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Sample records for bronchial artery embolization

  1. Permanent Cortical Blindness After Bronchial Artery Embolization

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    Doorn, Colette S. van, E-mail: cvandoorn@gmail.com; De Boo, Diederick W., E-mail: d.w.deboo@amc.uva.nl [Academic Medical Centre, Department of Radiology (Netherlands); Weersink, Els J. M., E-mail: e.j.m.weersink@amc.uva.nl [Academic Medical Centre, Department of Pulmonology (Netherlands); Delden, Otto M. van, E-mail: o.m.vandelden@amc.uva.nl; Reekers, Jim A., E-mail: j.a.reekers@amc.uva.nl; Lienden, Krijn P. van, E-mail: k.p.vanlienden@amc.uva.nl [Academic Medical Centre, Department of Radiology (Netherlands)

    2013-12-15

    A 35-year-old female with a known medical history of cystic fibrosis was admitted to our institution for massive hemoptysis. CTA depicted a hypertrophied bronchial artery to the right upper lobe and showed signs of recent bleeding at that location. Bronchial artery embolization (BAE) was performed with gelfoam slurry, because pronounced shunting to the pulmonary artery was present. Immediately after BAE, the patient developed bilateral cortical blindness. Control angiography showed an initially not opacified anastomosis between the embolized bronchial artery and the right subclavian artery, near to the origin of the right vertebral artery. Cessation of outflow in the bronchial circulation reversed the flow through the anastomosis and allowed for spill of embolization material into the posterior circulation. Unfortunately the cortical blindness presented was permanent.

  2. Myocardial Infarction as a Complication of Bronchial Artery Embolization

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    Labbé, Hugo, E-mail: hugo.labbe.1@ulaval.ca [Université Laval, Department of Medicine (Canada); Bordeleau, Simon [Université Laval, Department of Emergency Medicine (Canada); Drouin, Christine [Université Laval, Department of Anesthesiology and Critical Care Medicine (Canada); Archambault, Patrick [Université Laval, Department of Emergency Medicine (Canada)

    2017-03-15

    Bronchial artery embolization is now a common treatment for massive pulmonary hemoptysis if flexible bronchoscopy at the bedside failed to control the bleeding. Complications of this technique range from benign chest pain to devastating neurological impairments. We report the case of a 41-year-old man who developed an ST elevation myocardial infarction during bronchial artery embolization, presumably because of coronary embolism by injected particles. In this patient who had no previously known coronary artery disease, we retrospectively found a communication between the left bronchial artery and the circumflex coronary artery. This fistula was not visible on the initial angiographic view and likely opened because of the hemodynamic changes resulting from the embolization. This case advocates for careful search for bronchial-to-coronary arterial fistulas and the need for repeated angiographic views during embolization procedures.

  3. Bronchial Artery Embolization for Massive Hemoptysis: a Retrospective Study

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    Ali Fani

    2013-05-01

    Full Text Available   Introduction: To assess the efficacy and safety of bronchial artery embolization in the treatment of massive hemoptysis.   Materials and Methods: A retrospective study on 46 patients (26 males and 20 females who were referred to the Razavi Hospital from April 2009 to May 2012 with massive hemoptysis and had bronchial artery embolization procedures. General characteristics of the patients including age, gender, etiology, and thorax computed tomograms, findings of bronchial angiographic, results of the embolization, complications related to bronchial artery embolization and clinical outcome during follow-up were reviewed. Results: The etiology included previous pulmonary tuberculosis in 20 cases, previous tuberculosis with bronchiectasis in 16 cases, bronchiectasis in 6 cases, and active pulmonary tuberculosis in one case. No identifiable causes could be detected in three patients. Moreover, massive hemoptysis was successfully and immediately controlled following the embolization procedure in all patients. One patient developed recurrent hemoptysis during one month following the procedure and was treated by re-embolization. No major procedure–related complication such as bronchial infarction was identified However none of the patientsexperienced neurological complications. Conclusion: Bronchial artery embolization is a safe and effective means of controlling massive hemoptysis and should be regarded as the first-line treatment for this condition.

  4. Prognostic factors in bronchial arterial embolization for hemoptysis

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    Kim, Eui Jong; Yoon, Yup; Oh, Joo Hyeong; Lim, Joo Won; Sung, Dong Wook [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1994-07-15

    To find the rebleeding factors in bronchial arterial embolization for treatment of hemoptysis, a retrospective study was performed. Medical records, angiographic findings and embolic materials of 35 patients who had undertaken arterial embolization for control of hemoptysis were reviewed. The period of follow-up for rebleeding was from 3 to 32 months after arterial embolization. We investigated the angiographic findings of extravasation, neovascularity, intervascular shunt, aneurysm and periarterial diffusion. Neovascularity was classified as mild(numerable neovascularity) and severe(innumerable). Rebleeding occurred in 15(43%) among 35 cases. Only two of 11 cases with no past episode of hemoptysis showed recurrence, while 9 of 15 cases who had more than three episodes did. Severe neovascularity were seen in 11 of 15 recurred cases, but seven of 20 non- recurred cases showed severe neovascularity. More than three angiographic findings representing hemoptysis were seen on 11(73%) among recurred 15 cases and seven(35%) among non- recurred 20 cases. The lesion was supplied by more than two different arteries on 8(54%) of the recurred cases, but only three(15%) of the non- recurred cases. Six of seven cases persistent neovascularity after arterial embolization were recurred. The history of repeated hemoptysis, severe neovascularity, variable angiographic findings, and post-embolization persistency of neovascularity were the factors related with the rebleeding after arterial embolization for hemoptysis. Careful and active arterial embolization are required on these conditions.

  5. "BRONCHIAL ARTERY EMBOLIZATION IN MASSIVE HEMOPTYSIS WITH A RARE CAUSE AND UNUSUAL BRONCHIAL ARTERY ANATOMY"

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    M.A. Shabani H. Saberi

    2004-09-01

    Full Text Available Massive hemoptysis is one of the most important respiratory emergencies and pulmonary infiltrating diseases are among the rare causes of hemoptysis. Bronchial artery embolization (BAE is a safe and effective treatment in these patients. Our case was a 45 years old woman with a 7 year history of Hodgkin's lymphoma who presented with massive hemoptysis of 20 days duration. CT scan revealed prebronchial infiltrating pattern. Diagnostic angiography showed hypervascularity in both hilar and perihilar areas and simultaneous opacification of both bronchial arteries from a right common trunk. BAE was successfully performed with 300 µ diameter polyvinyl alcohol. In follow up, hemoptysis did not recurred and patient was in good general health.

  6. Bronchial artery embolization in hemoptysis: a systematic review

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    Panda, Ananya; Bhalla, Ashu Seith; Goyal, Ankur

    2017-01-01

    We systematically reviewed the role of bronchial artery embolization (BAE) in hemoptysis. Literature search was done for studies on BAE published between 1976 and 2016. Twenty-two studies published in English, with sample size of at least 50 patients, reporting indications, technique, efficacy, and follow-up were included in the final analysis. Common indications for BAE included tuberculosis (TB), post-tubercular sequelae, bronchiectasis, and aspergillomas. Most common embolizing agent used was polyvinyl alcohol (size, 300–600 μm) with increasing use of glue in recent years. Overall immediate clinical success rate of BAE, defined as complete cessation of hemoptysis, varied from 70%–99%. However, recurrence rate remains high, ranging from 10%–57%, due to incomplete initial embolization, recanalization of previously embolized arteries, and recruitment of new collaterals. Presence of nonbronchial systemic collaterals, bronchopulmonary shunting, aspergillomas, reactivation TB, and multidrug resistant TB were associated with significantly higher recurrence rates (P < 0.05). Rate of major complications remained negligible and stable over time with median incidence of 0.1% (0%–6.6%). Despite high hemoptysis recurrence rates, BAE continues to be the first-line, minimally invasive treatment of hemoptysis in emergency settings, surgically unfit patients, or in patients with diffuse or bilateral lung disease. PMID:28703105

  7. Posterior Circulation Stroke After Bronchial Artery Embolization. A Rare but Serious Complication

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    Laborda, Alicia [Universidad de Zaragoza, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain); Tejero, Carlos [Hospital Clinico Universitario Lozano Blesa, Servicio de Neurologia (Spain); Fredes, Arturo, E-mail: fredesarturo@gmail.com [Universidad de Zaragoza, Hospital Quiron, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain); Cebrian, Luis; Guelbenzu, Santiago; Gregorio, Miguel Angel de, E-mail: mgregori@unizar.es [Universidad de Zaragoza, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain)

    2013-06-15

    Bronchial artery embolization (BAE) is the treatment of choice for massive hemoptysis with rare complications that generally are mild and transient. There are few references in the medical literature with acute cerebral embolization as a complication of BAE. We report a case of intracranial posterior territory infarctions as a complication BAE in a patient with hemoptysis due to bronchiectasis.

  8. Embolization of a Bronchial Artery Aneurysm in a Chronic Obstructive Pulmonary Disease (COPD) Patient with Non-Massive Hemoptysis.

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    Salamone, Ignazio; Cavallaro, Marco; Visalli, Carmela; Velo, Mariano; Barbaro, Ugo; Galletta, Karol; Andò, Filippo

    2017-01-01

    Bronchial artery aneurysm (BAA) is a rare condition with a reported prevalence of less than 1% of all selective bronchial arterial angiograms. Despite its low incidence, BAA represents a potential cause of hemoptysis. We describe the case of a 63-year-old man suffering from chronic obstructive pulmonary disease (COPD), who presented with non-massive hemoptysis. CT angiography revealed a single bronchial artery aneurysm of 9 mm in diameter, abutting the esophageal wall. Other CT findings included hypertrophy of the bronchial arteries along the mediastinal course, diffuse thickening of the walls of numerous bronchial branches and a "ground glass" opacity in the anterior segment of the right upper pulmonary lobe suggestive of alveolar hemorrhage. The final diagnosis was established based on selective angiography, which was followed by transcatheter arterial embolization (TAE) of the BAA and of the pathological bronchial circulation. Follow-up CT scans revealed a total exclusion of the aneurysm from the systemic circulation, resolution of the parenchymal "ground glass" opacity and absence of further episodes of hemoptysis over a period of two years. An incidental finding of a bronchial artery aneurysm necessitates prompt treatment. CT angiography and TAE represent the methods of choice for an appropriate diagnosis and treatment, respectively. In case of a BAA associated with chronic inflammatory diseases, such as COPD, in patients with hemoptysis, TAE of the BAA and of the pathological bronchial circulation, in association with the treatment of the underlying disease, represents a valid approach that can improve the pulmonary status and prevent further episodes of hemoptysis.

