The document discusses various embolizing agents used for therapeutic embolization procedures. It describes both temporary and permanent agents, including gelfoam particles, polyvinyl alcohol particles, drug-eluting beads, cyanoacrylate glue, Onyx liquid, coils, and vascular plugs. Complications of embolization procedures are also noted, such as paralysis, ischemic injury, pulmonary embolism, and vessel rupture.

1. Overview of Embolizing Agents
Dr. Sujeet Agrawal
JR III Radiodiagnosis
Tata Memorial hospital

2. Introduction:
• Therapeutic embolization is the intentional endovascular occlusion of
an artery or vein.
• Historically, the first agent used for embolotherapy was autologous
blood clot.
• Modern embolic agents are either temporary or permanent.
Trauma – Temporary.
AVF – Permanent.

3. TEMPORARY:
A. PARTICULATES:
1.Gelfoam.
2. Avitene.
3. Autologous blood clot.
PERMANENT:
A. PARTICULATES:
1. PVA.
2.Embolic spheres.
3.Drug eluting beads.
B. LIQUIDS :
1.Glue.
2.Onyx.
3. Alcohol.
4. Ethonalamine.
5. Sclerosants.
C. MECHANICAL :
1 Coils.
2. Vascular plugs.
3. Drug eluiting particles.

4. Indication:
• Occlusion of vascular abnormalities which have potential
to cause adverse health effects(aneurysm, malformation
etc.).
• Acute or chronic hemorrhage.
• Devascularization of benign or malignant tumours.
• Ablation of non-neoplastic tissue causing adverse health
effect (hypersplenism, varicocele).
• Flow distribution to protect normal tissue or to facilitate
sub-sequent treatment.
• Endoleak management.
• Vehicle for targeted delivery of drugs or other agents.

5. Gelfoam:
• Gelatin foam is a biologic substance made from purified skin
gelatin.
• Temporary – dissolves after few days to weeks.
• First embolic particle used in humans.
• It is mainly used to either stop bleeding or to devascularize a
lesion prior to surgical removal.
• Two different forms:
- Powder – 40 - 60 µ m - occludes capillaries.
- Sheet – 1 - 2 mm, occludes larger vessels.

6. Gelfoam

9. TEMPORARY:
A. PARTICULATES:
1.Gelfoam.
2. Avitene.
3. Autologous blood clot.
PERMANENT:
A. PARTICULATES:
1. PVA.
2.Embolic spheres.
3.Drug eluting beads.
B. LIQUIDS :
1.Glue.
2.Onyx.
3. Alcohol.
4. Ethonalamine.
5. Sclerosants.
C. MECHANICAL :
1 Coils.
2. Vascular plugs.
3. Drug eluiting particles.

10. POLYVINYL ALCOHOL PARTICLES:
• The particles are made from a PVA foam sheet.
• Available in sizes ranging from 100 µm to 1100 µ m.
• Polyvinyl alcohol particles are irregular in shape, which
promotes aggregation.
• They can be oblong, oval, irregular, sharp and angulated
with small fragments after suspension.
• Permanent occlusion by causing thrombosis and fibrosis.

14. TEMPORARY:
A. PARTICULATES:
1.Gelfoam.
2. Avitene.
3. Autologous blood clot.
PERMANENT:
A. PARTICULATES:
1. PVA.
2.Embolic spheres.
3.Drug eluting beads.
B. LIQUIDS :
1.Glue.
2.Onyx.
3. Alcohol.
4. Ethonalamine.
5. Sclerosants.
C. MECHANICAL :
1 Coils.
2. Vascular plugs.
3. Drug eluiting particles.

15. TRIS-ACRYL GELATIN
MICROSPHERES/SPHERICAL EMBOLICS
Microspheres are biocompatible, hydrophilic,
non-resorbable, precisely calibrated acrylic
polymer microspheres.
1. Embosphere Microspheres.
2. Hepasphere Microspheres.
3. Quadrasphere Microspheres.
4. Embozene.
5. Oncozene.

16. • Ease of injection and less clogging of
catheters, resulting in more predictable levels
of occlusion.
• More complete occlusion of the vessel.
• Loadable.
• Entire microsphere loads and absorbs drug.
• Sustained drug delivery.
• Homogenous drug dispersion.

17. 1.Embosphere:
• Precisely calibrated acrylic polymer microspheres impregnated with
porcine gelatin.
• Embosphere Microspheres are indicated for use in embolization of
arteriovenous malformations, hypervascular tumors, and symptomatic
uterine fibroids.
• Embospheres are available in six size ranges: 40 to 120 µm,100 to 300 µm,
300 to 500 µm, 500 to 700 µm, 700 to 900 µm, and 900 to 1200 µm.
• 8 ml glass vial closed with screw-top cap.
• Contents: 1 ml or 2 ml of microspheres in pyrogen-free, sterile, NaCl 0.9%
saline solution.
• Total volume of saline and microspheres: 5 ml.

