Society of Interventional Radiology Quality Improvement Standards for Percutaneous Transcatheter Embolization

Percutaneous embolization procedures are commonly performed by interventional radiologists. This quality improvement (QI) standard was first published in 2010 (1Angle J.F. Siddiqi N.H. Wallace M.J. et al.Quality guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards Practice Committee.J Vasc Interv Radiol. 2010; 21: 1479-1486Abstract Full Text PDF PubMed Scopus (152) Google Scholar), and this document represents the second update. Since standards, many additional randomized controlled trials, meta-analyses, observational studies have been on various disease entities, further establishing as an effective treatment. Additionally, indications expanded with newer procedures, like prostatic benign hyperplasia (BPH), emerging such left gastric artery treatment obesity genicular pain related to osteoarthritis (OA). revised includes a discussion performance pediatric patients, emphasizes current literature, builds upon previous documents provide up-to-date information ensure effective, safe, high-quality care. is widely practiced method therapeutic vascular occlusion, which has successfully applied virtually every territory arrest hemorrhage, occlude congenital acquired abnormalities, palliate neoplasms, reduce operative blood loss, infarct tissue. With accumulated experience design agents devices, choice abnormalities. addresses QI standards bronchial, celiac, superior inferior mesenteric, renal, hypogastric, arterial territories. Pulmonary embolization, portal vein before operation, gonadal discussed well. Specific that not include intracranial embolizations, hepatic embolization/chemoembolization neoplasm, gastroesophageal or splenorenal varices. Please refer other SIR these topics more (2Brown D.B. Nikolic B. Covey A.M. transhepatic chemoembolization, chemotherapeutic infusion malignancy.J 2012; 23: 287-294Abstract (145) Scholar,3Dariushnia S.R. Haskal Z.J. Midia M. transjugular intrahepatic portosystemic shunts.J 2016; 27: 1-7Abstract Scholar). The developed use evaluating outcomes clinical practice. It intended be used programs assess interventions patients. most important processes care (a) patient selection, (b) performing procedure, (c) monitoring patient, (d) longitudinal management after procedure. outcome measures indicators indications, success rates, complication rates. assigned threshold levels. For full about division methodology, please Appendix A (available online article’s Supplemental Material page at www.jvir.org). Starting August 2017, periodic updates through December 2019, workgroup members search combining all terms Group (percutaneous, transcatheter, artery, vein, incompetence, coil, particle, glue) those B (bronchial, pulmonary, internal iliac, external lumbar, gastroduodenal, gastric, splenic, varicocele, pelvic, prostate/proststic). yielded 122 citations were English language publications from 1983 2019 classified one following: prospective study; prospective, nonrandomized case series; retrospective review article meta-analysis. An updated conducted May 2020, specifically searching existing systematic reviews (with without meta-analysis) large population-based cohort (N > 500). These references included graded evidence table (Appendix [available www.jvir.org]) update document. Data C calculate appropriate thresholds adverse events. defined intravascular placement device agent (solid liquid) produce intentional vessel occlusion. Embolic occlusion may any level, arteries veins capillary beds, it temporary permanent. curative, temporizing, palliative. Depending indication, degree require partial complete territory, resulting varying degrees reduction cessation flow focal lesion entire target organ. encompass wide range situations, control hemorrhage tumor devascularization. Embolization procedure itself component intervention regional drug, gene, radiation, biologic therapies. staged particularly cases complex multiple lesions. Technical immediate angiographic result typically evaluated completion angiography. Clinical reflects measured results within 30 days assessed imaging follow-up both. Complete resolution signs symptoms prompted Partial significant positive impact course subsequent need reintervention (eg, minimal blood-tinged sputum successful massive hemoptysis) (4Hayakawa K. Tanaka F. 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Chong B.W. al.Advances biomaterials technologies embolization.Adv Mater. 2019; 31e1901071Crossref (24) Therefore, selection each scenario indication utmost importance deliver while also minimizing collateral injury adjacent structures. example, nonclumping, smaller particles (<700 microns) higher tissue necrosis should caution only when goal. Smaller particles, 100–300 micron size, yield than 300–500 larger less (9Maeda N. Verret V. Moine L. al.Targeting recanalization calibrated resorbable microspheres versus hand-cut gelatin sponge porcine kidney model.J 2013; 24: 1391-1398Abstract Gelfoam slurry pledgets agent, postpartum where preservation future fertility desired, setting trauma (10Soyer P. Dohan A. Dautry R. al.Transcatheter hemorrhage: technique, results, complications.Cardiovasc 2015; 38: 1068-1081Crossref (37) note many, if all, options setting. However, tremendous size weight children, extremely difficult strict type optimal, suggested operators requisite experience.Table 1Embolization Devices AgentsEmbolization Devices•Coils•Stents•Plugs•BalloonsParticulate AgentsNoncalibrated particles•Permanent?Nonspherical PVA particles?Spherical PVA?Acryl microspheres•Temporary?GelfoamCalibrated Particles•Permanent?TGMSLiquids/Gels?FDA liquid gel embolics limited. Off-label reported safe studies, but they advanced training safely.Sclerosing Agents•Ethanol#Although sclerosant, purposes.•Sodium tetradecyl sulfateˆA true sclerosant administered intra-arterially.•PolidocanolˆA intra-arterially.In Situ•EVOH•Thrombin+An enzyme physiologic create autologous clot purposes addition direct injection promote situ thrombosis pseudoaneurysms.Shear Thinning•N-butyl-2-cyanoacrylateEVOH = ethylene vinyl alcohol copolymer; polyvinyl alcohol; TGMS trisacryl microspheres.? FDA safely.# Although purposes.ˆ intra-arterially.+ pseudoaneurysms. 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