  9. Transarterial microcatheter glue embolization of the bronchial artery for life-threatening hemoptysis: Technical and clinical results

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    Baltacioglu, Feyyaz [Marmara University School of Medicine, Department of Radiology, Istanbul (Turkey)], E-mail: fbaltaci@yahoo.com; Cimsit, Nuri Cagatay [Marmara University School of Medicine, Department of Radiology, Istanbul (Turkey)], E-mail: cagataycimsit@gmail.com; Bostanci, Korkut [Marmara University School of Medicine, Department of Thoracic Surgery, Istanbul (Turkey)], E-mail: kbostanci@marmara.edu.tr; Yueksel, Mustafa [Marmara University School of Medicine, Department of Thoracic Surgery, Istanbul (Turkey)], E-mail: myuksel@marmara.edu.tr; Kodalli, Nihat [Marmara University School of Medicine, Department of Radiology, Istanbul (Turkey)], E-mail: nihatkodalli@yahoo.com

    2010-02-15

    Objectives: To report our experience with transarterial glue embolization of the bronchial artery for life-threatening hemoptysis. Materials and methods: Twenty-five patients underwent bronchial artery embolization, using coaxial microcatheter technique, with a liquid agent, n-butyl-2-cyanoacrylate (NBCA), named glue, for life-threatening hemoptysis. The technical and clinical outcomes were followed in terms of immediate control of bleeding, recurrence of hemoptysis and complications of the procedure. Results: Four patients had acute hemoptysis when they were evaluated. The average number of arteries embolized per patient was 2.9. BAEs were successful in controlling hemoptysis immediately in all 25 patients (100%) and in 24 patients (96%) at 1 month follow-ups. One patient had recurrent hemoptysis on the tenth day after embolization. The follow-up time ranged from 2 to 63 months (mean 14 months). Six patients (25%) died all as a result of their disease process. Bleeding recurred in 3 patients after 30 days (7th, 11th, 12th months). One patient had vomitting attacks with dysphagia after the procedure that lasted 24 h. Three patients had transient thoracic pain lasting 3-5 days. There were no procedure related spinal or vascular complications. Conclusions: Glue embolization with microcatheter technique is a safe and effective treatment in cases of life-threatening hemoptysis with a very high rate of success and low rate of complications.

  10. A retrospective review comparing the treatment outcomes of emergency lung resection for massive haemoptysis with and without preoperative bronchial artery embolization.

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    Alexander, Gerard R

    2014-02-01

    The objective of this review was to determine the feasibility of emergency lung resection for massive haemoptysis without preoperative bronchial artery embolization (BAE). The potential for fatal recurrent haemoptysis following BAE may be avoided if surgery is undertaken instead. Furthermore, if the outcomes for emergency lung resection with and without BAE are equivalent, it may be advisable to bypass BAE and proceed directly to resection. A retrospective review of case records from January 2005 to October 2007 of patients admitted to the Department of Cardiothoracic Surgery with massive haemoptysis deemed suitable for emergency lung resection was undertaken. Following urgent clinical evaluation, emergency lung resection with or without preoperative BAE was undertaken. If BAE was selected, the timing of lung resection was dependent upon the presence of recurrent haemoptysis. Sixty-one patients with massive haemoptysis were deemed suitable for emergency lung resection. Forty-one patients had lung resection without BAE. One patient (2%) had recurrent minor haemoptysis after surgery. Other complications included 2 deaths, 1 post-resection empyema thoracis and 1 deep thoracotomy wound infection. Twenty patients underwent surgery following BAE. Fifteen (75%) patients had recurrent haemoptysis after BAE. None developed recurrent haemoptysis after surgery. Other complications included 1 death and 2 post-resection empyema thoraces. This retrospective study suggests that emergency lung resection is feasible in appropriately selected patients presenting with radiologically localized disease and massive haemoptysis. These data also suggest that BAE is probably best utilized as a temporizing measure in patients unsuitable for emergency lung resection.

  11. Left bronchial artery arising from a replaced left hepatic artery in a patient with massive hemoptysis

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    Khil, Eun Kyung; Lee, Jae Myung [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon (Korea, Republic of)

    2015-09-15

    A 70-year-old man with a 3-year history of bronchiectasis presented with massive hemoptysis that had lasted for 3 days. In our attempt to perform bronchial artery embolization, upper abdominal angiography was required to locate the left bronchial artery, which in this case was of anomalous origin, arising from a replaced left hepatic artery, which arose from the left gastric artery-a very unusual anatomical variant. We performed embolization with polyvinyl alcohol particles, and the patient's symptoms resolved completely, with no additional complications after conservative treatment.

  12. Pregnancy after uterine arterial embolization

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    Cláudio E. Bonduki

    2011-01-01

    Full Text Available OBJECTIVE: To evaluate pregnancy outcomes, complications and neonatal outcomes in women who had previously undergone uterine arterial embolization. METHODS: A retrospective study of 187 patients treated with uterine arterial embolization for symptomatic uterine fibroids between 2005-2008 was performed. Uterine arterial embolization was performed using polyvinyl alcohol particles (500-900 mm in diameter. Pregnancies were identified using screening questionnaires and the study database. RESULTS: There were 15 spontaneous pregnancies. Of these, 12.5% were miscarriages (n = 2, and 87.5% were successful live births (n = 14. The gestation time for the pregnancies with successful live births ranged from 36 to 39.2 weeks. The mean time between embolization and conception was 23.8 months (range, 5-54. One of the pregnancies resulted in twins. The newborn weights (n = 14 ranged from 2.260 to 3.605 kg (mean, 3.072 kg. One (7.1% was considered to have a low birth weight (2.260 kg. There were two cases of placenta accreta (12.5%, treated with hysterectomy in one case [6.3%], one case of premature rupture of the membranes (PRM (6.3%, and one case of preeclampsia (6.3%. All of the patients were delivered via Cesarean section. CONCLUSION: In this study, there was an increased risk of Cesarean delivery. There were no other major obstetric risks, suggesting that pregnancy after uterine arterial embolization is possible without significant morbidity or mortality.

  13. Transarterial embolization of acute intercostal artery bleeding

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    Bae, Jae Ik; Park, Auh Whan; Lee, Seon Joo [Inje University College of Medicine, Busan (Korea, Republic of); Ko, Gi Young; Yoon, Hyun Ki [University of Ulsan College of Medicine, Seoul (Korea, Republic of); Yoon, Chang Jin [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Shin, Tae Beom [Donga University College of Medicine, Busan (Korea, Republic of); Kim, Young Hwan [Kyimyung University School of Medicine, Daegu (Korea, Republic of)

    2005-09-15

    To report our experiences of transarterial embolization for acute intercostal artery bleeding. A retrospectively analysis of the causes, clinical manifestations, angiographic findings and transarterial embolization technique in 8 patients with acute intercostal artery bleeding, with a review of the anatomical basis. The causes of intercostal artery bleeding were iatrogenic and traumatic in 88 and 12% of cases, respectively. Active bleeding from the collateral intercostal or posterior intercostal arteries was angiographically demonstrated in 75 and 25% of cases, respectively. Transarterial embolization successfully achieved hemostasis in all cases. However, two patient with hypovolemic shock expired due to a massive hemothorax, despite successful transarterial embolization. Intercostal access should be performed through the middle of the intercostal space to avoid injury to the collateral intercostal artery. Transarterial embolization is an effective method for the control of intercostal artery bleeding.

  14. Animal models of cerebral arterial gas embolism

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    Weenink, Robert P.; Hollmann, Markus W.; van Hulst, Robert A.

    2012-01-01

    Cerebral arterial gas embolism is a dreaded complication of diving and invasive medical procedures. Many different animal models have been used in research on cerebral arterial gas embolism. This review provides an overview of the most important characteristics of these animal models. The properties

  15. Radiologic management of haemoptysis. Diagnostic and interventional bronchial arterial embolisation

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    Ittrich, H.; Adam, G. [Univ. Medical Center Hamburg, Hamburg (Germany). Diagnostic and Interventional Radiology Dept. and Clinic; Klose, H. [Univ. Medical Center Hamburg, Hamburg (Germany). Section Pneumology

    2015-04-15

    Hemoptysis can be a life-threatening pulmonary emergency with high mortality, is symptomatic of an underlying severe pulmonary disease and requires immediate diagnosis and treatment. Diagnostically, bronchoscopy, conventional chest x-ray and contrast-enhanced multislice computed tomography (MSCT) with CT angiography (CTA) provide information regarding the underlying pulmonary disease, bleeding site, the vascular anatomy of the bronchial arteries (BA) and extrabronchial branches, as well a basis for planning of endovascular intervention. Therapeutically, bronchial artery embolization (BAE) is a safe and effective technique in the hands of an experienced interventionist with profound knowledge of the BA anatomy and possible pitfalls as well as experience with first-line therapy of recurrent and massive hemoptysis or as an intervention prior to elective surgery. Recurrent episodes of hemoptysis are not uncommon and require a prompt repeat BAE after exclusion of extrabronchial systemic and pulmonary artery bleeding sources. This review article should give an overview of the history, anatomical and pathophysiological basics and the clinical context of hemoptysis and diagnosis, as well as a survey of management, treatment and results of BAE.

  16. Coronary to Bronchial Artery Fistula Causing Massive Hemoptysis in Patients with Longstanding Pulmonary Tuberculosis

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    Yoon, Ji Young; Jeon, Eui Yong; Lee, In Jae; Koh, Sung Hye [Hallym University College of Medicine, Anyang (Korea, Republic of)

    2012-01-15

    We report on three cases of longstanding pulmonary tuberculosis patients with coronary to bronchial artery fistula (CBF) who presented with recurrent massive hemoptysis. The first and second patients died because of decreased functional pulmonary volume plus massive hemoptysis and cannulation failure of CBF due to hypovolemic vasospasm, respectively. When recurrent hemoptysis occurs despite successful embolization treatment, CBF should be considered as a potential bleeding source. Moreover, a coronary angiography should be performed, especially in patients with longstanding cardiopulmonary disease such as pulmonary tuberculosis.

  17. Bronchial artery embolisation for the treatment of massive ...

    African Journals Online (AJOL)

    Bronchial arteriography and embolisation were performed using a 4 French C2 catheter and polyvinyl alcohol (PVA) particles ranging from 300 to 900 micrometers. Results. Seven bronchial arteries in total were embolised (2 patients required embolisation of 2 arteries each). The haemoptysis was controlled during the first ...

