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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3869_Библиотеки_им_академика_М_И_Перельмана.pdf
486 P.A. Stangl
Follow-Up
• Clinical observation for ongoing hemorrhage.
• Imaging typically not necessary.
• Hemorrhage related to retained products of conception may require dilatation and
curettage as definitive therapy.
• Normal menses and fertility can be expected in most cases after several months.
• Multiple cases of successful pregnancy and delivery following embolization for
PPH have been reported.
• Recurrence rates of PPH with subsequent deliveries are likely higher than the
incidence in the general population.
Alternative Therapies
• Surgical treatment typically involves ligation of both IIAs.
• Patients with persistent hemorrhage proceed to hysterectomy.
• Surgery can usually be avoided where there are clear protocols in place for the
management of PPH.
• Case selection and utilization of endovascular therapy vary widely across
institutions.
Specific Complications
• Unsuccessful embolizations—minority of cases require repeat embolization, and
failures requiring surgery are rare.
• Non-target embolization resulting in symptomatic lower extremity ischemia has
been described; standard techniques of careful embolization under fluoroscopy
should prevent most instances of non-target embolization.
• Ischemic complications in the distribution of the anterior division of the IIA have
been reported i n 3–7% of patients. Such complications include uterine necrosis, transient ovarian failure, bladder necrosis, vaginal fistulae, muscle pain, and
neurological damage.
• Use of temporary embolic agents (gelfoam) or larger particles should minimize
ischemic complications.
• Theoretical concerns about radiation and embolization impacting fertility have
largely been allayed (the alternative, hysterectomy, has a clear impact on
fertility).
Keypoints
• Work with the labor and delivery team to develop a strategy and written
protocol.
48 Post-partum Hemorrhage: Embolization and Endovascular Management 487
• Embolization for PPH is an established therapy, safe, and effective.
• Negative angiographic findings do NOT contraindicate embolization.
• Embolization is appropriate before, during, after, or instead of surgery.
• Bilateral embolization is necessary for uterine bleeding unless a specific
bleeding source is identified.
Suggested Reading
Banovac F, Lin R, Shah, D, White A, Pelage JP, Spies J. Angiographic and Interventional
Options in Obstetric and Gynecologic Emergencies. Obstetric and Gynecologic Clinics of North
America 2007;34(3):599–616
Eriksson LG, Mulic-Lutvica A, Jangland L, Nyman R. Massive Postpartum Hemorrhage Treated
with Transcatheter Arterial Embolization: Technical Aspects and Long-Term Effects on Fertility
and Menstrual Cycle. Acta Radiologica 2007;48(6):635–642
Mitty HA, Sterling KM, Alvarez M, Gendler R. Obstetric Hemorrhage: Prophylactic and
Emergency Arterial Catheterization and Embolotherapy. Radiology 1993;188(1):183–187
Index
A
AAA, see Abdominal aortic aneurysm (AAA)
Abdominal aortic aneurysm (AAA)
endovascular repair, 375
perfusion after endovascular stent-graft
deployment, see Endoleaks
Abdominal embolization, pre-procedure
imaging of
acute gastrointestinal tract hemorrhage,
92–96
trauma, 96–97
Absolute alcohol, 52–53
ACA, see Anterior cerebral artery (ACA)
Accessory renal arteries, 217
Acrylamido polyvinyl alcohol microspheres,
32
Acrylic polymer microspheres, 429
ACT, see Activated clotting time (ACT)
Activated clotting time (ACT), 420
Active extravasation, 93, 299
AML, see Angiomyolipoma (AML)
Amplatzer vascular plug (AVP), 265, 410
deployment of, 24–26
self-expanding nitinol wire mesh, 24–25
sizes of, 25
Analgesia
during embolization procedures, 113–115
following embolization procedures, 117
medications for, 114–115
for PES, 131–133
and sedation, 111
Anchor technique, 22–23, 154, 166
