Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/22566
Title: Endovascular embolization of canine hepatic arteriovenous malformations using precipitating hydrophobic injectable liquid (PHIL) liquid embolic agent: a proof of concept study.
Austin Authors: Ryan, Stewart D;Nambiar, Anjali;Maingard, Julian T;Kok, Hong Kuan;Turner, Robert B S;Brooks, Duncan Mark ;Asadi, Hamed 
Affiliation: TRACTS, UVet Hospital, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Melbourne, Australia
School of Medicine and Dentistry, James Cook University, Townsville, Australia
Interventional Neuroradiology Unit, Monash Health, Melbourne, Australia
TRACTS, UVet Hospital, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Melbourne, Australia
Interventional Radiology Service, Northern Hospital Radiology, Melbourne, Australia
Interventional Radiology Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
Interventional Neuroradiology Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
Issue Date: 1-Aug-2019
metadata.dc.date: 2019-08-01
Publication information: CVIR endovascular 2019; 2(1): 27
Abstract: Hepatic arteriovenous malformations (HAVMs) are rare congenital lesions consisting of multiple high-pressure arteries feeding into low-pressure veins via a central nidus. Massive haemorrhage, portal hypertension and hepatic insufficiency can ensue. Endovascular embolization is increasingly a first line treatment method although there is no general consensus or guidelines on the most effective embolic agent or approach. We describe the novel treatment of two dogs with congenital hepatic AVMs using a modified version of the 'pressure cooker' technique often utilised in neurointervention with the DMSO-based PHIL embolic agent delivered via the DMSO compatible Scepter-XC dual lumen balloon catheter. Two paediatric dogs were diagnosed with hepatic AVMs. Both dogs presented with ascites and abnormal liver function tests. CT angiograms revealed hepatic arterio-portal malformations arising from an enlarged celiac artery. Selective catheterisation of the artery supplying the AVM was achieved via a femoral artery approach. A Scepter XC dual-lumen compliant balloon microcatheter and Traxcess 0.014 guidewire combination was advanced to the nidus via through the 5Fr guide catheter towards the nidus. Inflation of the balloon occluded arterial inflow and PHIL was injected under continuous fluoroscopic screening until the PHIL embolic agent penetrated into the draining portal vein beyond the nidus. In patient 1, normal portal venous waveform was restored with reversal of severe hepatic insufficiency. Whilst there was initial improvement post-operatively in patient 2 with normalisation of portal vein pressures and flow, opening of collateral nidus vessels re-established the high-pressure communication, and euthanasia was elected by the owner. The 'pressure cooker' technique is a safe and efficacious approach to the treatment of canine HAVMs. The novel use of PHIL and the Scepter XC balloon catheter has several advantages over conventional endovascular approaches. Translational application to human paediatric interventions for similar conditions where embolic and contrast agent volume constraints are similar can be considered.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22566
DOI: 10.1186/s42155-019-0070-4
ORCID: 0000-0003-2475-9727
0000-0001-8958-2411
0000-0001-7016-771X
PubMed URL: 32026126
Type: Journal Article
Subjects: Hepatic arteriovenous malformation
Liquid embolic
PHIL
Scepter XC
Appears in Collections:Journal articles

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