Episode # 3 • 17 Jan 2025
Liquid Embolic Techniques and Strategies for GI Bleeds
What makes you reach for a liquid embolic in a gastrointestinal bleed instead of coils? On this episode of the BackTable 2026 Liquid Embolics Creator Weekend™, Dr. Gary Siskin and Dr. Alexander Misono join host Dr. Ally Baheti to examine seven bleeding cases where a liquid agent decided the plan, from a lost distal position in the gastroduodenal artery to a patient exsanguinating from a duodenal ulcer at four in the morning. They work through case selection, access in hostile postsurgical anatomy, agent preparation, how much to inject, and the complications that follow when the judgment is wrong.
This podcast is supported by an educational grant from Sirtex.
Timestamps
00:00 - Introduction
01:00 - Case 1: Gastroduodenal Artery Bleed
05:08 - Case 2: Prophylactic Embolization and an Overnight Rebleed
09:24 - Case 3: Postsurgical Anatomy and Difficult Access
13:43 - Agent Preparation and Shaking Protocol
16:21 - Injection Volume, Dead Space and Catheter Removal
19:11 - Case 4: Duodenal Ulcer Hemorrhage
25:56 - Cases 5 and 6: Non-Target Embolization and Territory Loss
32:06 - Case 7: Pseudoaneurysm in a Pancreatic Pseudocyst
36:45 - Renal Angiomyolipoma Embolization
40:18 - Distal Embolic Agents in Clinical Trials
44:06 - Closing Remarks
Resources
- Arslan B, Razavi MK, Siskin G, et al. The LAVA Study: A Prospective, Multicenter, Single-Arm Study of a Liquid Embolic System for Treatment of Peripheral Arterial Hemorrhage. J Vasc Interv Radiol. 2025
- Liquid Embolization of Arterial Hemorrhages in the Peripheral Vasculature: The LAVA Study (NCT04649255)
- Evaluation of a Simple-Prep Controlled Embolic, the GPX Trial (NCT06453642)
- Urbano J, Paul L, et al. Elective and Emergency Renal Angiomyolipoma Embolization with Ethylene Vinyl Alcohol Copolymer: Feasibility and Initial Experience. J Vasc Interv Radiol. 2017
- Rolland R, Loubet A, et al. Safety, Efficacy and Mid-Term Outcome for Transarterial Embolization of Renal Angiomyolipoma Using Ethylene Vinyl Alcohol Copolymer Liquid Embolic Agent. J Clin Med. 2023
- Dr. Gary Siskin, Albany Med Health System
- Dr. Gary Siskin, BackTable contributor page
- Dr. Alexander Misono, Hoag
- Dr. Ally Baheti, BackTable contributor page
- Dr. Ally Baheti, LinkedIn
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More about this episode
The conversation centers on the gastroduodenal artery as the recurrent problem vessel, including a prophylactic embolization that rebled overnight, a cast tracking into the common hepatic artery, and a left gastric embolization that took more territory than intended. The panel covers agent preparation, dead space, microcatheter inner diameter, and the clinical pitfalls when a pseudoaneurysm ruptures during injection. They also discuss renal angiomyolipoma embolization, two investigational cases with new distal agents, and the skill worth teaching in this space: not how much to deliver, but when to stop.
The Materials available on BackTable are provided for informational and educational purposes only and are not a substitute for the independent professional judgment of a qualified healthcare professional in diagnosing or treating patients. Any opinions, statements, or views expressed are those of the individual contributors and do not necessarily reflect those of the publisher, platform, or any affiliated organization.