Anesthesia, 65, 387
Aneurysm, 395
rupture of, 285
size of, 388
See also Abdominal aortic aneurysm
(AAA); Internal iliac artery
aneurysm (IIAA)
Angiodysplasia, 346
Angiography, 107, 388, 397, 399
of AVF, 163
of extremity vascular injury, 254–255
of high-flow lesions, 143–144
of inferior pancreaticoduodenal artery
pseudoaneurysm, 338
of internal iliac artery aneurysm, 380
of low-flow lesions, 137
in patient with recurrent hemoptysis, 351
of PAVMs, 152
of pelvic AVM, 143
performing, 107–108
of post-operative hemorrhage, 298
of priapism, 279
of renal metastasis in femur, 122
of trauma, 266
of upper gastrointestinal hemorrhage,
334–335
of upper GI hemorrhage, 337
of uterine artery, 236–237
of vascular large right renal cancer, 216
Angiomyolipoma (AML), 215–216
Angioplasty balloon, 397
Anterior cerebral artery (ACA), 428
Antibiotics for PES, 132
Anticoagulation, 388
Antiemetics for PES, 132–133
Aortocaval fistulae, 166
Arterial anatomy of target lesion
arterial variations, 5
end arterial supply, 6–7
Arteriography
bronchial, 352–354
of hemorrhage in pelvis fracture, 241–242
of neuroendocrine hepatic metastases, 209
selective inferior pancreatico-duodenal,
285
of upper extremity, 252
Transcatheter Embolization and Therapy,
Techniques in Interventional Radiology, DOI 10.1007/978-1-84800-897-7,
C
Springer-Verlag London Limited 2010
489
490 Index
Arteriovenous fistula (AVF), 163, 257
aftercare of, 169–170
angiography, 161–163
cardiovascular effects, 157
diagnostic evaluation
CTA, 158–159
laboratory evaluation, 158
ultrasound, 158
embolization therapy for
anatomical considerations in, 160
ancho approach, 166
arterial approach, 168
catheters in, 160
complications in, 160
contraindications for, 160
embolic agent in, 160–161
indications for, 159
liquid agent in, 167–168
occlusion devices in, 166–167
stents, 168
venous approach, 169
etiology of, 163–164
follow-up, 170
high-output states in, 158
local effects, 157
medications for, 161
physical examination, 157
post-procedure pain medications, 170
renal, 164
surgical interventions for, 159
Arteriovenous shunting (AV), 122
Atherosclerotic disease, 415
Autologous blood clot
applications, 42–43
physical properties, 41
preparation, 42
problems associated with, 43
AV, see Arteriovenous shunting (AV)
AV F, see Arteriovenous fistula (AVF)
AV P, see Amplatzer vascular plug (AVP)
Avulsions, 455
Axial T1-weighted images, loculated
transfacial multicystic mass, 461
Axillary artery injury, 258
B
Balloon remodeling, 388
Benign hypervascular lesions, 186
Benzodiazepine, 410
Biliary drainage, 390
Bioabsorbable polymeric GDC coils, 17
BIPP, see Bismuth iodophore paste (BIPP)
Bismuth iodophore paste (BIPP), 421
Bland embolization
in hepatic metastases, 201
vs. TACE, 190–191
Bleeding
around drains, 311
causes of, 293
following biopsy, see Post-biopsy
hemorrhage
following “blind” procedures, 311
Bleomycin, 465–466
Blunt abdominal trauma
alternative therapies for
contraindications to, 263–264
surgery, 263
angiography of
complications associated with, 264
vascular abnormalities, 266
clinical evaluation of, 261–262
clinical features, 261
contrast-enhanced CT of, 262
embolization of
aftercare, 272
embolic agent for, 265
equipment for, 264–265
indications to, 263
kidney, 269–272
liver, 267
spleen, 268–269
FAST scan of, 262
See also Trauma
Blunt injury, 249
Bolus administration, 209
Bone tumor
complications in, 228
contraindications to, 224
diagnostic evaluation, 223–225
embolization
access approach, 225
angiography, 226
complications in, 224
embolic agents, 225
equipment, 225
follow-up, 228
palliative, 227
PES in, 228
pre-operative, 226–227
indications for, 224
Brachial artery access, 192, 254
Brachial artery injury, 258
Bronchial arteries
anastomoses between, 355
anatomy of, 87, 352
filling from internal mammary artery, 354
Index 491
and intercostal arteries, 352
superselective catheterization of, 30
spinal branches of, 352, 354
