstract

Objective: To evaluate the safety and efficacy of the Phil liquid embolic agent in non-neurological embolization procedures. M&M: Thirty-five patients with a mean age of 62.5 years underwent percutaneous embolization using Phil for the treatment of visceral arterial bleedings in 20/35 patients (including three gluteal, one bladder, two superior mesenteric, three epigastric, one deep femoral, five internal iliac, four intercostal, and one lingual arteries), splanchnic pseudoaneurysms in 11/35 patients (including three hepatic, five splenic, and three renal arteries), pancreatic bleeding metastasis in 1/35 patient, and gastric bleeding varices in 3/35 patients. Phil is composed of a non-adhesive copolymer dissolved in DMSO (Anhydrous Dimethyl Sulfoxide) with different viscosity. Procedures were performed slowly under continuous fluoroscopic guidance to avoid embolization of non-target vessels.

Results: Clinical success was obtained with a single intervention in 34 cases (97.15%), while a repeated procedure was required in one case (2.85%). No technical complications nor non-target embolization occurred. A case of post-embolic syndrome was noted (2.85%) in one patient. DMSO administration-related pain was successfully controlled by medical therapy.

Conclusion: Phil can be considered a safe and effective embolic agent for the treatment of non-neurologic bleeding.

Keywords: bleeding; liquid embolic agent; non-neurologic intervention; transcatheter embolization.

Figure 1

Patient with cavernomatosis and portal hypertension who had episodes of bleeding from gastric varices. (a) shows the pre-procedural CT scan with voluminous gastric varices. The patient underwent TIPS and embolization of gastric varices via jugular access. (b,c) show the pre-embolization portography; (e,f) show the post-embolization portography with TIPS placement; (d) shows the post-procedure follow-up CT demonstrating the correct embolization of the gastric varices in the absence of non-target embolizations).

Figure 2

Patient with multiple post-pancreatitis hepatic pseudoaneurysms who had undergone previous embolization with metal coils and who presented with new hemoglobin drop underwent CT scan, demonstrating the presence of new pseudoaneurysms. (e) shows the pre-procedural CT scan with pseudoaneurysms and the results of the embolization with metal coils. The patient underwent embolization of the pseudoaneurysms ((a) shows pre-embolization angiography; (b–d) show outcomes of embolization and completion angiography). Post-procedural CT scan demonstrates the correct embolization of the pseudoaneurysms in the absence of non-target embolization (f).