Interventional metabology: A review of bariatric arterial embolization and endovascular denervation for treating metabolic disorders

Abstract

The rising prevalence of metabolic disorders such as obesity and type 2 diabetes mellitus (T2DM) poses a major challenge to global health. Existing therapeutic approaches have limitations, and there is a need for new, safe, and less invasive treatments. Interventional metabolic therapy is a new addition to the treatment arsenal for metabolic disorders. This review focuses on two interventional techniques: bariatric arterial embolization (BAE) and endovascular denervation (EDN). BAE involves embolizing specific arteries feeding ghrelin-producing cells to suppress appetite and promote weight loss. EDN targets nerves that regulate metabolic organs to improve glycemic control in T2DM patients. We describe the current state of these techniques, their mechanisms of action, and the available safety and effectiveness data. We also propose a new territory called "Interventional Metabology" to encompass these and other interventional approaches to treating metabolic disorders.

Keywords: 2型糖尿病; T2DM; intervention metabology; metabolic disorders; obesity; 代谢干预; 代谢紊乱; 肥胖.

FIGURE 1

Bariatric embolization. The left gastric artery is the feeding artery of the fundus and lesser curvature. Embolic agents are delivered through the catheter to achieve embolization. CHA, common hepatic artery; LGA, left gastric artery; SA, splenic artery.

FIGURE 2

Endovascular denervation. The sympathetic nerves originating from the celiac ganglia run along the feeding arteries of the abdominal organs. The six‐electrode radiofrequency catheter is placed at the celiac artery to achieve denervation of the liver and islets. AA, abdominal artery; CA, celiac artery; CG, celiac ganglion; CHA, common hepatic artery.