eMedicine Specialties > Radiology > Vascular/Interventional
Embolization, Vascular Lesions: Multimedia
Updated: Oct 27, 2009
Multimedia
 | Media file 1: Digital subtraction angiogram shows a small arteriovenous malformation in the lateral aspect of the foot. A small feeder vessel is seen arising from the widely patent posterior tibial artery. An early draining vein is demonstrated clearly. Delayed opacification of the dorsalis pedis artery (not seen) is secondary to proximal anterior tibial arterial disease. These small arteriovenous malformations are occasionally encountered during arteriography in the extremities of elderly patients. The importance of the lesions is unclear in this patient population. If a similar lesion were encountered in a young child, it would be a more significant finding, one possibly requiring treatment. |
 | Media file 2: Arteriovenous malformation in the foot. This is an example of an extensive form of arteriovenous malformation. In most patients, the lesions require aggressive treatment by means of surgical excision, transcatheter embolization, or both. The feeders arise from large-caliber foot arteries, and obvious arteriovenous connections (nidus) are seen. Most of these are centered in the midfoot. |
 | Media file 3: Transluminal embolization using a microcatheter (same patient as in Image 2 in Multimedia). These lesions usually require embolotherapy with precise embolization techniques. Small feeders are catheterized by using a microcatheter and embolized with embolic material (eg, alcohol) under continuous fluoroscopic control. The tip of the microcatheter is in a tiny plantar feeding artery on this image. |
 | Media file 4: Postembolization arteriogram (same patient as in Images 2-3 in Multimedia). After successful embolization, significant improvement is seen because most of the arteriovenous connections have disappeared. |
 | Media file 5: A lower-extremity venogram (digital subtraction angiogram) in a patient with a venous malformation in the upper calf. The deep veins are patent but appear to be displaced by the vascular malformation. |
 | Media file 6: Direct intralesional contrast agent injection into a vascular lesion in the upper calf (same patient as in Image 5 in Multimedia). This type of contrast agent filling, with or without opacification of the draining veins, is characteristic of the venous malformation. Contrast material outlines the malformation without opacification of the draining veins. Because no draining veins are present, a sclerosant agent can be safely injected into the lesion (sclerotherapy). |
 | Media file 7: Venous malformation following intralesional sclerosant injection (same patient as in Images 5-6 in Multimedia). This is the expected appearance of a venous malformation after sclerotherapy. Speckled contrast agent collections are scattered throughout the malformation. |
 | Media file 8: Axial CT image through the upper part of the neck after percutaneous cyanoacrylate embolization. The patient was a young girl with an extensive head and neck venous malformation resulting in significant airway obstruction, which required a tracheostomy. |
 | Media file 9: Contrast material injection in the gastroduodenal artery via a microcatheter demonstrates a tiny saccular aneurysm in a patient who presented with upper gastrointestinal bleeding. |
 | Media file 10: Postembolization with coils (same patient as in Image 9 in Multimedia). The involved proximal segment of the gastroduodenal artery was embolized with several microcoils. The patient's bleeding episode ceased immediately. |
 | Media file 11: Contrast agent injection in the common bronchial artery demonstrates prominent bronchial arteries bilaterally, with patchy hypervascularities over the lung fields, particularly in the left upper lung. This is the most commonly seen angiographic appearance in patients with hemoptysis. Contrast agent extravasation is encountered only rarely. |
 | Media file 12: Uterine artery angiography (preembolization). |
 | Media file 13: Uterine artery angiography (postembolization) (same patient as in Image 12 in Multimedia). |
 | Media file 14: Chemoembolization. Contrast agent injection in the common hepatic artery. A tumoral stain is identified within the region of the porta hepatis. |
 | Media file 15: Postchemoembolization image in the same patient as in Image 14 in Multimedia. |
 | Media file 16: Contrast agent injection in the left spermatic vein fills the vein below the inguinal ring. This finding is consistent with a varicocele. |
 | Media file 17: Embolotherapy was successfully performed by means of sclerotherapy with sodium tetradecyl and coil embolization, both proximally and distally (same patient as in Image 16 in Multimedia). |
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References
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Keywords
vascular lesion embolization, transcatheter embolization, embolotherapy, minimally invasive treatment, sclerotherapy, vascular occlusion, chemoembolization, vascular anomalies, arteriovenous malformation, venous malformation, hemangioma, lymphatic malformation, hemorrhage
