CardioVascular and Interventional Radiology

, Volume 39, Issue 4, pp 530–537 | Cite as

Usefulness of Cone-Beam Computed Tomography and Automatic Vessel Detection Software in Emergency Transarterial Embolization

  • Gianpaolo Carrafiello
  • Anna Maria Ierardi
  • Ejona Duka
  • Alessandro Radaelli
  • Chiara Floridi
  • Alessandro Bacuzzi
  • Maximilian de Bucourt
  • Giuseppe De Marchi
Clinical Investigation



This study was designed to evaluate the utility of dual phase cone beam computed tomography (DP-CBCT) and automatic vessel detection (AVD) software to guide transarterial embolization (TAE) of angiographically challenging arterial bleedings in emergency settings.


Twenty patients with an arterial bleeding at computed tomography angiography and an inconclusive identification of the bleeding vessel at the initial 2D angiographic series were included. Accuracy of DP-CBCT and AVD software were defined as the ability to detect the bleeding site and the culprit arterial bleeder, respectively. Technical success was defined as the correct positioning of the microcatheter using AVD software. Clinical success was defined as the successful embolization. Total volume of iodinated contrast medium and overall procedure time were registered.


The bleeding site was not detected by initial angiogram in 20 % of cases, while impossibility to identify the bleeding vessel was the reason for inclusion in the remaining cases. The bleeding site was detected by DP-CBCT in 19 of 20 (95 %) patients; in one case CBCT-CT fusion was required. AVD software identified the culprit arterial branch in 18 of 20 (90 %) cases. In two cases, vessel tracking required manual marking of the candidate arterial bleeder. Technical success was 95 %. Successful embolization was achieved in all patients. Mean contrast volume injected for each patient was 77.5 ml, and mean overall procedural time was 50 min.


C-arm CBCT and AVD software during TAE of angiographically challenging arterial bleedings is feasible and may facilitate successful embolization. Staff training in CBCT imaging and software manipulation is necessary.


Imaging Arterial intervention Clinical practice 


Compliance with Ethical Standards

Conflict of interest

Alessandro Radaelli declares his relationship of employee with Philips. The remaining Authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

Informed consent was obtained from all individual participants included in the study, when possible.


  1. 1.
    Keeling AN, McGrath FP, Thornton J, Brennan P, Lee MJ. Emergency percutaneous transcatheter embolisation of acute arterial hemorrhage. Ir J Med Sci. 2010;179(3):385–91.CrossRefPubMedGoogle Scholar
  2. 2.
    Brooks B. The treatment of traumatic arteriovenous fistula. South Med J. 1930;23:100–6.CrossRefGoogle Scholar
  3. 3.
    Angle JF, Siddiqi NH, Wallace MJ, Kundu S, Stokes L, Wojak JC, et al. Quality improvement guidelines for percutaneous transcatheter embolization: society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol. 2010;21(10):1479–86.CrossRefPubMedGoogle Scholar
  4. 4.
    Iwazawa J, Ohueo S, Hashimoto N, Mitani T. Feasibility of using vessel-detection software for the endovascular treatment of visceral arterial bleeding. Diagn Interv Radiol. 2014;20(2):160–3.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Angle JF. Cone-beam CT: vascular applications. Tech Vasc Interv Radiol. 2013;16(3):144–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Dijkstra ML, Eagleton MJ, Greenberg RK, Mastracci T, Hernandez A. Intraoperative C-arm cone-beam computed tomography in fenestrated/branched aortic endografting. J Vasc Surg. 2011;53(3):583–90.CrossRefPubMedGoogle Scholar
  7. 7.
    van Bindsbergen L, Braak SJ, van Strijen MJ, de Vries JP. Type II endoleak embolization after endovascular abdominal aortic aneurysm repair with use of real-time three-dimensional fluoroscopic needle guidance. J Vasc Intervent Radiol. 2010;21(9):1443–7.CrossRefGoogle Scholar
  8. 8.
    Lee IJ, Chung JW, Yin YH, Kim HC, Kim YI, Jae HJ, et al. Cone-beam computed tomography (CBCT) hepatic arteriography in chemoembolization for hepatocellular carcinoma: performance depicting tumors and tumor feeders. Cardiovasc Intervent Radiol. 2015;38:1218–30.CrossRefPubMedGoogle Scholar
  9. 9.
    Chiaradia M, Radaelli A, Campeggi A, Bouanane M, De La Taille A, Kobeiter H. Automatic three-dimensional detection of prostatic arteries using cone-beam CT during prostatic arterialembolization. J Vasc Interv Radiol. 2015;26(3):413–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Tacher V, Radaelli A, Lin M, Geschwind JF. How I do it: cone-beam CT during transarterial chemoembolization for liver cancer. Radiology. 2015;274(2):320–34.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Patil VV, Fischman AM, Patel RS, Kim E, Lookstein RA, Tabori NE, et al. GI hemorrhage arising from splenic artery: intraprocedure cone-beam CT as problem-solving tool to aide in safe catheterization of offending vessel. Clin Imaging. 2015;39:928–30.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2015

Authors and Affiliations

  • Gianpaolo Carrafiello
    • 1
  • Anna Maria Ierardi
    • 1
  • Ejona Duka
    • 1
  • Alessandro Radaelli
    • 2
  • Chiara Floridi
    • 1
  • Alessandro Bacuzzi
    • 3
  • Maximilian de Bucourt
    • 4
  • Giuseppe De Marchi
    • 1
  1. 1.Department of Radiology, Interventional RadiologyInsubria UniversityVareseItaly
  2. 2.Philips HealthcareBestThe Netherlands
  3. 3.Anaesthesia and Palliative CareUniversity of InsubriaVareseItaly
  4. 4.Department of RadiologyCharité - University Medicine BerlinBerlinGermany

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