  18. Local thrombolysis in renal artery embolism

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    Billmann, P.; Hoerl, W.H.; Hohnloser, S.

    1985-02-01

    Thrombo-embolic occlusions of the renal arteries are usually a result of co-existing cardiac disease, in most cases cardiac arrhythmias or ischaemic heart disease. Similar findings have been observed in mesenteric infarction and embolism into the lower extremities. The duration of ischeamia determines the prognosis. Surgical intervention has been the mainstay of previous therapy. However, the application of local thrombolysis, which is an extension of the diagnostic catheter studies, provides an alternative form of treatment. As in the case of peripheral artery disease, the choice of treatment can only be made in consultation with the surgeon. This report presents experience with the use of local thrombolysis of renal artery emboli.

  19. Uterine artery embolization for adenomyosis without fibroids

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    Kim, M.D. E-mail: mdkim@cha.ac.kr; Won, J.W.; Lee, D.Y.; Ahn, C.-S

    2004-06-01

    AIM: To evaluate the potential usefulness of transcatheter uterine artery embolization as a treatment for symptomatic adenomyosis in patients without uterine fibroids. MATERIALS AND METHODS: Uterine artery embolization using polyvinyl alcohol particles sized 250-710 mm was performed in 43 patients (mean; 40.3 years, range; 31-52 years) with dysmenorrhoea, menorrhagia, or bulk-related symptoms (pelvic heaviness, urinary frequency) due to adenomyosis without fibroids. All patients underwent pre-procedural and 3.5 months (range 1-8 months) follow-up magnetic resonance imaging (MRI) with contrast enhancement. Clinical symptoms were also assessed at the time of MRI before and after embolization. RESULTS: Significant improvement of dysmenorrhoea (95.2%) and menorrhagia (95.0%) was reported in most patients. Contrast-enhanced MRI revealed non-enhancing areas suggesting coagulation necrosis of adenomyosis in 31 patients (72.1%), decreased size without necrosis in 11 patients (25.6%), and no change in one patient (2.3%). The mean volume reduction of the uteri after uterine artery embolization was 32.5% (from 321.7{+-}142.9 to 216.7{+-}130.1 cm{sup 3}). CONCLUSION: Transcatheter uterine artery embolization is an effective therapy for the treatment of symptomatic pure adenomyosis, and may be a valuable alternative to hysterectomy.

  20. Pulmonary Artery Cement Embolism after a Vertebroplasty

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    Anas Nooh

    2015-01-01

    Full Text Available Background Context. Vertebroplasty is a minimally invasive procedure most commonly used for the treatment of vertebral compression fractures. Although it is relatively safe, complications have been reported over time. Among those complications, massive cement pulmonary embolism is considered a rare complication. Here we report a case of massive diffuse cement pulmonary embolism following percutaneous vertebroplasty for a vertebral compression fracture. Study Design. Case report. Methods. This is a 70-year-old female who underwent vertebroplasty for T11 and T12 vertebral compression fracture. Results. CT-scan revealed an incidental finding of cement embolism in the pulmonary trunk and both pulmonary arteries. Since the patient was asymptomatic, she was monitored closely and she did not need any intervention. Conclusion. Vertebroplasty is a minimally invasive procedure used for treatment of vertebral compression fracture. Despite the low rate of complications, a pulmonary cement embolism can occur. The consequences of cement embolism range widely from being asymptomatic to embolism that can cause paralysis, radiculopathy, or a fatal pulmonary embolism.

  1. Empirical description of bronchial and nonbronchial arteries with MDCT

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    Yu Hong, E-mail: yuhong.2002@hotmail.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Liu Shiyuan, E-mail: cjr.liushiyuan@vip.163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Li Huimin, E-mail: yuhongphd@163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Xiao Xiangsheng, E-mail: cjr.xxsh@vip.163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Dong Weihua, E-mail: dongweihua2000@163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China)

    2010-08-15

    Purpose: We aimed to retrospectively evaluate bronchial and nonbronchial systemic arteries using multi-detector row helical computed tomographic (MDCT) angiography in patients with pulmonary disorders. Materials and Methods: Thirty-nine patients (24 men, 15 women; mean age, 63.4 years; range, 20-82 years) with congenital and acquired pulmonary disorders of the bronchial and nonbronchial systemic arteries underwent multi-detector row helical computed tomographic angiography of the thorax using a 16-detector row scanner. Each of these patients had experienced an episode of hemoptysis. Computed tomographic angiogram data, which included maximum intensity projections, multiplanar reconstruction, and three-dimensional volume-rendered images, were used to retrospectively analyse the characteristics of the bronchial and nonbronchial systemic arteries. Results: We identified a total of 128 bronchial arteries (76 on the right side and 52 on the left) in 39 patients. We detected 42 nonbronchial systemic artery branches, including 19 internal mammary artery branches, 8 subclavian artery branches, 8 inferior phrenic artery branches, 5 intercostal artery branches, 1 thyrocervical trunk branch, and 1 celiac trunk branch. Thirty-five dilated and tortuous nonbronchial systemic arteries entered into the lung parenchyma and extended down to the lesions. Every case, except the one case of sequestration, was associated with pleural thickening where the vascular structures passed through the extrapleural fat. Conclusions: The variations in both the bronchial artery anatomy and the location and type of the nonbronchial arteries were great. Nonbronchial arteries may be a significant source of hemoptysis. MDCT angiography can be used to detect detailed anatomical information about the origins and courses of bronchial and nonbronchial systemic arteries and their pathophysiologic features.

  2. Successful Treatment of Bronchial Fistula after Pulmonary Lobectomy by Endobronchial Embolization Using an Endobronchial Watanabe Spigot

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    Yuichiro Machida

    2015-01-01

    Full Text Available A bronchial fistula is one of the most serious complications that can occur following pulmonary lobectomy. We herein report a case of bronchial fistula that was successfully treated by endobronchial embolization using an Endobronchial Watanabe Spigot (EWS. A 72-year-old male underwent right lower lobectomy of the lung with nodal dissection for a pulmonary squamous cell carcinoma. A bronchial fistula developed 53 days after surgery. Tube drainage was performed, and air leakage was apparent. Under endoscopic observation, intrathoracic injection of indigo carmine revealed that a fistula existed at the peripheral site of the B2ai bronchus. After one EWS (small was inserted into the B2a bronchus tightly using a bronchoscope, the air leakage was stopped. Pleurodesis was further carried out, the thoracostomy tube was subsequently removed, and the patient was discharged. Endobronchial embolization using an EWS is an option for the treatment of a bronchial fistula after pulmonary resection.

  3. Arterial embolization in patients with renal carcinoma

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    Christensen, S W; Berg, J; Brynitz, S

    1989-01-01

    The literature concerning embolization of the renal artery in patients with renal cell carcinoma is reviewed. Based on this review it is concluded that the method is useful in this patient group as it will facilitate the surgical procedure if nephrectomy is performed afterwards. Used...

  4. Fertility after uterine artery embolization of fibroids

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    Karlsen, K; Hrobjartsson, A; Korsholm, M

    2018-01-01

    PURPOSE: The impact of uterine artery embolization (UAE) for the purpose of diminishing the effect of uterine fibroids on fertility is unclear. We have investigated the reported rates of pregnancy and miscarriage after treatment of uterine fibroids with UAE. MATERIALS AND METHODS: We searched...

  5. Uterine artery embolization to treat uterine fibroids

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    Machan, L.; Martin, M. [Univ. of British Columbia Hospital, Dept. of Radiology, Vancouver, BC (Canada)

    2001-06-01

    The first reported application of uterine artery embolization, in 1979, was to treat life-threatening hemorrhage after a failed hysterectomy. Since then, uterine artery embolization has been used very successfully to control acute or delayed post-partum hemorrhage, post-surgical hemorrhage and hemorrhage from ectopic pregnancy, to treat uterine arteriovenous malformations and as prophylaxis before high-risk surgery, such as cesarean delivery in women with placenta previa. In contrast to these proven but underutilized applications, uterine embolization for fibroids has, in a short time, achieved significant notice in the lay press and is being widely offered. Ravina and colleagues, first reported uterine fibroid shrinkage after embolization for the treatment of acute bleeding. Since then, his group has performed over 100 procedures with up to a 6-year follow-up. The cumulative clinical success rate for the treatment of abnormal uterine bleeding due to fibroids is reported to be approximately 85% and for treatment of pain or pressure symptoms, about 75%. Six-month follow-up sonography reveals an average reduction of fibroid size of approximately 40%. However, to date, no studies have compared patients who undergo embolization with a nontreatment cohort or with surgical intervention. (author)

  6. Uterine artery embolization for cervical ectopic pregnancy

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    Qiao Zhou, MD

    2015-12-01

    Full Text Available A 36-year-old woman with 3 prior C-sections is diagnosed with a caesarean scar ectopic pregnancy. Despite receiving intramuscular and transvaginal methotrexate injection 2 months before presentation, the beta human chorionic gonadotropin was recorded to be 73 mIU/mL at the time of encounter. The patient complained of vaginal bleeding with a significant drop in hematocrit from 40% to 33%. Transvaginal ultrasound confirmed retroplacental hemorrhage and because of the patient's desire to retain fertility, interventional radiology was consulted to perform an uterine artery embolization. The uterine artery embolization was successful in achieving hemostasis and resulted in a decrease of betaHCG to 46 on postprocedure day 1 to <1 mIU/mL by postoperative week 3.

  7. Recurrent Massive Hemoptysis due to Postbronchotomy Bronchial Artery Aneurysm: A Case Report

    Directory of Open Access Journals (Sweden)

    Achilleas Lioulias

    2008-01-01

    Full Text Available Bronchial artery aneurysm (BAA is a rare clinical entity. A case of intrapulmonary BAA associated with previous bronchotomy at the same site is described. A 22-year-old woman, who had undergone bronchotomy of the intermediate bronchus for the removal of a foreign body four years previously, presented with recurrent hemoptysis. Because of an increased risk for spinal cord ischemia, she immediately underwent lung resection rather than therapeutic embolization. The incidental finding of a BAA of any cause cannot be assumed to be stable, and immediate management should be undertaken regardless of the presence or absence of symptoms.