Bronchial arteriography, 352–354
Bronchial artery embolization (BAE), 349
aftercare, 360
catheters for, 355–356
for cystic fibrosis, 351
embolic agents for, 356
for hemoptysis, 30, 351
medication in, 356–357
patient follow-up, 360
procedure, 359
safety, 361
Bronchial artery false aneurysm, 358
Bronchial circulation, pathological, 357
C
Capillary malformation, 173–174
Caroticum, see Carotid body
Carotid body, 425
Catheter, 122, 387
blocking of, 125–126
for bone tumor embolization, 225
factors influencing selection of
anatomy of target vessel, 75
diagnostic angiography, 75–76
embolic agents, 76–77
need for co-axial system, 77
handling properties of, 77, 79–80
for HCC embolization, 189
hydrophilic, 80
non-selective, 151
position, 123
prophylactic placement of, 484–486
reverse curve, 77–78
selective, 151
shapes, 75–77
for trauma embolization, 264–265
Catheter angiography
extremity trauma, 251
extremity vascular injury, 251
systemic arteriovenous fistulae, 158
vs. MDCT, 92–93
Catheter-induced vasospasm, 357
Cavernosal blood gas analysis, 276
CECT, see Contrast-enhanced computed
tomography (CECT)
Celiac artery, 385
anatomical variations of, 264
Celiac axis arteriogram of liver with
hypervascular lesions, 210
CEMRI, see Contrast-enhanced MRI (CEMRI)
Chemoembolization premedication regimen,
209
Chylothorax
causes of, 471
contraindications to, 475
embolization
case study, 479
embolic agent for, 476
equipment, 476
guidewire, 477–478
midline skin puncture in, 477
occlusion of proximal thoracic duct,
478
etiology of, 471
imaging of, 472
surgical intervention for, 473, 475
thoracentesis in, 472
treatment of, 478
etilefrine, 474
MCT diet, 474
somatastatin/octreotide, 474
unremitting, 472
CIN, see Contrast-induced nephropathy (CIN)
Closed system, 154
Coagulation disorders, 416
Coagulopathies, 299
Coaxial technique, 22
Cobra catheter, 10
Coil embolization, 16
anchoring techniques, 22–24
in AVF, 164
coil extrusion, 21–22
coil introduction, 21
minimizing complications associated with,
26
stable catheter positioning, 20–21
Coil pusher, 21
Coils, see Embolization coils
Collateral supply, 122
from branch of cystic artery, 131
from gastroduodenal artery, 6
from right renal artery, 217
from uterine arteries, 235
Colonoscopy
for diverticular hemorrhage, 346
elective, 346
Common iliac artery, 243
Completion venogram post-embolization, 408
Computed tomography angiography (CTA)
with 3D reconstruction of AVF, 158–159
of extremity vascular injury, 249
of lower GI hemorrhage, 341
492 Index
of massive hematemesis, 335
of upper gastrointestinal hemorrhage,
331–332, 337
Computed tomography (CT) scan
of blunt abdominal trauma, 268
with intravenous contrast in
distal splenic embolization, 269
proximal splenic embolization, 269
of patient with massive hematemesis, 285,
287
in patient with severe hypotension after
biopsy of right kidney, 313
of pelvis, 245
of post-pancreatitis pseudoaneurysm, 286
Congenital arteriovenous fistulae, 163
Congenital bronchial atresia, 92
Congenital pulmonary varix, 92
Contralateral lobe puncture, 407
Contrast-enhanced computed tomography
(CECT)
of endoleaks, 376
of metastatic neuroendocrine tumor, 211
of pancreatic hemorrhage, 283
of PAVMs, 149
of post-operative hemorrhage, 294
of trauma, 262
Contrast-enhanced MRI (CEMRI)
of UAE, 232
Contrast-enhanced multidetector computed
tomography, 105
image reconstruction in, 106
purpose of, 106
Contrast-induced nephropathy (CIN)
definition of, 118
prevention of, 118
risk factors for, 118
Contrast media, safe administration of, 118
Cook Bentson wire, 84
Coronal T2-weighted image, microcystic
lympangioma, 460
CTA, see Computed tomography angiography
(CTA)
CT scan, see Computed tomography (CT) scan
Cyanoacrylate, 420
Cyanoacrylate glue, 408
D
DEB-TACE, see Drug-eluting
bead-transarterial
chemoembolization (DEB-TACE)
Deep vein thrombosis (DVT), 445
Detachable coils, 24–26
Detectable microspheres, 37
