Embolisation

L'embolisation est un procédé thérapeutique consistant en l'occlusion sélective de vaisseaux sanguins par l'injection d'un agent embolique. Elle est utilisée dans le traitement d'une large variété de pathologies et est généralement réalisée par un radiologue interventionnel.

Coupe histologique montrant la présence d'agent embolique au sein d'une lumière artérielle (embolisation réalisée dans le cadre d'un carcinome rénal à cellules claires).

Indications

Il peut s'agir d'arrêter un saignement comme dans le cas d'une hémoptysie[1], d'un épistaxis[2] ou encore d'une hémorragie du post-partum[3].

L'embolisation peut également être utilisée dans le traitement de certaines tumeurs. Un radiologue interventionnel peut ainsi emboliser au niveau cervico-céphalique des méningiomes[4],[5], des paragangliomes[6],[5], ou encore des angiofibromes naso-pharyngés[5]. L'embolisation de certaines tumeurs rénales est également pratiquée.

Les tumeurs hépatiques peuvent aussi bénéficier de cette modalité thérapeutique et il est même possible de réaliser dans ce cas une chimio-embolisation intra-artérielle. L'occlusion des artères nourricières par l'agent embolique est alors associée à l'injection intra-tumorale d'une chimiothérapie.

Agents emboliques

Les agents emboliques peuvent être liquides : copolymère d'alcool vinylique et d'éthylène (Onyx), cyanoacrylate de butyle (n-BCA), liquide d'embolisation (Precipitating Hydrophobic Injectable Liquid).

Il existe aussi des agents particulaires comme le Gelfoam, l'alcool polyvinylique ou les microsphères d'embolisation.

Enfin, on signalera la classe des dispositifs d'occlusion mécanique : coils et ballons détachables. Les coils sont généralement fait de platine et induisent la formation d'un thrombus à leur contact en raison de leur revêtement en polytéréphtalate d'éthylène.

Références

  1. ↑ Ananya Panda, Ashu Seith Bhalla et Ankur Goyal, « Bronchial artery embolization in hemoptysis: a systematic review », Diagnostic and Interventional Radiology, vol. 23, no 4,‎ , p. 307–317 (PMID 28703105, PMCID PMC5508955, DOI 10.5152/dir.2017.16454, lire en ligne, consulté le )
  2. ↑ Rafael Beck, Martin Sorge, Antonius Schneider et Andreas Dietz, « Current Approaches to Epistaxis Treatment in Primary and Secondary Care », Deutsches Ärzteblatt international,‎ (ISSN 1866-0452, PMID 29345234, PMCID PMC5778404, DOI 10.3238/arztebl.2018.0012, lire en ligne, consulté le )
  3. ↑ (en) Chengshi Chen, Sang Min Lee, Jong Woo Kim et Ji Hoon Shin, « Recent Update of Embolization of Postpartum Hemorrhage », Korean Journal of Radiology, vol. 19, no 4,‎ , p. 585 (ISSN 1229-6929 et 2005-8330, PMID 29962865, PMCID PMC6005941, DOI 10.3348/kjr.2018.19.4.585, lire en ligne, consulté le )
  4. ↑ (en) Guillaume Friconnet, Victor Hugo Espíndola Ala, Leslie Lemnos et Suzana Saleme, « Pre-surgical embolization of intracranial meningioma with Onyx: A safety and efficacy study », Journal of Neuroradiology, vol. 47, no 5,‎ , p. 353–357 (DOI 10.1016/j.neurad.2019.05.012, lire en ligne, consulté le )
  5. ↑ a b et c (en) Leonardo Rangel-Castilla, Ankit H Shah, Richard Paul Klucznik et Orlando M Diaz, « Preoperative Onyx embolization of hypervascular head, neck, and spinal tumors. Experience with 100 consecutive cases from a single tertiary center », Journal of NeuroInterventional Surgery, vol. 6, no 1,‎ , p. 51–56 (ISSN 1759-8478 et 1759-8486, DOI 10.1136/neurintsurg-2012-010542, lire en ligne, consulté le )
  6. ↑ (en) Ryan S. Jackson, Jeffrey A. Myhill, Tapan A. Padhya et Judith C. McCaffrey, « The Effects of Preoperative Embolization on Carotid Body Paraganglioma Surgery: A Systematic Review and Meta-analysis », Otolaryngology–Head and Neck Surgery, vol. 153, no 6,‎ , p. 943–950 (ISSN 0194-5998 et 1097-6817, DOI 10.1177/0194599815605323, lire en ligne, consulté le )

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