  8. Transcatheter Arterial Embolization With Spherical Embolic Agent for Pulmonary Metastases From Renal Cell Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Seki, Akihiko, E-mail: sekia@igtc.jp; Hori, Shinichi, E-mail: horishin@igtc.jp; Sueyoshi, Satoru, E-mail: sueyoshis@igtc.jp; Hori, Atsushi, E-mail: horiat@igtc.jp; Kono, Michihiko, E-mail: konom@igtc.jp; Murata, Shinichi, E-mail: muratas@igtc.jp; Maeda, Masahiko, E-mail: maedam@igtc.jp [Gate Tower Institute for Image Guided Therapy, Department of Radiology (Japan)

    2013-12-15

    Purpose: This retrospective study aimed to evaluate the safety and local efficacy of transcatheter arterial embolization (TAE) with superabsorbent polymer microspheres (SAP-MS) in patients with pulmonary metastases from renal cell carcinoma (RCC). Methods: Sixteen patients with unresectable pulmonary metastases from RCC refractory to standard therapy were enrolled to undergo TAE with the purpose of mass reduction and/or palliation. The prepared SAP-MS swell to approximately two times larger than their dry-state size (100-150 {mu}m [n = 14], 50-100 {mu}m [n = 2]). Forty-nine pulmonary nodules (lung n = 22, mediastinal lymph node n = 17, and hilar lymph node n = 10) were selected as target lesions for evaluation. Local tumor response was evaluated 3 months after TAE according to Response Evaluation Criteria in Solid Tumors (RECIST; version 1.1). The relationship between tumor enhancement ratio by CT during selective angiography and local tumor response was evaluated. Results: The number of TAE sessions per patient ranged from 1 to 5 (median 2.9). Embolized arteries at initial TAE were bronchial arteries in 14 patients (87.5 %) and nonbronchial systemic arteries in 11 patients (68.8 %). Nodule-based evaluation showed that 5 (10.2 %) nodules had complete response, 17 (34.7 %) had partial response, 15 (30.6 %) had stable disease, and 12 (24.5 %) had progressive disease. The response rate was significantly greater in 22 lesions that had a high tumor enhancement ratio than in 27 lesions that had a slight or moderate ratio (90.9 vs. 7.4 %, p = 0.01). Severe TAE-related adverse events did not occur. Conclusion: TAE with SAP-MS might be a well-tolerated and locally efficacious palliative option for patients with pulmonary metastases from RCC.

  9. Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?

    Energy Technology Data Exchange (ETDEWEB)

    Arrayeh, Elnasif; Fidelman, Nicholas, E-mail: nicholas.fidelman@ucsf.edu; Gordon, Roy L.; LaBerge, Jeanne M.; Kerlan, Robert K. [University of California San Francisco, Department of Radiology (United States); Klimov, Alexander; Bloom, Allan I. [Hadassah Hospital, Department of Radiology (Israel)

    2012-12-15

    Purpose: To determine whether transcatheter arterial embolization performed in the setting of active gastric or duodenal nonvariceal hemorrhage is efficacious when the bleeding source cannot be identified angiographically. Methods: Records of 115 adult patients who underwent visceral angiography for endoscopically documented gastric (50 patients) or duodenal (65 patients) nonvariceal hemorrhage were retrospectively reviewed. Patients were subdivided into three groups according to whether angiographic evidence of arterial hemorrhage was present and whether embolization was performed (group 1 = no abnormality, no embolization; group 2 = no abnormality, embolization performed [empiric embolization]; and group 3 = abnormality present, embolization performed). Thirty-day rates and duration of primary hemostasis and survival were compared.ResultsFor patients with gastric sources of hemorrhage, the rate of primary hemostasis at 30 days after embolization was greater when embolization was performed in the setting of a documented angiographic abnormality than when empiric embolization was performed (67% vs. 42%). The rate of primary hemostasis at 30 days after angiography was greater for patients with duodenal bleeding who either underwent empiric embolization (60%) or embolization in the setting of angiographically documented arterial hemorrhage (58%) compared with patients who only underwent diagnostic angiogram (33%). Patients with duodenal hemorrhage who underwent embolization were less likely to require additional invasive procedures to control rebleeding (p = 0.006). Conclusion: Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.

  10. Recurrent bleeding after arterial embolization in patients with hemoptysis : Comparison of angiographic findings and relapsing period

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Keun; Choi, Seok Jin; Choi, Gi Bok; Kim, Hae Yeon; Park, Auh Whan; Juhn, Jae Ryang; Cha, Seong Sook [Inje Univ., College of Medicine, Pusan (Korea, Republic of)

    2001-12-01

    To describe the angiographic findings of patients with recurrent hemoptysis after bronchial artery embolization (BAE) according to the point at which relapse occurred. From 125 patients who underwent BAE due to hemoptysis between 1996 and 2000, we selected 18 of 23 who underwent additional BAE due to recurrent bleeding after initial BAE. Depending on the point at which relapse occurred, they were divided into two groups (I and ll, according to whether additional BAE was performed within two weeks of initial BAE or more than two weeks after this) We retrospectively compared the two groups in terms of angiographic findings, number of embolized arteries, and character of feeding arteries at initial and additional BAE. Nine patients in group I (additional BAE: n=10) and nine in group ll (additional BAE: n=13) were admitted for recurrent hemoptysis within two weeks of initial BAE and more than two weeks after this, respectively. In group I (n=29) and ll(n=31), angiography demonstrated two direct and 27 indirect, and two direct and 29 indirect signs of hemorrhage, respectiveIy. No statistically significant differences were observed (x{sup 2}=0.005, {rho}=0.945). Among the embolized feeder ressels in group I (n=30) there were 20 bronchial artery and 10 non bronchial systemic collaterals, while for group ll (n=35), the corresponding totals were 21 and 14. Again, no statistically significant differences were encountered(x{sup 2}=0.308; {rho}=0.579). In group I, feeders were newly developed in one case(10%), previously embolized in five(50%), and missed in four(40%), while in group two the corresponding figures were none, twelve(92.3%), and one(7.7%) No significant differences were noted, though the incidence of previously embolized feeders in Group ll was very high (x{sup 2}=5.383, {rho}=0.068). Among patients in whom hemoptysis after BAE recurred at different times, the angiographic findings and number of embolized arteries were not significantly different, but differences

  11. Upper limb amputation due to a brachial arterial embolism associated with a superior mesenteric arterial embolism: a case report

    Directory of Open Access Journals (Sweden)

    Yamada Tsuyoshi

    2012-07-01

    Full Text Available Abstract Background Acute mesenteric ischemia due to an embolism of the superior mesenteric artery is associated with a high mortality rate. Over 20 percent of acute mesenteric embolism cases consist of multiple emboli, and the long-term prognosis depends on the incidence of subsequent embolic events at other sites. The incidence of emboli in the upper extremity associated with a superior mesenteric arterial embolism has rarely been described. The signs and symptoms of ischemic change in the upper limb can be masked by other circumstances, such as postoperative conditions or complications. In these cases, a late presentation or delayed diagnosis and treatment can result in limb loss. Case presentation We present a rare case of a 67-year-old Japanese woman with atrial fibrillation who developed an embolic occlusion of the brachial artery associated with a superior mesenteric arterial embolism. She developed gangrene in her right hand, which had progressed to the point that amputation was necessary by the time the gastrointestinal surgeon had consulted the Department of Orthopedic Surgery. The brachial arterial embolism diagnosis was delayed by the severe abdominal symptoms and shock conditions that followed the emergency enterectomy, resulting in amputation of the upper limb despite anticoagulation therapy. In this case, multiple infarctions of the spleen were also observed, indicating a shower embolism. Conclusions When treating a superior mesenteric arterial embolism in a patient with atrial fibrillation, the possibility of recurrent or multiple arterial thromboembolic events should be considered, even after the procedure is completed.

  12. Hepatocellular carcinoma treatment: ablation and arterial embolization.

    Science.gov (United States)

    Bilbao, J I; Páramo, M; Madrid, J M; Benito, A

    2017-11-03

    Percutaneous and endovascular techniques take an important role in the therapeutic management of patients with hepatocarcinoma. Different techniques of percutaneous ablation, especially indicated in tumors up to 2cm diameter offer, at least, similar results to surgical resection. Taking advantage of double hepatic vascularization and exclusive tumor nutrition by the artery, several endovascular techniques of treating the tumor have been developed. Intra-arterial administration of embolizing particles, alone or charged with drug (chemoembolization), will produce ischemia and consequent necrosis with excellent results in selected patients. Certain types of particles may exclusively be carriers of a therapeutic agent when they incorporate a radioisotope that facilitates the direct intratumoral selective irradiation (radioembolization). This technique has demonstrated its efficacy in lesions not susceptible to be treated with other methods and should be considered, together with ablation and chemoembolization, in the therapeutic algorithms of hepatocarcinoma. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Tentorial artery embolization in tentorial dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N. [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

    2006-10-15

    The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

  14. [Disseminated arterial occlusions revealing bilateral venous thrombosis with paradoxical embolisms].

    Science.gov (United States)

    Elsendoorn, A; Desport, E; Vialle, R; Frat, J-P; Bridoux, F; Touchard, G

    2009-06-01

    Paradoxical embolism is a diagnosis of exclusion. Clinical triad associates deep venous thrombosis with or without pulmonary embolism, arterial embolism, and intracardiac communication with right-to-left shunt. The intracardiac communication is generally related to a patent foramen ovale (PFO). We report a 75-year-old patient, who presented with bilateral deep venous thrombosis of the legs, complicated by massive pulmonary embolism and paradoxical embolisms through a PFO. This resulted in cerebral, mesenteric, splenic and bilateral kidney infarctions. A promptly initiated anticoagulant treatment allowed a favourable outcome.

  15. Acute tumor lysis syndrome after proximal splenic artery embolization

    Directory of Open Access Journals (Sweden)

    Jason T. Salsamendi

    2016-06-01

    Full Text Available Preoperative splenic artery embolization for massive splenomegaly has been shown to reduce intraoperative hemorrhage during splenectomy. We describe a case of tumor lysis syndrome after proximal splenic artery embolization in a patient with advanced mantle cell lymphoma and splenic involvement. The patient presented initially with hyperkalemia two days after embolization that worsened during splenectomy. He was stabilized, but developed laboratory tumor lysis syndrome with renal failure and expired. High clinical suspicion of tumor lysis syndrome in this setting is advised. Treatment must be started early to avoid serious renal injury and death. Lastly, same day splenectomy and embolization should be considered to decrease the likelihood of developing tumor lysis syndrome.

  16. Hypertension following Therapeutic Arterial Embolization: A Rare Complication

    Directory of Open Access Journals (Sweden)

    Ghansham Biyani

    2014-05-01

    Full Text Available Accelerated hypertension following therapeutic arterial embolization is a rare phenomenon. A patient of left upper limb chronic lymphedema was posted for shoulder disarticulation under general anaesthesia. Coil embolization of the left subclavian artery was done prior to surgery. Following the intervention, patient’s blood pressure increased by more than 30% of the base line value and was managed with antihypertensives for the next 3 hours to get the blood pressure optimised prior to taking the patient for surgery.

  17. Congenital anomalous/aberrant systemic artery to pulmonary venous fistula: Closure with vascular plugs & coil embolization

    Directory of Open Access Journals (Sweden)

    Pankaj Jariwala

    2014-01-01

    Full Text Available A 7-month-old girl with failure to thrive, who, on clinical and diagnostic evaluation [echocardiography & CT angiography] to rule out congenital heart disease, revealed a rare vascular anomaly called systemic artery to pulmonary venous fistula. In our case, there was dual abnormal supply to the entire left lung as1 anomalous supply by normal systemic artery [internal mammary artery]2 and an aberrant feeder vessel from the abdominal aorta. Left Lung had normal bronchial connections and normal pulmonary vasculature. The fistula drained through the pulmonary veins to the left atrium leading to ‘left–left shunt’. Percutaneous intervention in two stages was performed using Amplatzer vascular plugs and coil embolization to close them successfully. The patient gained significant weight in follow up with other normal developmental and mental milestones.

  18. Transcatheter Embolization of Cystic Artery Pseudoaneurysms Secondary to Acute Cholecystitis.

    Science.gov (United States)

    Tapnio, Richard H; Kolber, Marcin K; Shukla, Pratik A; Berkowitz, Eric

    2017-10-01

    Cystic artery pseudoaneurysm is a rare entity most closely associated with trauma to the biliary vasculature (usually iatrogenic) or inflammation from adjacent cholecystitis. Most cases are treated intraoperatively during cholecystectomy. We describe 3 cases of cystic artery pseudoaneurysms secondary to acute cholecystitis, 2 with active hemobilia, treated with transcatheter embolization at our institution.

  19. Transcatheter arterial embolization in gastric cancer patients with acute bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Joo; Shin, Ji Hoon; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong-Il; Song, Ho-Young; Sung, Kyu-Bo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Seoul (Korea)

    2009-04-15

    The safety and clinical effectiveness of transcatheter arterial embolization for bleeding associated with unresectable gastric cancer was evaluated. Twenty-three patients with bleeding from unresectable gastric cancer underwent transcatheter arterial embolization. Of the 23 patients, eight showed signs of active bleeding, such as contrast extravasation or pseudoaneurysm, seven showed only tumor staining, and the remaining eight patients showed negative angiographic findings. All embolization procedures were successful without procedure-related complications. In all eight active bleeding patients, immediate hemostasis was achieved. The overall clinical success rate was 52% (12/23). Recurrent bleeding within 1 month occurred in one (8%) in 12 patients with initial clinical success. One patient showed partial splenic infarction after embolization of the splenic artery for active bleeding from the short gastric artery. Overall 30-day mortality rate was 43% (10/23). The median overall survival period was 38 days. In patients with bleeding from unresectable gastric cancer, transcatheter arterial embolization was found to be safe and effective for achieving immediate hemostasis for active bleeding. Although the clinical success rate was not high, the recurrent bleeding rate was low at 1 month post procedure. (orig.)

  20. Uterine arterial embolization for uterine leiomyoma: efficacy and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Seon; Lee, Do Yon; Kim, Yong Tae; Park, Ki Hyun; Park, Yong Won; Cho, Jae Sung; Kim, Myung Jun [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of); Won, Je Hwan [Ajou Univ. College of Medicine, Suwon (Korea, Republic of); Kang, Byung Chul [Ewha Womans Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-09-01

    To determine the efficacy and clinical outcome of uterine arterial embolization as a new approach to the management of uterine leiomyomas. Uterine arterial embolization was performed in 21 patients aged 26-62(mean, 42) years. Twenty of these had menorrhagia, dysmenorrhea, and mass-related symptoms (low abdominal discomfort, backache, urinary frequency, etc.) and one was diagnosed incidentally. Bilateral uterine arteries were selected individually and polyvinyl alcohol and/or gelfoam was used as an embolic material. Nineteen patients were followed up after embolization. Seventeen (89.5 %)reported satisfactory improvement of symptoms and follow-up sonography three months later showed a 58.5 % reduction in mean myoma volume. In 17 patients (89.5 %), the menstrual cycle returned to normal. All patients experienced pain after the procedure and other complications were vaginal bleeding (26.3 %) and fever (23.8 %). Uterine arterial embolization represents a new approach to the management of uterine leiomyoma-related symptoms. Further investigations and long-term follow-up are, however, enquired.

  1. Uterine artery embolization angiography and fertility related aspects

    Directory of Open Access Journals (Sweden)

    Irina A. Horhoianu

    2016-05-01

    Full Text Available Purpose. Uterine artery embolization is a minimally invasive technique. It applies the principle of targeted anatomical structure devascularisation with utility in fibroid conservative therapy, including for future fertility preserving status. The objective of our paper represents a description and evaluation of angiography utility as a predictive method for fertility maintenance. Material and Methods. The angiography and ultrasound aspects obtained from a prospective study in which selected patients have undergone uterine artery embolization for fertility preservation are detailed. Results. The following angiography aspects have been detected: left- right shunt and utero-ovarian collaterals; these have been compared with the ultrasound aspects related to the fibroid evolution form a volumetric and Doppler ultrasound point of view. The angiographical description predicts the impact on post embolization fibroid evolution and upon fertility. An analysis is made in order to assess the way in which angiography can contribute to fertility alteration. Conclusions. The angiography aspects during embolization and the following ultrasound aspects can represent predictive factors as to fertility evolution after uterine artery embolization.

  2. Coil embolization of the splenic artery: impact on splenic volume.

    Science.gov (United States)

    Preece, Stephen R; Schriber, Stacey M; Choudhury, Kingshuk R; Suhocki, Paul V; Smith, Tony P; Kim, Charles Y

    2014-06-01

    To determine the impact of coil embolization of the splenic artery on splenic volume based on computed tomography (CT) imaging. Splenic artery embolization (SAE) was performed in 148 consecutive patients over an 8-year period in an institutional review board-approved retrospective study. Of these, 60 patients (36 men; mean age, 49 y) had undergone contrast-enhanced CT before and after SAE with a mean time interval of 355 days. Pre- and postembolization splenic volumes were calculated with volume-rendering software. Presence of Howell-Jolly bodies was ascertained on laboratory tests. A trauma control group consisted of 39 patients with splenic laceration and follow-up CT but no splenic intervention. SAE in trauma patients resulted in an insignificant decrease in mean spleen size from 224 cm(3) to 190 cm(3) (P = .222). However, postembolization splenic volume was significantly smaller than follow-up volume in the trauma control group (353 cm(3); P Howell-Jolly bodies after SAE. No patients required repeat embolization or splenectomy. Coil embolization of the splenic artery resulted in a modest but significant decrease in splenic volume when performed distally; proximal embolization resulted in an insignificant volume change. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  3. Anatomical Variants in Prostate Artery Embolization: A Pictorial Essay.

    Science.gov (United States)

    Carnevale, Francisco Cesar; Soares, Guilherme Rebello; de Assis, Andre Moreira; Moreira, Airton Mota; Harward, Sardis Honoria; Cerri, Giovanni Guido

    2017-09-01

    Prostate artery embolization (PAE) has emerged as a new treatment option for patients with symptomatic benign prostatic hyperplasia. The main challenges related to this procedure are navigating arteries with atherosclerosis and anatomical variations, and the potential risk of non-target embolization to pelvic structures due to the presence of collateral shunts and reflux of microparticles. Knowledge of classical vascular anatomy and the most common variations is essential for safe embolization, good clinical practice, and optimal outcomes. The aim of this pictorial essay is to illustrate the pelvic vascular anatomy relevant to PAE in order to provide a practical guide that includes the most common anatomical variants as well as to discuss the technical details related to each.

  4. Endovascular embolization of thyroid arteries with grave’s disease

    OpenAIRE

    Arzykulov Zh.A.; Zhuraev Sh. Sh.; Shokebayev A.A.; Ormanov B.K.; Lee A.I.; Imammyrzayev N.E.; Aliev A.K.

    2014-01-01

    Background: The purpose of this study is to improve the results of treatment of patients with Graves’ disease by applying Roentgen endovascular embolization (REE) thyroid arteries. Materials and methods: REE thyroid arteries, we used as an independent method of treatment GD. Following this procedure the treatment of 27 patients received for the period from 2012 to July 2014 y. All patients hospitalized with a confirmed diagnosis. Among the 27 patients had 5 (18.5%) men and 22 (81.5%) of women...

  5. Uterine artery embolization: Long term follow-up and implementation

    NARCIS (Netherlands)

    van der Kooij, S.M.

    2013-01-01

    This thesis aims to determine the position of uterine artery embolization (UAE) in the spectrum of treatments for symptomatic uterine fibroids and to stimulate its implementation into daily practice. To do this, firstly the following aspects of UAE were investigated: the long-term clinical results

  6. Temporary Anorgasmia Following Uterine Artery Embolization for Symptomatic Uterine Fibroids.

    Science.gov (United States)

    Speir, Ethan; Shekhani, Haris; Peters, Gail

    2017-11-01

    We report a rare case of temporary anorgasmia following uterine artery embolization (UAE) performed for symptomatic uterine fibroids. To our knowledge, this is only the second time that this complication has been reported in the literature. We briefly explore the possible pathophysiologic explanations for this complication and review the effects of UAE compared to hysterectomy on sexual functioning in women.

  7. Nonthrombotic Pulmonary Artery Embolism: Imaging Findings and Review of the Literature.

    Science.gov (United States)

    Unal, Emre; Balci, Sinan; Atceken, Zeynep; Akpinar, Erhan; Ariyurek, Orhan Macit

    2017-03-01

    The purpose of this article is to emphasize the imaging findings encountered in the setting of nonthrombotic pulmonary embolism. Nonthrombotic pulmonary embolism refers to a spectrum of clinical and radiologic disorders caused by embolization of the pulmonary artery vasculature by various cell types, microorganism, and foreign bodies. Awareness of the imaging and clinical features of the nonthrombotic pulmonary embolism may facilitate prompt diagnosis.