Digital subtraction angiogram, 165
after coil embolization of right lumbar
pseudoaneurysm, 315
of cecal bleeding, 342
of common hepatic artery, 165
of PPH, 484
Dimethyl sulfoxide (DMSO), 55–57
Diode lasers
for E VLA, 63
for occlusion of blood vessels, 62
Direct fluoroscopic angiography, 374
Distal embolization, 269
Diverticular hemorrhage, 341
DMSO, see Dimethyl sulfoxide (DMSO)
Double-curve catheters, 78
Doxorubicin-eluting microspheres, 35
Doxycycline, 466, 467
Drainage catheter upsizing, 311–312
Drug-eluting beads
for HCC embolization, 190, 193
for neuroendocrine hepatic metastases
embolization, 207
Drug-eluting bead-transarterial
chemoembolization (DEB-TACE),
197
in hepatic metastases, 201
Drug-eluting microspheres
factors influencing, 35
types of, 34–35
DVT, see Deep vein thrombosis (DVT)
Dysplastic nodules, 186
E
ECA, see External carotid artery (ECA)
Ehlers–Danlos syndrome, 384
Embolic material, 151, 254, 407
for AVF embolization, 159
for blunt abdominal trauma embolization,
265
for bone tumor embolization, 225
for chylothorax embolization, 476
classification, 29–30
delivery of, 11–12
developments of, 69
for endoleak embolization, 373
for extremity vascular injury embolization,
254
factors influencing selection of, 7, 15, 122
for HCC embolization, 190
for high-flow lesions, 144
for IIAA embolization, 380
liquid, see Liquid embolic agents
for Lower GI hemorrhage embolization,
343–344, 347
Index 493
for neuroendocrine hepatic metastases
embolization, 208
for pancreatic hemorrhage embolization,
287–288
PAVM embolization, 151
permanent particulate, see Permanent
particulate embolization agents
for post-biopsy hemorrhage embolization,
316
for post-operative hemorrhage
embolization, 297, 299
for priapism embolization, 278
pulmonary arterial hemorrhage
embolization, 366
silk suture, 17
temporary, see Temporary embolic agents
for trauma embolization, 265
tris-acryl microspheres, 29, 33
for UGIH embolization, 334
Embolization coils, 16
deployment steps
anchoring techniques, 22–24
coil extrusion, 21–22
coil introduction, 21
stable catheter positioning, 20–21
materials of
issues associated with, 18
physical properties of, 17–19
retrieval of, 126–127
shapes of, 19
sizes of, 20
terminology, 20
thrombogenicity of, 18–19
Embolization therapy
access equipments for
catheter, see Catheter
guidewires, 83
microcatheters, 80–81
occlusion balloons, see Occlusion
balloons
vascular sheaths, 82–83
adverse outcomes of, 111
choice of particle size for, 38
collateral pathways in, 5–7
complications
blocked catheter, 125–126
detection and recognition, 124–125
non-target embolization, 126
prevention, 121–124
tissue necrosis, 127
goal of, 179
indications for
high-flow lesions, 143
low-flow lesions, 137
inducing cell replication, 71
of large hepatoma, 131
likely outcomes of, 7–8
objectives, 3
performing
informing patient and clinicians in,
8–9
vascular access, 9
planning
pathological process, 4
roles of alternative therapies, 4
target lesion identification, 5
post-procedural considerations, 112
administration of contrast media, 118
imaging modalities, 125
sedation and analgesia administration,
117
pre-procedural considerations, 112
preserving vessels in, 12
procedural considerations, 112–113
complications, 115–116
medications, 114–115
sedation and analgesia administration,
113–115
staff and care e quipement, 113–114
selective catheterization in, see Selective
catheterization
target of
disease process, 182
patients, 181
target organs, 181
vascular occlusion in, 7
Embolized tissue/organ
long-term effects of, 181
short-term effects of, 180
Embolotherapy, see Embolization therapy
Emergency equipment, 114
End arteries
embolization of, 7
occlusion of, 6
Endoleaks
angiography of, 374
contrast-enhanced CT scan of, 376
definition, 371
embolization, 371
aftercare, 375
catheters for, 373
embolic agents for, 373
patient follow-up, 375
imaging, 372
lesion assessment, 374
medication for, 373
494 Index
treatment plan, 374–375
types, 371
Endovascular treatments, 400
Epistaxis
aftercare
arterial puncture site, 422
post-embolization, 423
anatomy of, 418
angiography
access, 420
angiographic a ppearance, 421
ECA, 420–421
catheters for embolization of, 418–419
clinical features, 415
definition of, 415
diagnostic evaluation
imaging, 416
laboratory, 416
nasal endoscopy, 415
embolic agents, 420
follow-up, 423
management of
contraindications, 417
indications for embolization, 416–417
initial therapy, 416
specific complications, 418
medication, 420
treatment plan and technique
hereditary hemorrhagic telangiectasia,
422
juvenile nasal angiofibroma, 422
spontaneous epistaxis, 421–422
trauma including traumatic
pseudoaneurysms, 422
Ethylene vinyl alcohol (EVOH), 55–57
Etilefrine, 474
EVOH, see Ethylene vinyl alcohol (EVOH)
Exchange catheters, 84
External carotid artery (ECA), 418
External iliac artery, 243
Extra-hepatic supply, 188
Extremity vascular injury
alternative therapies for, 251
analgesia and sedation for, 254
angiography of, 254–255
clinical evaluation of, 250
clinical manifestations of, 249
contraindications for, 252
embolization of
catheters for, 253–254
embolic agents for, 254
findings of, 255
imaging of, 250–251
indications for, 251
intervention for, 249
mechanisms of, 249
F
FAST scan, see Focused assessment with
sonography for trauma (FAST)
scan
Fibro-muscular dysplasia, 395
Fluoroscopic imaging
contrast injected, 467
direct, 372
Flush aortogram, 397
Foam sclerotherapy injection in breast veins,
456
Focused assessment with sonography for
trauma (FAST) scan
of trauma, 105, 262
G
Gadolinium, 427
Gastroduodenal artery (GDA)
embolization, 336
pseudoeneurysm, 6, 94
GDA, see Gastroduodenal artery (GDA)
Gelatin sponge, 43
Gelfoam pledgets, 265
for tract embolization, 307
Gene therapy, 69
challenges in, 70
gene transfer/modulation mechanism, 70
mode of action of, 70
roles for interventional radiology, 71
for vascular embolization, 71
Glycerine trinitrate (GTN), 422
Gonadal vein
embolization, 435
left/right, 438
Gonadal vein reflux, 435
aftercare, 441
alternative therapies for, 437
anatomy of, 438
angiographic a ppearance of, 440
catheters for embolization of, 439
clinical features, 435
clinical scenarios, 440–441
complications
back/scrotal pain, 437
post-embolization syndrome, 437
vasovagal episodes, 437
contraindications
general, 437
specific, 437
diagnostic evaluation, 435
Index 495
females with pelvic pain, 436
males with varicocele, 436
embolic agents, 439
female, 437
follow-up, 442
indications for, 436
male, 436
medication, 439
post-embolization, 442
treatment plan and technique
ovarian vein, 441
spermatic vein, 441
venography
access, 439
jugular route, 439
transfemoral route, 440
venous puncture site, 442
Gonadal venogram, 440
Gore Viabahn-covered stent, 402
Great saphenous vein, EVLA ablation of, 446
Gross great saphenous varicose veins
pre-treatment, 446
GTN, see Glycerine trinitrate (GTN)
Guidewires, 83
Guiding catheters, 83
H
HCC, see Hepatocellular carcinoma (HCC)
Heat-induced vessel occlusion
applications of, 66
by lasers, 64
by radiofrequency, 65–66
Hemangiopericytoma, 426
Hemoptysis, 349
adjunctive and alternative therapies for, 351
causes of, 349
complications to, 351–352
CT and CXR imaging of, 350
indications for, 351
infection control in, 357
laboratory examination of, 350
pre-procedure imaging of, 87–88
treatment plan and technique, 359
Hemorrhage
following pancreatic surgery, 283
in pancreatitis, 283
Hepatic artery, 188
variability in anatomy of, 188, 208
Hepatic embolization
in clinical scenarios, 267
complications of, 267–268
See also Liver embolization
post-percutaneous biopsy/drainage
Hepatic metastases
clinical features, 197
complications of, 202
diagnostic evaluation
clinical examination, 197
laboratory tests, 198
pre-treatment angiography, 198
embolic therapeutic options for, 197
equipment uses in, 199
treatment procedure, 200
