Peripheral Embolization

Peripheral Embolization

Towards more targeted embolization

What is Embolotherapy? 

The field of embolotherapy is continuously expanding towards new indications, in the last decade towards benign prostate embolization; more towards emborrholds and musculoskeletal embolization, with the consequence of making embolization technique more and more demanding.

Aim of embolization procedure is to deliver effective treatment while preserving adjacent tissues/structures. Among embolization principles, targeted and flow-directed embolization are fundamental ones. The increasing use of microcatheters participated to not only improve targeted embolization but also to maintain maximum blood flow to foster embolics delivery.1 

Still, the variability in vascularization anatomy associated to the variability of embolic material that may be used, can make deliver of those embolics a real challenge. 

One of the challenges is to avoid Non-Target embolization (NTE) to preserve adjacent tissues. NTE may be minimized by cautious planning and being as targeted as possible. However, presence of small vessels proximal to the target vessel makes it very difficult to control especially when using microspheres that tend to reflux at the tip of the catheter.2 


The challenge of Non-target Embolization (NTE)



  • Acute cholecystitis3, 4
  • Pancreatitis3
  • Liver infarction and parenchyma focal necrosis3,4


• Premature menopause (ovarian NTE)5
• Buttock necrosis6
• Labium minora ulceration (internal pudendal artery)7


  • Spinal cord ischemia (spinat arteries NTE)8
  • Dysphagia (esophageal branches NTE)8
  • Ischemic colitis8

An underestimated challenge

Rarely symptomatic - but can be dramatic

Induce further patients´ follow up

Of tissue damages following chemo-embolization(*in a study examining 51 HCC patients)

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Acute necrotizing pancreatitis following DEB-TACE for HCC10

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Of incomplete treatment after DEB-TACE11(*in a study examining 44 HCC patients)

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Physicians talk about NTE


Jafar Golzarian (Minneapolis, MN, USA)

"By the time we can see (contrast) reflux, it is already too late to prevent NTE"

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T.De Barre

Thierry De Baere (Villejuif, France)

"Because embolics went off target to embolize the cystic artery, the patient went to surgery for bilioma inside the peritunum"

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Irene Bargellini (Pisa, Italy)

"NTE is an under diagnosed problem"

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Florian Wolf (Vienna, Austria)

"The patient had transient paraplegia so anti-reflux microcatheters would have been helpful"

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Non-target embolization (NTE)

An Educational Guide to Embolization
Procedures and Related Complications

Download the guide (PDF)


  1. Transcatheter Embolization and Therapy, Techniques in Interventional Radiology, DOI 10.1007/978-1-84800-897-7_1, Springer-Verlag London Ltd. 2010, pp 3-10,
  2. Transcatheter Embolization and Therapy, Techniques in Interventional Radiology, DOI 10.1007/978-1-84800-897-7_3, Springer-Verlag London Ltd. 2010, pp 29-31,
  3. Safety Profile of Sequential Transcatheter Chemoembolization with DC Bead: Results of 237 Hepatocellular Carcinoma (HCC) Patients. Katerina Malagari, et al. Cardiovasc Intervent Radiol (2011) 34:774–785 DOI
  4. Analysis of Nontarget Embolization Mechanisms During Embolization and Chemoembolization Procedures. Ruben Lopez-Benıtez. Et al. Cardiovasc Intervent Radiol (2009) 32:615–622 DOI 10.1007/s00270-009-9568-9
  5. Contrast-enhanced sonography during uterine artery embolization for the treatment of leiomyomas. Marret, H.,et al. (2004) Ultrasound in Obstetrics and Gynecology, 23 (1), pp. 77-79.
  6. Buttock necrosis after uterine artery embolization. Dietz, D.M et al. (2004) Obstetrics and Gynecology, 104 (5 PART 2), pp. 1159-1161.
  7. Patient presentation and management of labial ulceration following uterine artery embolization. Gonsalves, C., et al. (2007) CardioVascular and Interventional Radiology, 30 (6), pp. 1263-1266
  8. Bronchial and Nonbronchial Systemic Artery Embolization for lifethreatening Hemoptysis: A Comprehensive Review. Woong Yoon et al. RadioGraphics 2002; 22:1395–1409. Published online 10.1148/rg.226015180
  9. Efficacy and Nontarget Effects of Transarterial Chemoembolization in Bridging of Hepatocellular Carcinoma Patients to Liver Transplantation: A Histopathologic Study. Ulrike Stampfl, MD, et al. J VascIntervRadiol2014;25:1018–1026
  10. Acute necrotizing pancreatitis as a fatal complication following DC Bead transcatheter arterial chemoembolization for hepatocellular carcinoma: A case report and review of the literature. Takashi Yamaguchi et al. Molecular and Clinical Oncology 2018; 9: 403-407; DOI: 10.3892/mco.2018.1690
  11. Transarterial chemoembolization with DC Bead LUMI™ radiopaque beads for primary liver cancer treatment: Preliminary experience. Aliberti et al. Future Oncology 2017, (25):2243-2252. doi: 10.2217/fon-2017-0364
  12. Beads accumulation reports DR-1800178 & TR-026
  13. Vessel Flow Dynamic Indication (Beads Reflux) Bench Test report TR-002
  14. Usability, Safety and Efficacy of a Novel Microcatheter for Reducing Non-Target Embolization. Michael Tal et al. WCIO 2018 Poster. Animal study.

SEQURE™ microcatheers are class IIb medical devices intended for use by Interventional radiologists and interventional oncologists for the infusion of contrast media into all peripheral vessels and for drug infusion in intra-arterial therapy, and infusion of embolic materials. They should not be used in cerebral vessels. 

For complete information about precautions and optimal usage conditions for these medical devices, we recommend consulting the instructions for use supplied with each device or with your local Guerbet representative(s). Information for use only in countries with applicable health authority registrations. 

Notified Body: MedCert 0482. Manufacturer: Accurate Medical Therapeutics Ltd. EC Rep: Guerbet. Document creation data: April 2020. SEQURE™ microcatheters are registered trademarks of Guerbet Group or Its affiliates.