  8. Thrombolytic therapy in bilateral embolism of renal arteries branches

    Directory of Open Access Journals (Sweden)

    Marcelo F. Cassini

    2003-04-01

    Full Text Available Bilateral renal artery embolism is rare, but it is a significant cause of arterial hypertension and renal failure, and most often is associated with cardiac arrhythmias. We report a case of bilateral renal artery embolism with a satisfactory outcome following use of thrombolytic therapy. A 42 year-old Caucasian man presented a sudden complaint of intense abdominal pain, in mesogastrium and left flank with dorsal irradiation, 3 days after electrical cardioversion due to cardiac arrhythmia. Laboratory tests revealed slight leukocytosis, hematuria, and creatinine of 1.8 mg/dL. Chest radiography was normal and computerized tomography showed an area of massive ischemia in left kidney, and focal ischemia in right kidney and spleen. The patient was then submitted to systemic venous therapy with 1.5 million units of streptokinase, with an excellent outcome.

  9. Arterial gas embolism: a review of cases at Prince of Wales Hospital, Sydney, 1996 to 2006

    National Research Council Canada - National Science Library

    Trytko, B E; Bennett, M H

    2008-01-01

    ... aware of the role for hyperbaric oxygen therapy in non-diving related gas embolism. This review is part of an Australian appraisal of experience in the management of arterial gas embolism over the last 10 years...

  10. Selective Embolization of Systemic Collaterals for the Treatment of Recurrent Hemoptysis Secondary to the Unilateral Absence of a Pulmonary Artery in a Child

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Yin, E-mail: zhouyin502@163.com [West China Hospital, Sichuan University, Department of Pediatric Surgery (China); Tsauo, Jiaywei, E-mail: 80732059@qq.com [West China Hospital, Sichuan University, Institute of Interventional Radiology (China); Li, Yuan, E-mail: liyuanletters@163.com [West China Hospital, Sichuan University, Department of Pediatric Surgery (China); Li, Xiao, E-mail: simonlixiao@gmail.com [West China Hospital, Sichuan University, Institute of Interventional Radiology (China)

    2015-10-15

    The unilateral absence of the pulmonary artery (UAPA) is a rare anomaly. Hemoptysis due to systemic collaterals is one of the most common complications of UAPA. To the best of the authors’ knowledge, the utility of selective embolization for the treatment of this condition in children has not been reported previously. This report describes a 6-year-old girl with isolated UAPA (IUAPA) admitted for a 10-month history of recurrent hemoptysis that had worsened during the previous 2 months. Selective embolization of the bronchial systemic collaterals was performed. The patient remained asymptomatic with no recurrence of hemoptysis 8 months after the procedure.

  11. Aberrant Ovarian Collateral Originating from External Iliac Artery During Uterine Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Joon Ho; Kim, Man Deuk, E-mail: mdkim@yuhs.ac; Lee, Kwang-hun; Lee, Myungsu; Lee, Mu Sook; Won, Jong Yun; Park, Sung Il; Lee, Do Yun [Yonsei University College of Medicine, Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Korea, Republic of)

    2013-02-15

    We report a case of a 35-year-old woman who underwent uterine artery embolization (UAE) for symptomatic multiple uterine fibroids with collateral aberrant right ovarian artery that originated from the right external iliac artery. We believe that this is the first reported case in the literature of this collateral uterine flow by the right ovarian artery originated from the right external iliac artery. We briefly present the details of the case and review the literature on variations of ovarian artery origin that might be encountered during UAE.

  12. Transcatheter Arterial Embolization Alone for Giant Hepatic Hemangioma

    OpenAIRE

    Jun-Hui Sun; Chun-Hui Nie; Yue-Lin Zhang; Guan-Hui Zhou; Jing Ai; Tan-Yang Zhou; Tong-Yin Zhu; Ai-Bin Zhang; Wei-Lin Wang; Shu-Sen Zheng

    2015-01-01

    Giant hepatic hemangioma is a benign liver condition that may be treated using surgery. We studied the digital subtraction angiographic (DSA) characteristics of giant hepatic hemangioma, and the effectiveness of transcatheter arterial embolization (TAE) alone for its treatment. This was a retrospective study of 27 patients diagnosed with giant hepatic hemangioma and treated with TAE alone (using lipiodol mixed with pingyangmycin) at the Division of Hepatobiliary and Pancreatic Surgery, First ...

  13. Giant vertebral artery aneurysm in a child treated with endovascular parent artery occlusion and coil embolization.

    Science.gov (United States)

    Park, Hun-Soo; Nakagawa, Ichiro; Wada, Takeshi; Nakagawa, Hiroyuki; Hironaka, Yasuo; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2014-01-01

    Intracranial giant vertebral artery aneurysms are extremely rare in the pediatric population and are associated with significant morbidity and mortality. The present report describes a case of a pediatric patient with giant vertebral artery aneurysm who presented with intracranial mass effect. This patient was successfully treated with endovascular parent artery occlusion and coil embolization. A 7-year-old girl presented with tetraparesis, ataxia, dysphagia, and dysphonia. Cerebral angiography revealed intracranial giant aneurysm arising from the right vertebral artery. The patient underwent endovascular parent artery occlusion alone to facilitate aneurysmal thrombosis as an initial treatment. This was done to avoid a coil mass effect to the brainstem. However, incomplete thrombosis occurred in the vicinity of the vertebral artery union. Therefore, additional coil embolization for residual aneurysm was performed. Two additional coil embolization procedures were performed in response to recurrence. Mass effect and clinical symptoms gradually improved, and the patient had no associated morbidity or recurrence at 2 years after the last fourth coil embolization. Intracranial giant vertebral artery aneurysms are rare and challenging in pediatric patients. Staged endovascular strategy can be a safe and effective treatment option.

  14. Transcatheter arterial embolization of a pseudoaneurysm of gastroduodenal artery: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Han, Young Min; Kang, Sung Soo; Lee, Jeong Min; Chung, Jin Young; Lee, Sang Yong; Chung, Gyung Ho; Kim, Chong Soo; Sohn, Myung Hee; Choi, Ki Chul [Chonbuk National University School of Medicine, Chonju (Korea, Republic of)

    1997-01-01

    Gastroduodenal artery pseudoaneurysm is a relatively rare and potentionally life-threatening complication of chronic pancreatitis, which is thought to occur because of autodigestion of arterial walls by pancreatic enzymes. Embolotherapy should probably be the first method of treatment, since surgical treatment carries a high risk of mortality and morbidity. We report the case of 30-year-old male with gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis which was successfully treated by transcatheter embolization using Gianturco spring coils.

  15. Uterine artery embolization for the treatment of symptomatic fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Ah; Kim, Man Deuk; Kim, Hee Jin; Lee, Mee Hwa; Cho, Jin Ho; Cha, Sun Hee; Yoon, Sang Wook; Ahn, Eun Hee [Bundang CHA General Hospital Pochon CHA University, Sungnam (Korea, Republic of)

    2005-07-15

    The aim of this study was to determine the potential usefulness of uterine artery embolization (UAE) for the management of uterine leiomyoma. Sixty nine patients (mean age; 40.3 years, age range; 31-52 years) who underwent UAE for symptomatic fibroids (with menorrhagia, dysmenorrhoea and bulk-related symptoms) from January 2000 to December 2000 were retrospectively analyzed. The mean follow-up period was 3.5 months (range: 1-8 months). The fibroids ranged in size from 2.0 cm to 13.2 cm with a mean size of 5.8 cm. We performed embolization using polyvinyl alcohol particles (250-710 {mu} m). The improvement of the clinical symptoms was analyzed. Reduction of the uterine and predominant fibroid volumes was assessed using MRI. Symptom improvement for the menorrhagia (87.5%), dysmenorrhoea (83.3%) and the bulk-related symptoms (79.2%) was reported. Complications includes ovarian failure in four patients (5.8% of the total patients, mean age: 43.3 yrs) and infection in three patients (4.3% of the total patients) who underwent conservative management with intravenous antibiotics and analgesics. The volume reduction rate of the uterus and the predominant fibroids after uterine artery embolization were 36.3% and 56.6%, respectively. UAE is a promising new treatment for symptomatic fibroids and may be a valuable alternative to hysterectomy.

  16. Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Hong, T.-M.; Tseng, H.-S. E-mail: hstseng@vghtpe.gov.tw; Lee, R.-C.; Wang, J.-H.; Chang, C.-Y

    2004-01-01

    AIM: To present the findings of uterine artery embolization (UAE) in the management of obstetric haemorrhage. MATERIALS AND METHODS: From October 1999 to February 2003, 10 women with postpartum haemorrhage (n=7) and post-abortion haemorrhage with placenta accreta (n=3), were referred to our department for pelvic angiography and possible arterial embolization. RESULTS: Angiography revealed engorged and tortuous uterine arteries in all patients; and contrast medium extravasation in three patients. Eight patients (three with and five without detectable active bleeding) then underwent bilateral UAE. Medium-sized (250-355 {mu}m) polyvinyl alcohol particles were injected via a coaxial catheter into the uterine arteries, followed by gelatin sponge pieces via a 4 F Cobra catheter. Microcoil devascularization was also performed in the two patients with visible, active bleeding. The vaginal bleeding resolved in all patients, without any ischaemic complications. At follow-up, all patients who underwent UAE had normal menstruation; three of them subsequently gave birth to full-term healthy babies. CONCLUSION: Selective UAE by the coaxial method is safe and effective to control obstetric haemorrhage, with the potential to preserve fertility.

  17. Intra-procedural Bronchoscopy to Prevent Bronchial Compression During Pulmonary Artery Stent Angioplasty.

    Science.gov (United States)

    O'Byrne, Michael L; Rome, Nita; Santamaria, Ramiro W Lizano; Hallbergson, Anna; Glatz, Andrew C; Dori, Yoav; Gillespie, Matthew J; Goldfarb, Samuel; Haas, Andrew R; Rome, Jonathan J

    2016-03-01

    Stenosis of the pulmonary arteries frequently occurs during staged palliation of hypoplastic left heart syndrome and variants, often necessitating stent angioplasty. A complication of stent angioplasty is compression of the ipsilateral mainstem bronchus. Following such a case, we re-evaluated our approach to PA stent angioplasty in these patients. The incident case is described. A retrospective observational study of children and adults with superior (SCPC) and/or total cavopulmonary connection (TCPC) undergoing left pulmonary artery (LPA) stent angioplasty between January 1, 2005 and January 5, 2014 and subsequent chest CT was performed to assess the incidence of bronchial compression. The current strategy of employing bronchoscopy to assess bronchial compression during angioplasty is described with short-term results. Sixty-five children and adults underwent LPA stent angioplasty. Other than the incident case, none had symptomatic bronchial compression. Of the total study population, 12 % had subsequent CT, of which one subject had moderate bronchial compression. To date, seven subjects have undergone angioplasty of LPA stenosis and bronchoscopy. In one case, stent angioplasty was not performed because of baseline bronchial compression, exacerbated during angioplasty. In the rest of cases, mild-moderate compression was seen during angioplasty. Following stent angioplasty, the resultant compression was not worse than that seen on test angioplasty. Bronchial compression is a rare complication of stent angioplasty of the pulmonary arteries in children and adults with SCPC/TCPC. Angioplasty of the region of interest with procedural bronchoscopy can help to identify patients at risk of this complication.

