title: A comparison of particulate and Onyx embolization in preoperative devascularization of carotid body tumors.
abstract: BACKGROUND
  Preoperative embolization of a carotid body tumor (CBT) is a useful adjunct prior to surgical excision because it decreases operative blood loss and improves surgical outcomes. Traditionally, this is performed by transarterial particulate embolization (TAPE). More recently, direct percutaneous embolization (DPE) with Onyx is recognized as a promising technique for preoperative embolization. We compared these two techniques in patients treated for CBTs at our institution.
  
  
  METHODS
  We retrospectively reviewed cases of preoperative devascularization of CBT from 1 January 1995 through 1 September 2012. Patient cases were placed into two groups: TAPE and DPE. Operative blood loss, operative length, angiographic devascularization, embolization procedure complications, operative transfusion requirements, postoperative hospital stay, intensive care unit (ICU) stay, and procedure-related mortalities were compared.
  
  
  RESULTS
  A total of 17 patients underwent preoperative devascularization of their CBT with TAPE technique and ten patients using the DPE technique with Onyx. Average operative blood loss was significantly higher in the TAPE group (Mann-Whitney U test, p = 0.04). Operative time was also higher, although this difference was not significant. Two patients required intraoperative blood transfusions in the TAPE group while none required transfusions in the DPE group. There was no significant difference in ICU stay or length of hospitalization. One serious embolization procedure complication occurred in the TAPE group and none in the DPE group.
  
  
  CONCLUSIONS
  Operative blood loss in the DPE group was significantly less than the TAPE group. Blood transfusion requirement, operative time, and complications were less in the DPE group, although they did not reach statistical significance.
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Julius
authors.initials: J
authors.lastname: Griauzde
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gemmete
authors.forename: Neeraj
authors.initials: N
authors.lastname: Chaudhary
authors.forename: Aditya S
authors.initials: AS
authors.lastname: Pandey
authors.forename: Steven E
authors.initials: SE
authors.lastname: Sullivan
authors.forename: Erin L
authors.initials: EL
authors.lastname: McKean
authors.forename: Lawerence J
authors.initials: LJ
authors.lastname: Marentette
mesh_terms: D000328:Adult; D002345:Carotid Body Tumor / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009389:Neovascularization, Pathologic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D052638:Particulate Matter / Q000627:therapeutic use*; D011145:Polyvinyls / Q000627:therapeutic use*; D011292:Premedication / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; C450660:Onyx copolymer; D052638:Particulate Matter; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide