乙醇-碘海醇混合液与乙醇-碘化油悬浮液在兔肾动脉栓塞中的使用比较研究

doi:10.3877/cma.j.issn.2095-5782.2026.02.004

目的

评估乙醇-碘海醇混合液（ethanol-iohexol mixture, EIM）作为血管内栓塞剂在兔肾动脉栓塞模型中的有效性和安全性，并与乙醇-碘化油悬浮液（ethanol-lipiodol suspension, ELS）进行比较。

方法

45只兔被分为对照、EIM、ELS三组，经导管注入1 mL 栓塞剂并在数字减影血管造影（digital subtraction angiography, DSA）下根据脑梗死溶栓评分（thrombolysis in cerebral infarction score, TICI）评估血管闭塞。

结果

两种制剂均能在短时间内实现完全、持续的肾动脉闭塞（TICI 0级）。EIM因水溶性好、黏度低、无分层，注射更顺畅、扩散更均匀；ELS黏性高且易分离，注射困难并易出现回流。组织病理学证实EIM、ELS组均形成稳定血栓。EIM组栓塞后肝肾功能指标短暂升高，但均于术后1、2周恢复正常，提示系统性毒性可逆。

结论

EIM在可视化、注射性能和均匀栓塞方面优于ELS，而两者在有效性与安全性上均表现良好。

关键词: 乙醇-碘海醇混合液, 乙醇-碘化油悬浮液, 酒精, 介入栓塞

Objective

To evaluate the efficacy and safety of an ethanol–iohexol mixture (EIM) as an endovascular embolic agent in a rabbit renal artery embolization model and compare it with an ethanol–lipiodol suspension (ELS).

Methods

Forty-five rabbits were randomly divided into a control group, an EIM group, and an ELS group (n=15 each). All underwent transcatheter renal angiography and embolization with 1 mL of either EIM or ELS. Post-embolization vessel occlusion was assessed using digital subtraction angiography (DSA) and graded via the Thrombolysis in Cerebral Infarction (TICI) scale.

Results

Both EIM and ELS achieved complete and persistent occlusion (TICI 0) without recanalization or collateral formation. EIM, being water-soluble with lower viscosity, was easier to inject and showed rapid intravascular diffusion, enabling faster visualization of embolization. ELS was more viscous, difficult to inject, and exhibited phase separation within one minute. Histopathology confirmed comparable thrombus formation in both groups. Transient elevations in hepatic and renal biomarkers were observed but returned to baseline by 1 and 2 weeks, respectively.

Conclusion

EIM and ELS both provided effective, durable renal artery embolization with minimal systemic toxicity. EIM offered superior injectability and handling, while overall efficacy and safety were similar.【Keywords】Ethanol-iohexol mixture; Ethanol-iodized oil suspension; Alcohol;Interventional embolization

图1 EIM组和ELS组体外成像图示比较EIM组（1A）和ELS组（1B）的体外DSA试验成像强度，两者在DSA下显示出相似的强度，但是EIM组的密度更加均匀而ELS组出现了乙醇和碘化油的分离。EIM，乙醇-碘海醇混合液；ELS，乙醇-碘化油悬浮液。

图2 EIM组和ELS组体内成像图示比较注射EIM（2A、2C）和ELS（2B、2D）前后肾脏动脉的成像强度。EIM组给药后明显观察到肾脏的肾动脉。ELS组给药未能进入肾脏，而是从侧支血管流出，因此肾脏无法清晰成像。EIM，乙醇-碘海醇混合液；ELS，乙醇-碘化油悬浮液。

图3 EIM和ELS在体内的栓塞效果 3A，EIM组栓塞前肾血管结构；3B，ELS组栓塞前肾血管结构；3C，EIM组栓塞后1 min肾血管构；3D，ELS组栓塞后1 min肾血管结构；3E，EIM组栓塞后5 min肾血管结构；3F，ELS组栓塞后5 min肾血管结构。EIM group，乙醇-碘海醇混合液组；ELS group，乙醇-碘化油悬浮液组。

图4 对照组、EIM组和ELS组组织学变化对照组中，观察到正常的肾小球和肾小管上皮组织（4A~C）。而EIM组（4D~F）及ELS组（4J~L）第3天可见肾小管出现变性，伴有炎症细胞浸润，肾间质充血和水肿。第1周时，EIM组（4G~I）及ELS组（4M~O）均观察到肾组织梗死、间质纤维化增生及钙盐沉积。EIM group：乙醇-碘海醇混合液组；ELS group：乙醇-碘化油悬浮液组。3^nd Day：术后第3天；1^st week：术后第一周。

图5 EIM组、ELS组和对照组的肝肾功能指标结果肝功能指标包括ALT（5A）和AST（5B），肾功能指标为Scr（5C）、Bun（5D）、UA（5E）、β2-MG（5F）和Cys C（5G）。数据为均值±标准误，代表单次实验结果，每组每时间点包含15只动物。*P<0.05；**P<0.01；***P<0.001，表示组间差异具有统计学意义。ALT，丙氨酸氨基转移酶；AST，天冬氨酸氨基转移酶；SCR，血清肌酐；BUN，血尿素氮；UA，尿酸；β2-MG，β2-微球蛋白；Cys C，胱抑素C。

