1. Endovascular treatment of intra- and extra cranial malformation
S.Sirakov , assoc.prof. Penev, prof. Bosnjakovic

2. Embolization
Embolization is a nonsurgical, minimally invasive procedure performed by an interventional radiologist and interventional neuroradiologist. It involves the selective occlusion of blood vessels or vascular territory by purposely introducing temporary or permanent agenst.
Embolization is used to treat a wide variety of conditions affecting different organs of the human body.

3. Embolization
The elegancy of the technique underscores the value of minimally invasive therapy.
Since the first reported cases using autologous clot in 1972 embolization techniques have evolved with the use of many agents and devices to achieved impressive results.

4. The treatment is used to occlude:
Arteriovenous malformation
Cerebral aneurysm
Gastrointestinal bleeding
Epistaxis
Primary post partum hemorrhage
Surgical hemorrhage
Uterine fibroids
Kidney and liver lesions

5. Embolization
The procedure is carried out as an endovascular procedure by a consultant radiologist in an interventional suite
It is common for most patients to have the treatment carried out with little or no sedation, although this depends largely on the organ to be embolized.

6. Types of embolization agents:
I . Permanent agent:
Coils
Detachable balloons
Particles
Acrylic gelatin microspheres
PVA – polyvinyl alcohol
Liquid embolic agent (NBCA, Onyx)
II . Temporary
Gelaspon
Autologous clot

7. Which embolic agent?
Is the vessel to be embolized a large or small vessel?
Is the desired occlusion permanent or temporary?
Is cellular or ( more specifically organ) death required ?

8. The aim of the procedure is by arterial or venous way to get area of interest (tumor, arteriovenous malformation, aneurysm and etc.) and using guidewires and catheters to apply embolic agent.

9. Carcinoma of basic crane (preoperative treatment)

10. Carcinoma of basic crane (preoperative treatment)

11. Metastatic lesion of vertebral body

12. Juvenile angiofibroma

13. Juvenile angiofibroma

14. Basocelular carcinoma (preoperative treatment)

15. Juvenile angiofibroma

16. Arteriovenous malformation

17. Arteriovenous malformation

18. Aneurysm of basilar artery

19. Spinal AV Fistula

20. Hepatocellular carcinoma

21. Advantages of embolization :
Minimally invasive
Minimal risk of infection
No or rare use of general anesthetic
Faster recovery time
High success rate compared to other procedures

22. Disadvantages of embolization:
User dependent success rate
Risk of emboli reaching healthy tissue
Not suitable for everyone
Expencive devices
Recurrence more likely

23. Thank You for you attention!