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Safety and effectiveness of transcatheter embolization in the treatment of internal mammary artery injuries

  • VASCULAR AND INTERVENTIONAL RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

Demonstrate the role of endovascular management in the treatment of internal mammary artery (IMA) injuries using transcatheter embolization reviewing our 7-year experience.

Materials and methods

Our retrospective analysis of cases consists of a total of 12 patients (8 M and 4 F; mean age 52 years) who underwent angiographic studies and transcatheter embolization for IMA injuries. Causes of vascular injury were divided in high-energy trauma (n = 6), iatrogenic (n = 3) and penetrating injuries (n = 3). Type of trauma, associated injury, imaging findings, treatments and complications were assessed. Imaging findings included active haemorrhage, pseudoaneurysm and focal dissection.

Results

Embolization was performed with microcoils in all patients; complete thrombosis was obtained in four patients by additional injection of Spongostan pledgets and in two patients with 300–500 μm particles. The technical success rate was 100%. No patient died as a direct result of vascular injury; one died of myocardial contusion and one for severe multiorgan failure related to high-energy trauma. No major and minor complications were registered. No patient required emergency surgery or subsequent surgical treatment.

Conclusion

Transcatheter embolization offers an effective, efficient and safe alternative to conventional surgical management of IMA injuries.

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References

  1. Chen J, Lv J, Ma K, Yan J (2014) Assessment of internal mammary artery injury after blunt chest trauma: a literature review. J Zhejiang Univ Sci B 15(10):864–869. https://doi.org/10.1631/jzus.B140009

    Article  PubMed  PubMed Central  Google Scholar 

  2. Chemelli AP, Chemelli-Steingruber IE, Bonaros N, Luckner G, Millonig G, Seppi K, Lottersberger C, Jaschke W (2009) Coil embolization of internal mammary artery injured during central vein catheter and cardiac pacemaker lead insertion. Eur J Radiol 71(2):269–274. https://doi.org/10.1016/j.ejrad.2008.04.024

    Article  CAS  PubMed  Google Scholar 

  3. Mehra S, Buch A, Truong CN, Moshiri M, Shriki JE, Bhargava P (2015) Post-traumatic internal mammary artery pseudoaneurysm: a rare complication of pericardiocentesis. Radiol Case Rep 9(1):e00031. https://doi.org/10.2484/rcr.v9i1.931

    PubMed  Google Scholar 

  4. Ayaon Albarràn A, Blàzquez Gonzàles JA, Hernàndez Cabrero T, Gonzàles Villegas E (2017) Internal mammary artery pseudoaneurysm following a Robicsek sternal closure. J Card Surg 32(4):264–265. https://doi.org/10.1111/jocs.13119

    Article  PubMed  Google Scholar 

  5. Okura Y, Kawasaki T, Hiura T, Seki H, Saito H (2012) Aneurysm of the internal mammary artery with cystic medial degeneration. Intern Med 52:2355–2359

    Article  Google Scholar 

  6. Braatz T, Mirvis SE, Killeen K, Lightman NI (2001) CT diagnosis of internal mammary artery injury caused by blunt trauma. Clin Radiol 5(2):120–123

    Article  Google Scholar 

  7. Whigham CJ Jr, Fischer RG, Goodman CJ, Dodds CA, Trinh CC (2002) Traumatic injury of the internal mammary artery: embolization versus surgical and nonoperative management. Emerg Radio 9(4):201–207

    Google Scholar 

  8. Niola R, Pinto A, Sparano A, Ignarra R, Romano L, Maglione F (2012) Arterial bleeding in pelvic trauma: priorities in angiographic ambolization. Curr Probl Diagn Radiol 41(3):93–101. https://doi.org/10.1067/j.cpradiol.2011.07.008

    Article  PubMed  Google Scholar 

  9. Corvino A, Catalano O, Corvino F, Sandomenico F, Setola SV, Petrillo A (2016) Superficial temporal artery pseudoaneurysm: what is the role of ultrasound? J Ultrasound 19(3):197–201. https://doi.org/10.1007/s40477-016-0211-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Filippiadis DK, Binkert C, Pellerin O, Hoddmann RT, Krajina A, Pereire PL (2017) Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol 40:1141–1146

    Article  CAS  Google Scholar 

  11. Patel K, Kimbrell BJ, Marx MV, Petrone P, Asensio JA (2009) Angiographic embolization of an expanding breast hematoma after blunt trauma: a novel approach to a rare injury. J Trauma 67(1):E14–E16. https://doi.org/10.1097/TA.0b013e3180485cc4

    Article  PubMed  Google Scholar 

  12. Cagini L, Vannucci J, Scialpi M, Puma F (2013) Diagnosis and endovascular treatment of an internal mammary artery injury. J Emerg Med 44(1):e117–e119. https://doi.org/10.1016/j.jemermed.2012.02.035

    Article  PubMed  Google Scholar 

  13. Horn H (1930) Bemerkenswerter Fall einer Stichverletzung der Art. Mammaria intern. sin. mit grossem mediastinalem HaÅNmatom. Ausgang in voÅN llige Heilung. Zbl Chir 57:250

    Google Scholar 

  14. Smith DC, Senac MO, Bailey LL (1982) Embolotherapy of a ruptured internal mammary artery secondary to blunt chest trauma. J Trauma 22:333–335

    Article  CAS  PubMed  Google Scholar 

  15. McVay CB (1984) Anson and McVay’s surgical anatomy. WB Saunders, Philapelphia, pp 347–349

    Google Scholar 

  16. Kim YH, Kim JD, Visconti G, Kim JT (2010) Life-threatening bleeding and radiologic intervention after aesthetic surgeries with minial invasive approaches: report of two cases. J Plast Reconstr Aesthet Surg 63(10):e745–e748. https://doi.org/10.1016/j.bjps.2010.06.001

