Endovascular particle embolization is a common procedure with a relatively safe profile. We report here four cases in which cranial nerves, skin and mucosal ischemic complications occurred with the use of hydrogel microspheres (250–500 µm in size). Given the compressibility and higher penetration potential of microsphere particles compared with polyvinyl alcohol particles of similar size, we suggest oversizing hydrogel microsphere particles for head and neck embolizations.
DubelGJAhnSHSoaresGM. Transcatheter embolization in the management of epistaxis. Semin Intervent Radiol2013; 30: 249–262.
2.
QuislingRGMickleJPBallingerW. Small particle polyvinyl alcohol embolization of cranial lesions with minimal arteriolar-capillary barriers. Surg Neurol1986; 25: 243–252.
3.
WehrliMLieberherrUValavanisA. Superselective embolization for intractable epistaxis: experiences with 19 patients. Clin Otolaryngol Allied Sci1988; 13: 415–420.
4.
EldenLMontaneraWTerbruggeK. Angiographic embolization for the treatment of epistaxis: a review of 108 cases. Otolaryngol Head Neck Surg1994; 111: 44–50.
5.
MoreauSDe RugyMGBabinE. Supraselective embolization in intractable epistaxis: review of 45 cases. The Laryngoscope1998; 108: 887–888.
6.
TsengEYNarducciCAWillingSJ. Angiographic embolization for epistaxis: a review of 114 cases. The Laryngoscope1998; 108: 615–619.
7.
RicciGMoliniEHamamM. Treatment of severe epistaxis by superselective embolization: a review of 22 cases. Rev Laryngol Otol Rhinol (Bord)2004; 125: 247–251.
8.
AndersenPJKjeldsenADNepper-RasmussenJ. Selective embolization in the treatment of intractable epistaxis. Acta Otolaryngol2005; 125: 293–297.
9.
OzanneAPereiraVKringsT. Arterial vascularization of the cranial nerves. Neuroimag Clin North Am2008; 18: 431–439, xii.
10.
TadavarthySMMollerJHAmplatzK. Polyvinyl alcohol (Ivalon) – a new embolic material. Am J Roentgenol Radium Ther Nucl Med1975; 125: 609–616.
11.
SokoloffJWickbomIMcDonaldD. Therapeutic percutaneous embolization in intractable epistaxis. Radiology1974; 111: 285–287.
12.
DerdeynCPMoranCJCrossDT. Polyvinyl alcohol particle size and suspension characteristics. AJNR Am J Neuroradiol1995; 16: 1335–1343.
13.
BerensteinAGraebDA. Convenient preparation of ready-to-use particles in polyvinyl alcohol foam suspension for embolization. Radiology1982; 145: 846.
LasjauniasP. Nasopharyngeal angiofibromas: hazards of embolization. Radiology1980; 136: 119–123.
16.
RepaIMoradianGPDehnerLP. Mortalities associated with use of a commercial suspension of polyvinyl alcohol. Radiology1989; 170: 395–399.
17.
GottumukkalaRKadkhodayanYMoranCJ. Impact of vessel choice on outcomes of polyvinyl alcohol embolization for intractable idiopathic epistaxis. J Vasc Interv Radiol2013; 24: 234–239.
18.
YilmazMMamanovMYenerM. Acute ischemia of the parotid gland and auricle following embolization for epistaxis. The Laryngoscope2013; 123: 366–368.
19.
SadriMMidwinterKAhmedA. Assessment of safety and efficacy of arterial embolisation in the management of intractable epistaxis. Eur Arch Otorhinolaryngol2006; 263: 560–566.
20.
HorakDSvecFKalalJ. Hydrogels in endovascular embolization. I. Spherical particles of poly(2-hydroxyethyl methacrylate) and their medico-biological properties. Biomaterials1986; 7: 188–192.
21.
JayakrishnanAThanooBCRathinamK. Preparation and evaluation of radiopaque hydrogel microspheres based on PHEMA/iothalamic acid and PHEMA/iopanoic acid as particulate emboli. J Biomed Mater Res1990; 24: 993–1004.
22.
RaoVRRavimandalamKJayakrishnanA. Hydrolysed microspheres from cross-linked polymethyl methacrylate (Hydrogel). A new embolic material for interventional neuroradiology. J Neuroradiol1991; 18: 61–69.
23.
LaurentABeaujeuxRWassefM. Trisacryl gelatin microspheres for therapeutic embolization, I: development and in vitro evaluation. AJNR Am J Neuroradiol1996; 17: 533–540.
24.
LaurentA. Microspheres and nonspherical particles for embolization. Tech Vasc Interv Radiol2007; 10: 248–256.
StampflSStampflUBellemannN. Biocompatibility and recanalization characteristics of hydrogel microspheres with polyzene-F as polymer coating. Cardiovasc Intervent Radiol2008; 31: 799–806.
27.
BonomoGPediciniVMonfardiniL. Bland embolization in patients with unresectable hepatocellular carcinoma using precise, tightly size-calibrated, anti-inflammatory microparticles: first clinical experience and one-year follow-up. Cardiovasc Intervent Radiol2010; 33: 552–559.
28.
SluzewskiMvan RooijWJLohlePN. Embolization of meningiomas: comparison of safety between calibrated microspheres and polyvinyl-alcohol particles as embolic agents. AJNR Am J Neuroradiol2013; 34: 727–729.
29.
DerdeynCPGravesVBSalamatMS. Collagen-coated acrylic microspheres for embolotherapy: in vivo and in vitro characteristics. AJNR Am J Neuroradiol1997; 18: 647–653.
30.
BeaujeuxRLaurentAWassefM. Trisacryl gelatin microspheres for therapeutic embolization, II: preliminary clinical evaluation in tumors and arteriovenous malformations. AJNR Am J Neuroradiol1996; 17: 541–548.
31.
SpiesJBAllisonSFlickP. Polyvinyl alcohol particles and tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a randomized comparative study. J Vasc Interv Radiol2004; 15: 793–800.
32.
BilhimTPiscoJMDuarteM. Polyvinyl alcohol particle size for uterine artery embolization: a prospective randomized study of initial use of 350–500 mum particles versus initial use of 500–700 mum particles. J Vasc Interv Radiol2011; 22: 21–27.
33.
Worthington-KirschRLSiskinGPHegenerP. Comparison of the efficacy of the embolic agents acrylamido polyvinyl alcohol microspheres and tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: a prospective randomized controlled trial. Cardiovasc Intervent Radiol2011; 34: 493–501.
34.
YuSCLokIHoSS. Comparison of clinical outcomes of tris-acryl microspheres versus polyvinyl alcohol microspheres for uterine artery embolization for leiomyomas: results of a randomized trial. J Vasc Interv Radiol2011; 22: 1229–1235.
35.
Shlansky-GoldbergRDRosenMAMondscheinJI. Comparison of polyvinyl alcohol microspheres and tris-acryl gelatin microspheres for uterine fibroid embolization: results of a single-center randomized study. J Vasc Interv Radiol2014; 25: 823–832.