Document Detail


Pulmonary artery pressure changes during ethanol embolization procedures to treat vascular malformations: can cardiovascular collapse be predicted?
MedLine Citation:
PMID:  16517770     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Ethanol has been used for embolization of vascular malformations. Cardiovascular collapse, although rare, has been reported, occurring immediately to a few hours after ethanol embolization. The pathophysiology has been theoretically attributed to direct toxicity to the cardiac conduction system or pulmonary artery (PA) vasospasm leading to cardiovascular collapse. Because of cardiovascular collapse in one patient at the authors' institution, it was standard of care at the time of this study to monitor the pulmonary artery pressures during ethanol embolization. This study was conducted to clarify the effect of ethanol on the PA pressure during these procedures. METHODS: Data from 92 ethanol embolization procedures performed on 56 patients with vascular malformations between May 2001 and May 2003 are reported. PA and noninvasive cuff systemic pressures were recorded before and after each injection and also before and after the entire procedure. Upper limit for volume of ethanol used during these procedures was drawn at 1 mL/kg. Simple and multiple linear regression analyses were done to study factors affecting changes in PA and systemic blood pressure. RESULTS: For each injection, ethanol volume averaged 3.1 mL per injection. The systolic systemic and PA systolic pressures increased by 2.3 and 1.0 mm Hg, respectively. Amount of ethanol injected and systemic blood pressure changes were predictive of change in PA blood pressure. During the entire procedure, systemic systolic blood pressure increased by an average of 11.6 mm Hg, and PA systolic blood pressure by 5 mm Hg. Change in systemic blood pressure was a strong predictor of, and volume of ethanol was a weak predictor of, change in PA blood pressure. CONCLUSION: The mild rise in PA blood pressure in the patients during ethanol embolization correlated strongly with minor elevation in systemic blood pressure throughout the procedure, which the authors believe is related to pain from the ethanol injection causing sympathetic stimulation, even when patients are under general anesthesia. The minimal rise in PA blood pressure during these procedures does not elucidate the cause of the rare complication of cardiovascular collapse during ethanol embolization.
Authors:
Sally E Mitchell; Amber M Shah; Deborah Schwengel
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular and interventional radiology : JVIR     Volume:  17     ISSN:  1051-0443     ISO Abbreviation:  J Vasc Interv Radiol     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-03-06     Completed Date:  2006-08-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203369     Medline TA:  J Vasc Interv Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  253-62     Citation Subset:  IM    
Affiliation:
Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. smitche@jhmi.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Arteriovenous Malformations / therapy*
Blood Pressure Determination
Child
Child, Preschool
Coronary Vasospasm / etiology,  physiopathology*
Embolization, Therapeutic / adverse effects*
Ethanol / administration & dosage,  adverse effects*
Female
Heart Conduction System / physiopathology*
Humans
Infant
Linear Models
Male
Middle Aged
Predictive Value of Tests
Pulmonary Artery / physiopathology*
Shock / etiology*,  physiopathology
Chemical
Reg. No./Substance:
64-17-5/Ethanol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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