    Article  PubMed  Google Scholar 

  17. San Norberto EM, Cilleruelo A, Martin-Pedrosa M, Taylor J, Garcia-Yuste M, Vaquero C (2014) Endovascular treatment of posttraumatic pseudoaneurysm of the internal mammary artery. Ann Vasc Surg. https://doi.org/10.1016/j.avsg.2013.06.034

    PubMed  Google Scholar 

  18. Ma RY, Yang ZY, Jian Z, Chen L, Xiao YB (2012) Traumatic aneurysm of the right internal thoracic artery. Ann Thorac Surg 93:e107. https://doi.org/10.1016/j.athoracsur.2011.11.071

    Article  PubMed  Google Scholar 

  19. Lindblom RPF, Zemgulis V, Lilieqvist A, Nyman R (2013) Even small aneurysms can bleed: a ruptured small idiopathic aneurysm of the internal thoracic artery. Interact Cardiovasc Thorac Surg 17(3):583–585. https://doi.org/10.1093/icvts/ivt248

    Article  PubMed  PubMed Central  Google Scholar 

  20. Crowley JJ, Shapiro LM (1995) Noninvasive assessment of left internal mammary artery graft patency using transthoracic echocardiography. Circulation 92(9 Suppl):25–30

    Article  Google Scholar 

  21. Sims ME, Shin LK, Rosenberg J, Jeffrey RB (2011) Multidetector computed tomography of acute vascular injury in blunt abdominal/pelvic trauma: imaging predictors of treatment. Eur J Trauma Emerg Surg 37(5):525–532. https://doi.org/10.1007/s00068-011-0075-8

    Article  CAS  PubMed  Google Scholar 

  22. Pinto A, Niola R, Tortora G, Ponticiello G, Russo G, Di Nuzzo L, Gagliardi N, Scaglione M, Merola S, Stavolo C, Maglione F, Romano L (2010) Role of multidetector-row CT in assessing the source of arterial haemorrhage in patients with pelvic vascular trauma. Comparison with angiography. Radiol Med 115(4):648–667. https://doi.org/10.1007/s11547-010-0494-0

    Article  CAS  PubMed  Google Scholar 

  23. Tufato A, Arnold T, Rummel M, Matsumoto T, Kerstein MD (1994) Adverse outcome of non-operative management of intimal injuries caused by penetrating trauma. J Vasc Surg 20:656–659

    Article  Google Scholar 

  24. Hoffer EK, Sclafani SJA, Herskowitz MM, Scalea TM (1997) Natural history of arterial injuries diagnosed woth arteriography. J Vasc Interv Radiol 8:43–53

    Article  CAS  PubMed  Google Scholar 

  25. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Stàhle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW (2009) Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 360:961–971

    Article  CAS  PubMed  Google Scholar 

  26. Datta S, Manoly I, Karangelis D, Hasan R (2016) Pseudoaneurysm of the right internal mammary artery post vacuum-assisted closure therapy: a rare complication and literature review. Ann Vasc Surg 31:207.e1–207.e3

    Article  Google Scholar 

  27. Ierardi AM, Floridi C, Fontana F, Duka E, Pinto A, Petrillo M, Kehagias E, Tsetis D, Brunese L, Carrafiello G (2004) Transcatheter embolisation of iatrogenic renal vascular injuries. Radiol Med 119:261–268

    Article  Google Scholar 

  28. Surani S, Estement B, Manchandan S, Sudhakaran S, Varon J (2011) Spontaneous extraperitoneal lumbar artery haemorrhage. J Emerg Med 40:e111–e114

    Article  PubMed  Google Scholar 

  29. Dohan A, Sapoval M, Chousterman BG, di Primio M, Guerot E, Pellerin O (2015) Spontaneous soft-tissue hemorrhage in anticoagulated patients: safety and efficacy of embolization. AJR 204:1303–1310

    Article  PubMed  Google Scholar 

  30. White RI, Strandberg JV, Gross GS, Barth KH (1977) Therapeutic embolization with long-term occluding agents and their effects on embolized tissue. Radiology 125:677–687

    Article  PubMed  Google Scholar 

  31. Davidson GS, Terbrugge KG (1995) Histologic long-term follow-up after embolization with polyvinyl alcohol particles. Am J Neuroradiol 16:843–846

    CAS  PubMed  Google Scholar 

  32. Ozyer U (2017) Transcatheter arterial embolization with N-butyl-2-cyanoacrylate in the management of spontaneous hematomas. Cardiovasc Interv Radiol 40(1):41–49. https://doi.org/10.1107/s00270-016-1463-6

    Article  Google Scholar 

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Authors and Affiliations

  1. Interventional Radiology Department, AORN “A. Cardarelli”, Via A. Cardarelli 9, 80131, Naples, Italy

    Fabio Corvino, Francesco Giurazza, Gianluca Cangiano, Enrico Cavaglià, Francesco Amodio, Giuseppe De Magistris & Raffaella Niola

  2. Department of Radiology, University of Naples Parthenope, Naples, Italy

    Antonio Corvino

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  1. Fabio Corvino
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  2. Francesco Giurazza
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  3. Gianluca Cangiano
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Correspondence to Fabio Corvino.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The authors declare that they have no conflict of interest.

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Corvino, F., Giurazza, F., Cangiano, G. et al. Safety and effectiveness of transcatheter embolization in the treatment of internal mammary artery injuries. Radiol med 123, 369–377 (2018). https://doi.org/10.1007/s11547-017-0844-5

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  • DOI: https://doi.org/10.1007/s11547-017-0844-5

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