  18. Effectiveness of arterial embolization procedure in uterine cancer patients.

    Science.gov (United States)

    Hayashi, M; Murakami, A; Iwasaki, N; Yaoi, Y

    1999-01-01

    Patients with late stage gynecologic malignancies occasionally develop massive pelvic hemorrhage, and management of the hemorrhage is often difficult. Transcatheter arterial embolization with an absorbable gelatin sponge following the Seldinger method was performed to control hemorrhage in five patients with cancer of the uterine cervix. Pelvic arteriograms of five patients showed no further extravasation and their bleeding ceased. No patients died of pelvic hemorrhage, and all of them eventually died as a result of the original disease within two years of the procedure. As for complications of this procedure, slight fever (3/5) and minimal lumbar pain (2/5) were noticed, which were easily controlled by an indomethacin suppository. Based on these findings, this therapeutic embolization method proved to be useful in the management of massive pelvic hemorrhage in patients with cervical cancer.

  19. Cerebral arterial gas embolism, ingestion of hydrogen peroxide and flight.

    Science.gov (United States)

    Joob, Beuy; Wiwanitkit, Viroj

    2017-03-01

    We read with interest the recent report by Smedley et al. on an interesting case of cerebral arterial gas embolism (CAGE) after pre-flight ingestion of hydrogen peroxide (H₂O₂). The authors discuss the safety of aero-medical transfer following H₂O₂ ingestion. We agree with the possible problems but the concern on the other side of the coin needs to be mentioned; can transfer be delayed is the big question? Indeed, as reported by others, ingestion of even a small amount of concentrated H₂O₂ can result in CAGE. Hence, whether aero-medical transfer proceeds or not, severe, life-threatening embolism can occur. Since it was reported that "complete neurologic recovery occurred quickly with hyperbaric therapy", this supports the contention that the fastest transfer of the patient for hyperbaric treatment should be the primary focus.

  20. Bilateral Arterial Embolization of the Prostate Through a Single Prostatic Artery: A Case Series

    Energy Technology Data Exchange (ETDEWEB)

    Amouyal, Gregory, E-mail: gregamouyal@hotmail.com; Pellerin, Olivier, E-mail: olivier.pellerin@aphp.fr; Giudice, Costantino Del, E-mail: costantino.delgiudice@aphp.fr [Université Paris Descartes - Sorbonne - Paris - Cité, Faculté de Médecine (France); Déan, Carole, E-mail: carole.dean@aphp.fr [Assistance Publique - Hôpitaux de Paris, Interventional Radiology Department, Hôpital Européen Georges Pompidou (France); Thiounn, Nicolas, E-mail: nicolas.thiounn@aphp.fr; Sapoval, Marc, E-mail: marc.sapoval2@aphp.fr [Université Paris Descartes - Sorbonne - Paris - Cité, Faculté de Médecine (France)

    2017-05-15

    Peri-prostatic shunts are frequent during PAE, carrying the risk of non-target embolization of penis/corpus cavernosum or rectum but also the potential advantage to irrigate the contralateral lobe. Sometimes, bilateral embolization is impossible, carrying the risk of limited clinical success. The possibility to reach contralateral prostatic territory from the ipsilateral prostatic artery (PA) and embolize it via peri/intra-prostatic anastomoses could be of interest in this situation. We describe a series of three consecutive patients (among 89 consecutive patients treated by PAE for symptomatic BPH) who underwent successful embolization of both prostatic lobes through catheterization of a PA on only one side. All patients had clinical success after a mean follow-up of 3.3 months. Dosimetry of these three procedures indicates that there may be radiation dose savings.

  1. Successful management of uterine arteriovenous malformation by ligation of feeding artery after unsuccessful uterine artery embolization.

    Science.gov (United States)

    Yokomine, Daisaku; Yoshinaga, Mitsuhiro; Baba, Yasutaka; Matsuo, Takashi; Iguro, Yoshifumi; Nakajo, Masayuki; Douchi, Tsutomu

    2009-02-01

    Uterine arteriovenous malformation (AVM) is a rare and potentially life-threatening disease. The present report describes a postmenopausal patient with uterine AVM manifesting recurrent, massive genital bleeding. Uterine artery embolization (UAE) was scheduled before hysterectomy, but UAE was unsuccessful due to the dilated, tortuous internal iliac arteries, and extremely rapid arterial blood flow. Hysterectomy appeared to carry a potential risk of massive blood loss due to multiple dilated vessels around the uterine corpus and cervix. Therefore, six arteries feeding the uterus were surgically ligated. At 10 months after the operation there have been no episodes of atypical genital bleeding.

  2. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids : 10-year outcomes from the randomized EMMY trial

    NARCIS (Netherlands)

    de Bruijn, Annefleur M.; Ankum, Willem M.; Reekers, Jim A.; Birnie, Erwin; van der Kooij, Sanne M.; Volkers, Nicole A.; Hehenkamp, Wouter J. K.

    2016-01-01

    BACKGROUND: Since 1995 uterine artery embolization has been described as an alternative for hysterectomy in patients with symptomatic fibroids. Many studies including several randomized controlled trials established uterine artery embolization as a valuable treatment. These randomized controlled

  3. Embolization of a giant pediatric, posttraumatic, skull base internal carotid artery aneurysm with a liquid embolic agent.

    Science.gov (United States)

    Reig, Adam S; Simon, Scott; Mericle, Robert A

    2009-11-01

    Many treatments for posttraumatic, skull base aneurysms have been described. Eight months after an all-terrain-vehicle accident, this 12-year-old girl presented with right-side Horner syndrome caused by a 33 x 19-mm internal carotid artery aneurysm at the C-1 level. We chose to treat the aneurysm with a new liquid embolic agent for wide-necked, side-wall aneurysms (Onyx HD 500). We felt this treatment would result in less morbidity than surgery and was less likely to occlude the parent artery than placement of a covered stent, especially in a smaller artery in a pediatric patient. Liquid embolic agents also appear to be associated with a lower chance of recanalization and lower cost compared with stent-assisted coil embolization. After the patient was treated with loading doses of aspirin, clopidogrel bisulfate, and heparin, 99% of the aneurysm was embolized with 9 cc of the liquid embolic agent. There were no complications, and the patient remained neurologically stable. Follow-up angiography revealed durable aneurysm occlusion after 1 year. The cost of Onyx was less than the cost of coils required for coil embolization of similarly sized intracranial aneurysms at our institution. Liquid embolic agents can provide a safe, efficacious, and cost-effective approach to treatment of select giant, posttraumatic, skull base aneurysms in pediatric patients.

  4. Outcome in patients undergoing unilateral uterine artery embolization for symptomatic fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Nicholson, T. E-mail: tonynick@tonynick.demon.co.uk

    2004-02-01

    AIMS: To evaluate patients undergoing uterine artery embolization for symptomatic fibroids who, for technical reasons, underwent unilateral rather than bilateral embolization. PATIENTS: Prospective data were collected on 109 patients undergoing uterine artery embolization for symptomatic fibroids. Of these, six underwent unilateral embolization. They were followed with ultrasound or magnetic resonance imaging (MRI) at 3, 6 and 12 months. Patients' histories were reviewed and patients were asked to evaluate their symptoms at 3, 6 and 12 months on a scoring system, which scored their pre-embolization symptoms as 10. RESULTS: In one case the patient's symptoms did not change in the first 3 months. This patient underwent a second embolization procedure to occlude the non-embolized uterine artery. In four cases the patients' symptoms had begun to resolve at 3 months and by 12 months the patients no longer required any further treatment. In one case the patient passed a 10 cm fibroid per vagina 2 months post uterine artery embolization. After this the patient had a normal uterus on MRI and no further symptoms. CONCLUSION: Where planned bilateral uterine artery embolization is not possible for technical reasons and a unilateral embolization only is performed a conservative approach is indicated.

  5. Radioembolization: Is Prophylactic Embolization of Hepaticoenteric Arteries Necessary? A Systematic Review

    Energy Technology Data Exchange (ETDEWEB)

    Borggreve, Alicia S., E-mail: alicia.borggreve@gmail.com; Landman, Anadeijda J. E. M. C., E-mail: ajemclandman@gmail.com; Vissers, Coco M. J., E-mail: coco.vissers@hotmail.com; De Jong, Charlotte D., E-mail: charlotte-dejong@live.nl; Lam, Marnix G. E. H., E-mail: m.lam@umcutrecht.nl [University Medical Center Utrecht, Division of Radiology and Nuclear Medicine (Netherlands); Monninkhof, Evelyn M., E-mail: e.monninkhof@umcutrecht.nl [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care (Netherlands); Prince, Jip F., E-mail: jipfprince@gmail.com [University Medical Center Utrecht, Division of Radiology and Nuclear Medicine (Netherlands)

    2016-05-15

    PurposeTo study the effectiveness of prophylactic embolization of hepaticoenteric arteries to prevent gastrointestinal complications during radioembolization.MethodsA PubMed, Embase and Cochrane literature search was performed. We included studies assessing both a group of patients with and without embolization.ResultsOur search revealed 1401 articles of which title and abstract were screened. Finally, eight studies were included investigating 1237 patients. Of these patients, 456 received embolization of one or more arteries. No difference was seen in the incidence of gastrointestinal complications in patients with prophylactic embolization of the gastroduodenal artery (GDA), right gastric artery (RGA), cystic artery (CA) or hepatic falciform artery (HFA) compared to patients without embolization. Few complications were reported when microspheres were injected distal to the origin of these arteries or when reversed flow of the GDA was present. A high risk of confounding by indication was present because of the non-randomized nature of the included studies.ConclusionIt is advisable to restrict embolization to those hepaticoenteric arteries that originate distally or close to the injection site of microspheres. There is no conclusive evidence that embolization of hepaticoenteric arteries influences the risk of complications.