treatment results, 201
follow-up of, 200–201
patient preparation, 199
post-procedure medications, 200
pre-procedure medications, 199
See also Hepatocellular carcinoma (HCC)
Hepatocellular carcinoma (HCC)
chemoembolization for, 193–194
diagnosis of, 185
CT and MRI, 185–186
differential diagnosis of, 186
epidemiology of, 185
non-selective angiography of, 192–193
post-procedure care of, 194
post-procedure follow-up, 194
pre-procedure evaluation of, 187
radioembolization for, 191
TAC E fo r
anatomic considerations in, 188
bland embolization vs., 190–191
catheter, 189
embolic agents in, 190
indications and contraindications for,
187
patient consent for performing, 189
selective vs. non-selective, 191
Hereditary hemorrhagic telangiectasia (HHT),
147–148
HHT, see Hereditary hemorrhagic
telangiectasia (HHT)
HIF-1, see Hypoxia inducible factor 1 (HIF-1)
High-flow lesions
alternative therapies, 143
anatomy, 144
angiography, 144–145
blood tests, 143
clinical examination, 143
contraindications, 144
embolic agents for, 144
indications for embolization, 143
medication, 144
patient follow-up, 146
post-embolization, 146
496 Index
treatment plan and technique, 145–146
ultrasound and MRI of, 143
High flow priapism, 275
Hydrogel coil, 398
Hydrogel–polyzene F microspheres, 33
Hydrophilic-coated nitinol wire, 84
Hydrophilic hydrogel-coated platinum coils,
17
Hypertension, 395
Hypertrophy of bone and soft tissues, 173
Hypervascular lesions, 208
Hypervascular metastatic bone tumors, 223
Hypervascular paragangliomas, 427
Hypervascular renal cell cancer, 417
Hypotension
CT examination in patient with severe, 313
evaluation and treatment of, 116
Hypoxia i nducible factor 1 (HIF-1), 180
I
Iatrogenic arteriovenous fistulae, 164
Iatrogenic injury during central line placement,
300
Ibuprofen-loaded microspheres, 34
ICA, see Internal carotid artery (ICA)
IIAA, see Internal iliac artery aneurysm (IIAA)
Iliac artery, 400
IMA, see Internal maxillary artery (IMA)
Imaging departments, considerations for, 108
Inferior epigastric artery, 243
Inflow and outflow arteries, occlusion of, 6
Interlocking detachable coils, 22
Internal carotid artery (ICA), 418
pseudoaneurysms of, 421
Internal iliac artery, 243, 245
aneurysm, see Internal iliac artery
aneurysm (IIAA)
bilateral angiograms of, 483
Internal iliac artery aneurysm (IIAA)
angiography of, 380
complications in, 379
contraindications to, 378
diagnostic evaluation
CT/MRI, 378
laboratory examination, 377
embolization of
aftercare, 381–382
catheters for, 379
embolic agents for, 380
patient follow-up, 382
proximal/distal isolation, 381
indications for, 378
symptomatic, 377
Internal iliac artery territory embolization,
indication for, 377
Internal maxillary artery (IMA), 416
Intimal injury and thrombus formation, 16–17
Intra-arterial radioembolization, 37
Ipsilateral lobe access, 407
coil embolization, 409
Irinotecan-loaded microspheres, 34
J
Jaundice, 390
Juvenile nasal angiofibroma, 415
pre-operative embolization of, 416
tumors, 416, 417
K
Kidney, 269
aneurysm and autotransplanting, 400
embolization
contraindications of, 271–272
proximal renal artery, 270
Klatskin tumor, 390
Klippel-Trenaunay syndrome
clinical examination, 176
clinical features
capillary malformation, 173–174
gastrointestinal involvement, 175
hypertrophy of bone and soft tissues,
174
lymphatic vascular malformation, 175
venous malformation, 174–175
diagnosis of, 173
management of, 176–177
Klippel-Trenaunay syndromes, 459
Knee dislocation, 258
L
Laser
effect of heating tissues with, 61–62
fibers, 62–63
for occlusion of blood vessels, 64
dangers specific to, 65
power, 63–64
properties, 62
Lateral flush aortography, 345
Left gastric artery (LGA)
embolization, 336
thick-walled pseudoaneurysm from, 289
Left subclavian artery, large bronchial supply
from, 355
LGA, see Left gastric artery (LGA)
Lipiodol, 57–58, 71, 190, 193
Liquid embolic agents
absolute alcohol, 52–53