Parmi les articles plus cités de l’année 2023 dans la catégorie « Laboratory Investigation » on va retrouver une dernière publication de l’équipe marseillaise de Farouk Tradi et Vincent Vidal que nous félicitons à l’occasion !
Les auteurs comparent plusieurs agents d’embolisations pour la réalisation de la technique EMBORRHOID brevetée par eux-mêmes il y a quelques années et montrent les différents résultats histologiques chez le gros animal (cochon) en utilisant les microparticules, les coils et les agents liquides (ONYX). Les conclusions suggèrent d’adopter les particules dans la pratique clinique pour obtenir une embolisation à la fois plus distale et efficace que les coils et au moindre risque de complications, qui semblerait élevé si on utilise un agent liquide.
Tradi, F., Panneau, J., Brige, P. et al. Evaluation of Multiple Embolic Agents for Embolization of the Superior Rectal Artery in an Animal Model. Cardiovasc Intervent Radiol 45, 510–519 (2022).https://doi.org/10.1007/s00270-021-03041-7
Objective
To prospectively compare the safety of transcatheter embolization of superior rectal arteries in healthy pigs with multiple agents such as coils, spheres and liquids.
Materials and Methods
Nine adult domestic pigs (three males, mean weight: 60 kg [50–70]) were randomly assigned to the embolization group: copolymer of ethylene vinyl alcohol (EVOH)—Onyx® (group 1, n = 3), microspheres 500 µ (group 2, n = 3), 2-mm micro-coils (group 3, n = 3). After a selective angiogram has been acquired, the embolic agent was infused at the distal part of rectal arteries. An angio-CT was performed before and after each embolization. After one week, angiography was repeated prior to euthanasia. At necropsy, the anorectal juncture was removed for histopathologic examination.
Results
At necropsy, 100% of animals embolized with Onyx developed a significant necrosis zone of the distal part of the rectum. Histological examination revealed a mural infarction. For the micro-coil and microsphere groups, gross examination of the intestines did not reveal any evidence of ischaemia. The coils were found in the distal arterial vasculature of the meso-rectum, allowing a downstream revascularization by collaterals. The microspheres and onyx in the rectal wall, more distally.
Conclusion
Microspheres appear to induce fewer histologic complications than the liquid embolic agent and provide a more distal occlusion than micro-coils. These results suggest that, for superior rectal artery embolization, a super-selective embolization using spheres in human clinical conditions should be more effective and as safe as coil embolization. EVOH might be an unsafe embolization agent for haemorrhoids.