20. 2.Hepasphere:
• HepaSphere Microspheres are calibrated, spherical, hydrophilic
microspheres made from 2 monomers (vinyl acetate and methyl
acrylate) that combine to form a copolymer (sodium acrylate
alcohol copolymer).
• This design allows a more complete and targeted occlusion of
the blood vessels with or without delivery of doxorubicin HCl for
therapeutic or preoperative purposes in the following
procedures:
• Embolization of hepatocellular carcinoma.
• Embolization of metastases to the liver.

21. When in contact with non-ionic contrast media or normal
saline (NaCI 0.9%) before delivery, Hepa/QuadraSphere
Microspheres expand to approximately 4x their dry state
diameter.
HepaSphere Microsphere’s unique advantages:
• Targeted: Flow directed due to spherical shape.
• Absorbing: Rapidly absorbs aqueous solutions such as contrast
media, saline, or reconstituted doxorubicin HCI.
• Expanding: Expands up to four times the stated dry diameter
when hydrated.

22. The doxorubicin is loaded and eluted by a reversible ionic exchange
mechanism. The negatively charged acrylate of HepaSpheres
Microspheres interacts with the positively charged doxorubicin
hydrochloride.

26. It enables higher drug concentration that is precisely targeted and
delivered directly to the tumor site, resulting in fewer drug-related
adverse events. A major advantage of drug-delivery TACE compared to
conventional TACE is improved patient safety as a result of lower
systemic doxorubicin circulation, resulting in less impact on normal
liver function.

27. 3. Quadrasphere Microspheres – same as
hapasphere ( US only).
4. Embozene Microspheres.
5. Oncozene Microspheres.
Embozene/ Oncozene microspheres are precisely calibrated
microspheres engineered for greater embolization control. Unique
colored sizing allows for improved visualization during suspension.

29. Vascular embolization is a high-risk procedure. Complications may occur
at any time during or after the procedure and include:
• Paralysis resulting from untargeted embolization or ischemic injury
from adjacent tissue oedema.
• Undesirable reflux into normal arteries adjacent to the targeted lesion such as the internal
carotid artery, pulmonary, or coronary circulation or Ischemic stroke.
• Pulmonary embolism due to arteriovenous shunting.
• Vasospasm.
• Blindness, hearing loss, and loss of smell.
• Foreign body reactions, Infection.
• Complications related to catheterization.
• Vessel or lesion rupture and hemorrhage.
• Death.
Complications:

30. TEMPORARY:
A. PARTICULATES:
1.Gelfoam.
2. Avitene.
3. Autologous blood clot.
PERMANENT:
A. PARTICULATES:
1. PVA.
2.Embolic spheres.
3.Drug eluting beads.
B. LIQUIDS :
1.Glue.
2.Onyx.
3. Alcohol.
4. Ethonalamine.
5. Sclerosants.
C. MECHANICAL :
1 Coils.
2. Vascular plugs.
3. Drug eluiting particles.

31. Drug eluting particles:
• PVA hydrogel polymers.
• Two types:
1. Unloaded.
2. Loaded.
DEBDOX,DEBIRI

32. TEMPORARY:
A. PARTICULATES:
1.Gelfoam.
2. Avitene.
3. Autologous blood clot.
PERMANENT:
A. PARTICULATES:
1. PVA.
2.Embolic spheres.
3.Drug eluting beads.
B. LIQUIDS :
1.Glue.
2.Onyx.
3. Alcohol.
4. Ethonalamine.
5. Sclerosants.
C. MECHANICAL :
1 Coils.
2. Vascular plugs.
3. Drug eluiting particles.

33. Glue:
• Cyanoacrylate.
• Liquid monomeric cyanoacrylte converts to
solid immediately on contact with plasma,
blood cells, endothelium etc.

34. Onyx:
• It is etylene vinyl alcohol copolymer dissolved
in various concentrations of dimethyl sulfoxide
(DMSO).

35. Sclerosants:
• Sodium tetradecyl sulfate.
• Anionic surfactant.
• Sclerosis of esophageal varices and varicose
veins.
• It is a detergent containing 2 % benzyl alcohol.

36. TEMPORARY:
A. PARTICULATES:
1.Gelfoam.
2. Avitene.
3. Autologous blood clot.
PERMANENT:
A. PARTICULATES:
1. PVA.
2.Embolic spheres.
3.Drug eluting beads.
B. LIQUIDS :
1.Glue.
2.Onyx.
3. Alcohol.
4. Ethonalamine.
5. Sclerosants.
C. MECHANICAL :
1 Coils.
2. Vascular plugs.
3. Drug eluiting particles.

37. Coils:

42. TEMPORARY:
A. PARTICULATES:
1.Gelfoam.
2. Avitene.
3. Autologous blood clot.
PERMANENT:
A. PARTICULATES:
1. PVA.
2.Embolic spheres.
3.Drug eluting beads.
B. LIQUIDS :
1.Glue.
2.Onyx.
3. Alcohol.
4. Ethonalamine.
5. Sclerosants.
C. MECHANICAL :
1 Coils.
2. Vascular plugs.
3. Drug eluiting particles.