[1]	Hu J, Albadawi H, Chong BW, et al. Advances in biomaterials and technologies for vascular embolization[J]. Advanced Materials, 2019, 31(33): 1901071.
[2]	Leyon JJ, Littlehales T, Rangarajan B, et al. Endovascular embolization: review of currently available embolization agents[J]. Current problems in diagnostic radiology, 2014, 43(1): 35-53.
[3]	Li X, Ullah MW, Li B, et al. Recent progress in advanced hydrogel‐based embolic agents: from rational design strategies to improved endovascular embolization[J]. Advanced Healthcare Materials, 2023, 12(17): 2202787.
[4]	Gao F, Qian T, Chen MZ, et al. Therapeutic effects of transarterial infusion of lipiodol and ethanol in various ratios in a rabbit VX2 tumor model[J]. Diagnostic and Interventional Radiology, 2015, 21(3): 241.
[5]	Zhang Z, Albadawi H, Fowl RJ, et al. Treatment of Ruptured Wide‐Necked Aneurysms using a Microcatheter Injectable Biomaterial[J]. Advanced Materials, 2023, 35(46): 2305868.
[6]	Miszczuk MA, Chapiro J, Geschwind JH, et al. Lipiodol as an imaging biomarker of tumor response after conventional transarterial chemoembolization: prospective clinical validation in patients with primary and secondary liver cancer[J]. Translational Oncology, 2020, 13(3): 100742.
[7]	Ferreira AC, Sullo A, Winston S, et al. Influence of ethanol on emulsions stabilized by low molecular weight surfactants[J]. Journal of Food Science, 2020, 85(1): 28-35.
[8]	Wang L, Wang Z, Mao X, et al. Preoperative parent education and postoperative nurse-led care for boys versus routine hospital care for urethroplasty for hypospadias in Western China: a retrospective study[J]. Turkish Journal of Medical Sciences, 2024, 54(2): 459-470.
[9]	Behravesh S, Yakes W, Gupta N, et al. Venous malformations: clinical diagnosis and treatment[J]. Cardiovascular diagnosis and therapy, 2016, 6(6): 557.
[10]	Van Schaik TG, Meekel JP, Hoksbergen AW, et al. Systematic review of embolization of type I endoleaks using liquid embolic agents[J]. Journal of Vascular Surgery, 2021, 74(3): 1024-1032.
[11]	Wang CY, Hu J, Sheth RA, et al. Emerging embolic agents in endovascular embolization: an overview[J]. Progress in Biomedical Engineering, 2020, 2(1): 012003.
[12]	Ganguli S, Lareau R, Jarrett T, et al. A water-based liquid embolic: evaluation of its safety and efficacy in a rabbit kidney model[J]. Journal of Vascular and Interventional Radiology, 2021, 32(6): 813-818.
[13]	Zhang H, Ren Y, Li H, et al. Renal and hepatic artery embolization with Pickering gel emulsion of lipiodol in rabbit[J]. BMC cancer, 2022, 22(1): 1300.
[14]	Behme D, Tsogkas I, Colla R, et al. Validation of the extended thrombolysis in cerebral infarction score in a real world cohort[J]. PLoS One, 2019, 14(1): e0210334.
[15]	Hamada J, Kai Y, Mizuno T, et al. A Nonadhesive Liquid Embolic Agent of Ethylene Vinyl Alcohol Copolymer and Ethanol Mixture for Cerebral Arteriovenous Malformations: Clinical Experience[J]. Interventional Neuroradiology, 2004, 10(Suppl 1): 135-142.
[16]	Minici R, Venturini M, Fontana F, et al. Efficacy and Safety of Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs) in Transcatheter Arterial Embolization (TAE) of Acute Non-Neurovascular Bleeding: A Multicenter Retrospective Cohort Study[J]. Medicina (Kaunas), 2023, 59(4): 710.
[17]	Hamada J, Kai Y, Morioka M, et al. A mixture of ethylene vinyl alcohol copolymer and ethanol yielding a nonadhesive liquid embolic agent to treat cerebral arteriovenous malformations: initial clinical experience[J]. J Neurosurg, 2002, 97(4): 881-888.
[18]	Salaskar AL, Razjouyan F, Cho AL, et al. Single institutional experience of peripheral applications of a liquid embolic agent: Ethylene Vinyl Alcohol Copolymer[J]. CVIR Endovasc, 2020, 3(1): 38.
[19]	Nguyen QV, Lee MS, Lym JS, et al. pH-Sensitive sulfamethazine-based hydrogels as potential embolic agents for transcatheter vascular embolization[J]. Journal of materials chemistry B, 2016, 4(40): 6524-6533.
[20]	Mansueto G, Lanza G, Fisicaro F, et al. Central and peripheral nervous system complications of vasculitis syndromes from pathology to bedside: Part 1—central nervous system[J]. Current Neurology and Neuroscience Reports, 2022, 22(1): 47-69.
[21]	Young CC, Bonow RH, Barros G, et al. Magnetic resonance vessel wall imaging in cerebrovascular diseases[J]. Neurosurgical focus, 2019, 47(6): E4.
[22]	Mulligan P, Prajapati H, Martin L, et al. Vascular anomalies: classification, imaging characteristics and implications for interventional radiology treatment approaches[J]. The British journal of radiology, 2014, 87(1035): 20130392.
[23]	Qu ZY, Yang B, Yang FY, et al. Efficiency and safety of ethanol sclerotherapy for labial arteriovenous malformations[J]. J Vasc Surg Venous Lymphat Disord, 2022, 10(3): 713-720. e1.
[24]	Yang C, Li M, Li X, et al. Foam sclerotherapy in the treatment of hemangiomas and venous malformations[J]. Dermatologic Surgery, 2023, 49(9): 855-861.
[25]	Frandon J, Beregi JP. Special Issue: Present and Future Perspectives of Vascular Interventional Radiology[J]. J Pers Med, 2023, 13(7): 1131.

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Comparative Study of Ethanol-iohexol Mixture and Ethanol-iodized Oil Suspension in Rabbit Renal Artery Embolization

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Comparative Study of Ethanol-iohexol Mixture and Ethanol-iodized Oil Suspension in Rabbit Renal Artery Embolization