Table 3.
Techniques, Follow-up Variables, and Complications of LGA Embolization
| First Author (Reference) |
Embolization Techniques | Follow-up Evaluations and Treatments | Complications |
|---|---|---|---|
| Obesity clinical trials | |||
| Weiss (18,21) | Femoral artery approach, celiac artery digital subtraction angiography, cone-beam CT protocol with modified liver parenchymal blood volume protocol 5-F SOS catheter (AngioDynamics, Inc, Latham, NY) and 2.9-F high-flow microcatheter (Maestro; Merit Medical Systems, Inc, South Jordan, UT) LGA identification followed by nitroglycerin, verapamil, and heparin injection to improve distal penetration of embolic particles (300–500 μm Embosphere microspheres; Merit Medical Systems, Inc) |
Upper endoscopy 2 wk and 3 mo after procedure; gastric motility study at 1 mo; oral omeprazole (40 mg twice daily) and sucralfate (1 g 4 times daily) from 2 wk before to 6 wk after procedure | No major adverse events; 11 minor adverse events in 8 patients, including superficial mucosal ulcers; 1 case of mild gastritis (gastric body) that resolved 3 mo after procedure; delayed gastric emptying study in 1 patient (repeat study was normal at 6-mo follow-up); 1 patient developed transient subclinical pancreatitis (evident by elevated lipase during hospital stay), received supportive care, and was discharged after 48 h (remained asymptomatic during follow-up) |
| Elens (20) | Femoral artery access, insertion of 5-F sheath (Cordis Corp, Miami Lakes, Florida) Cannulation of celiac trunk using 5-F Cobra catheter (Cook, Inc, Bloomington, Indiana) Selective catheterization of LGA using 5-F multipurpose catheter or 5-F Van Schie catheter (Cook, Inc) Coaxial Progreat 2.7-F (Terumo Corp, Tokyo, Japan) microcatheter with guide wire advanced 3–4 cm distal to LGA origin Embosphere microspheres (Merit Medical Systems, Inc) 500–700 μm (300–500 μm in 2 cases) Repeated injections (alternated with contrast agent) followed by Gelfoam (Pfizer, New York, New York) to prevent reflux |
Upper endoscopy after 1–2 mo in 10 patients; pantoprazole 40 mg daily for 1 mo before procedure | One major adverse event: severe pancreatitis with splenic infarct and late gastric perforation (1-mo hospital stay, including intensive care); 1 case of superficial gastric ulceration treated with 40 mg pantoprazole daily for 6 wk |
| Pirlet (23) | Right radial access, Seldinger technique, insertion of 5- to 6FF sheath Cannulation of celiac artery using 5-F right Judkins catheter; 3-F Renegade microcatheter (Boston Scientific, Marlborough, Massachusetts) was used in a difficult case Selective catheterization of LGA over Terumo 0.035-inch guide wire (Terumo Corp) Angiography, infusion of 300–500 μm PVA particles, and confirmation of absence of distal flow |
PPI therapy for 24 h | Transient abdominal pain in 6 patients |
| Bai (14) | Right femoral artery access, Seldinger technique 5-F sheath and 5-F angiographic catheter to engage celiac artery 2.7-F microcatheter Progreat (Terumo Corp) and PVA (500–710 μm), dosed based on flow, for embolization |
Gastric endoscopy on day of procedure and day 3 and day 30 after procedure in case of positive findings; omeprazole prophylaxis (IV for 3 d, oral for 2 wk after procedure) | No severe adverse events (CTCAE grade III or worse); fullness, decreased appetite, mild epigastric discomfort in 4 patients; puncture site hematoma in 1 patient resolved after 22 d; small superficial gastric ulcer in 1 patient at cardia |
| Syed (17) | Ultrasound-guided right femoral or left arterial access followed by angiography of abdominal aorta Celiac artery access using 4-F or 5-F Simmons 1 catheter Coaxial microcatheter in LGA and Bead Block microspheres 300–500 μm (Biocompatibles, Farnham, United Kingdom) injection until complete cessation of flow |
Upper endoscopy before procedure and on day 3 and day 30 after procedure in case of positive findings; PPI 1 wk before to 1 mo after procedure | Transient mild nausea, occasional vomiting, and mild epigastric discomfort immediately after procedure in 3 patients; superficial gastric ulcers on day 3 in 3 patients |
| Kipshidze (16) | Femoral artery access using 6-F catheter and celiac trunk engagement using 6-F Heartrail II JR-4.0 guide catheter (Terumo Europe N.V., Leuven, Belgium) LGA wiring with 0.014-inch Runthrough NS-PTCA guide wire (Terumo Europe N.V.) Excelsior 1018 Microcatheter (Boston Scientific Corp, Cork, Ireland) in mid-LGA and Bead Block microspheres 300–500 μm embolization until distal branches of LGA are no longer visible |
Gastroscopy 1 d and 1 wk after procedure | Mild transient epigastric discomfort after procedure in 3 patients |
| GI bleeding studies | |||
| Takahashi (22) | NA | NA | NA |
| Kim (15) | Femoral artery access, followed by Bentson wire and insertion of 6-F sheath 5-F SOS catheter to engage celiac artery followed by Progreat catheter and gastrostomy wire insertion Gelfoam slurry in 19 patients followed by coil embolization in 6 patients, PVA particle embolization in 5 patients, or combination embolics in 9 patients |
Upper endoscopy examination (in 6 patients); assessed up to 30 d after procedure | Worsening ulcer in 2 patients; jejunal ischemia likely caused by holding anticoagulation in 1 patient; death in 1 patient within 60 d of procedure related to complex medical history, heart failure |
| Gunn (9) | Arterial embolization using coils in 9 patients, Gelfoam in 5 patients, and PVA particles in 5 patients | NA | NA |
CTCAE = Common Terminology Criteria for Adverse Events; IV = intravenous; LGA = left gastric artery; NA = not available; PVA = polyvinyl alcohol; PPI = proton pump inhibitor.