  6. Severe hypertension due to renal polar artery stenosis in an adolescent treated with coil embolization

    Energy Technology Data Exchange (ETDEWEB)

    Docx, Martine K. [Koningin Paola Kinderziekenhuis, Department of Paediatrics, Chronic Diseases and Hypertension, Antwerp (Belgium); Vandenberghe, Philippe [Koningin Paola Kinderziekenhuis, Department of Paediatric Cardiology, Antwerp (Belgium); Maleux, Geert [University Hospitals Leuven, Department of Radiology, Leuven (Belgium); Gewillig, Marc [University Hospitals Leuven, Department of Paediatric Cardiology, Leuven (Belgium); Mertens, Luc [Hospital for Sick Children, Paediatric Cardiology, Toronto (Canada)

    2009-11-15

    A 12-year-old boy presented with severe arterial hypertension due to a severe subsegmental renal artery stenosis. Treatment consisted of selective embolization of the stenosed polar artery, which resulted in near normalization of the arterial pressures. Renal artery stenosis should always be considered, even in young adolescents, as a cause for arterial hypertension. Only selective angiography was able to demonstrate the subsegmental artery stenosis in this patient. (orig.)

  7. Successful treatment of postoperative massive pulmonary embolism with paradoxal arterial embolism through extracorporeal life support and thrombolysis.

    Science.gov (United States)

    Grapatsas, Konstantinos; Leivaditis, Vasileios; Zarogoulidis, Paul; Tsilogianni, Zoi; Kotoulas, Sotirios; Kotoulas, Christophoros; Koletsis, Efstratios; Iliadis, Ilias Stylianos; Spiliotopoulos, Konstantinos; Trakada, Georgia; Veletza, Lemonia; Kallianos, Anastasios; Tsiouda, Theodora; Kosmidis, Christoforos; Hohenforst-Schmidt, Wolfgang; Huang, Haidong; Haussmann, Rainer; Haussmann, Erich; Dahm, Manfred

    2018-01-01

    Pulmonary embolism is a common clinical entity related to high mortality. About 200,000 to 300,000 patients die every year due to pulmonary embolism. The purpose of this article is to describe a case of a patient who on the second postoperative day after undergoing thromboembolectomy of the left femoral artery, manifested a massive pulmonary embolism. Due to cardiorespiratory collapse a combined treatment via extracorporeal life support (ECLS) and parallel catheter thrombolysis was decided and performed. By cardiorespiratory improvement and final stabilization the patient was successfully weaned from ECLS and the system was successfully removed. After a reasonable postoperative time the patient was dismissed in good overall condition.

  8. Obstetric iatrogenic arterial injuries of the uterus: diagnosis with US and treatment with transcatheter arterial embolization.

    Science.gov (United States)

    Kwon, Jung Hyeok; Kim, Gi Sung

    2002-01-01

    Uterine curettage or surgical trauma can cause uterine vascular abnormalities, including pseudoaneurysms, acquired arteriovenous malformations (AVMs), arteriovenous fistulas, and rupture of vessels. Recognition of these abnormalities as the cause of hemorrhage is important, since these abnormalities can be treated safely and effectively with transcatheter arterial embolization but may be worsened by uterine curettage, precipitating massive uterine bleeding. Ultrasonography (US) is the most commonly performed initial imaging examination for evaluation of abnormal uterine bleeding. Color and duplex Doppler US allows convincing detection and diagnosis of these vascular abnormalities and helps differentiate vascular abnormalities that require embolization from nonvascular abnormalities. In cases of pseudoaneurysms, color and duplex Doppler US shows a blood-filled cystic structure with swirling arterial flow. In cases of AVMs, color Doppler US shows an intense vascular tangle, whereas duplex Doppler US shows low-resistance, high-velocity arterial flow. Cases of an AVM combined with a pseudoaneurysm demonstrate the findings of both AVMs and pseudoaneurysms. Transcatheter arterial embolization after angiography is the therapy of choice for these vascular abnormalities, with the advantage of retained reproductive capacity. Routine use of color and duplex Doppler US during examination of abnormal uterine bleeding is recommended to identify and characterize the vascular abnormality. Copyright RSNA, 2002

  9. Bleeding in acute pancreatitis treated by transcatheter arterial embolization with ethylene-vinyl alcohol copolymer (Onyx).

    Science.gov (United States)

    Zelenák, Kamil; Sinák, Igor; Janík, Ján; Laca, Ludovít; Talapková, Renáta

    2012-09-01

    Hemorrhagic complications are usually manifestations of the progress of severe pancreatitis. In major arterial hemorrhage resulting from pancreatic inflammatory disease, visceral angiography is valuable in localizing the site of bleeding, and hemostasis can be achieved by transcatheter arterial embolization. Successful transcatheter embolization of bleeding in the anterior superior pancreaticoduodenal artery using ethylene-vinyl alcohol copolymer (Onyx) was performed in a 38-year-old woman with acute biliary necrotic-hemorrhagic pancreatitis.

  10. Lumbar artery pseudoaneurysm and arteriovenous fistula as a complication of laparoscopic splenectomy: treatment by transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Maleux, G.; Wilms, G. [Department of Radiology, University Hospitals, Leuven (Belgium); Vermylen, J. [Department of Internal Medicine-Vascular Diseases, University Hospitals, Leuven (Belgium)

    2002-06-01

    Iatrogenic injury of a lumbar artery is very rare and mostly causes retroperitoneal hemorrhage. We report a case of a lumbar artery pseudoaneurysm and a concomitant arteriovenous fistula complicating laparoscopic splenectomy and provoking renal colic-like flank pain due to mass effect on the left ureter. Definitive treatment of both vascular lesions was obtained after percutaneous transcatheter embolization of several lumbar arteries. Control computed tomography scan 3 months after embolization showed almost complete resorption of the retroperitoneal hematoma. (orig.)

  11. Arterial Embolization for Prophylaxis and Treatment in Severe Obstetric and Gynecologic Hemorrhage

    Directory of Open Access Journals (Sweden)

    Krisdee Prabhasavat

    2016-11-01

    Full Text Available Objective: To evaluate the efficacy and safety of arterial embolization for prophylaxis and treatment in severe obstetric and gynecologic hemorrhage. Methods: A retrospective study was conducted among 17 patients who undergone arterial embolization for prophylaxis and treatment in severe obstetric and gynecologic hemorrhage between 2008 and 2013 at Siriraj Hospital. Efficacy of embolization, embolization procedure details, clinical outcomes and complications were collected and analyzed. Results: The obstetric causes were abnormal placentation (n=6, 35.2%, postpartum hemorrhage (n=5, 29.4%, and intractable bleeding from gynecologic cause (n=6, 35.2%. The median age of the patients in prophylaxis for severe obstetric hemorrhage group, postpartum hemorrhage group and in the gynecologic group were 35 (range, 32-37 years, 31 (range 25-38 years, and 45 (range 28-61 years, respectively. Out of 17 patients, a total of 21 embolization procedures were performed. The technical success rate was 95.6%. Superselection into ovarian artery for embolization of arteriovenous shunting was unsuccessful in one patient. The clinical success rate was 82.6%. Second embolization was done in one patient. Major complication occurred in 3 patients which were microembolism of first dorsal metatarsal artery, pseudoaneurysm at the puncture site and lumbosacral plexopathy. Conclusion: Arterial embolization has an important role in management of obstetric and gynecologic hemorrhage which is safe, effective and has a low rate of complications.

  12. [Embolism of the humeral artery originating in a thrombosed axillo-femoral bypass].

    Science.gov (United States)

    Barba, A; Escribano, J V; García-Alfageme, A

    1992-01-01

    A case of a patient, with acute arterial ischemia at the upper limb is reported. On this case, ischemia was caused by humeral arterial embolism. The embolic origin was focused on the proximal end of a thrombosed axillofemoral bypass. After a rude manipulation during surgical procedure, part of the thrombus, following the sanguineous current, occluded the humeral artery. Patient underwent an emergent surgery. Posterior course was good. Histology showed a re-epithelialized, ancient thrombus. Cardiologic studies and angiography showed no others embolic focuses.

  13. Vesical Artery Embolization in Haemorrhagic Cystitis in Children

    Energy Technology Data Exchange (ETDEWEB)

    García-Gámez, Andrés, E-mail: agargamez@gmail.com; Bermúdez Bencerrey, Patricia, E-mail: PBERMUDE@clinic.ub.es [Hospital Clinic (Spain); Brio-Sanagustin, Sonia, E-mail: sbrio@santpau.cat [Hospital de la Santa Creu y Sant Pau (Spain); Guerrero Vara, Rubén, E-mail: rguerrerov@santpau.cat [Hospital Clinic (Spain); Sisinni, Luisa, E-mail: lsisinni@santpau.cat [Hospital de la Santa Creu y Sant Pau (Spain); Stuart, Sam, E-mail: sam.stuart@gosh.nhs.uk; Roebuck, Derek, E-mail: Derek.Roebuck@gosh.nhs.uk [Great Ormond Street Hospital for Children (United Kingdom); Gómez Muñoz, Fernando, E-mail: FEGOMEZ@clinic.ub.es [Hospital Clinic (Spain)

    2016-07-15

    Haemorrhagic cystitis is an uncommon and, in its severe form, potentially life-threatening complication of haematopoietic stem cell transplantation or cancer therapy in children. The severe form involves macroscopic haematuria with blood clots, urinary obstruction and/or renal impairment. There are many therapeutic options to treat acute haemorrhage, but only recombinant factor VII has a high level of clinical evidence in children. Supraselective vesical artery embolization (SVAE) is an increasingly used therapeutic procedure for controlling haemorrhage in adults, but is less commonly used in children. This might be due to several factors, such as the invasive nature of the procedure, lack of appropriate medical experience and possible long-term side effects. We present three cases of children successfully treated by means of effective SVAE.

  14. Selective Uterine Artery Embolization for Management of Interstitial Ectopic Pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Lee, Sang Jin; Joe, Hwan Sung; Goo, Dong Erk; Chang, Yun Woo [Soonchunhyang University Gumi Hospital, Gumi (Korea, Republic of); Kim, Dong Hun [Chosun University Hospital, Gwangju (Korea, Republic of)

    2007-04-15

    Interstitial pregnancy is defined as any gestation that develops in the uterine portion of the fallopian tubes lateral to the round ligament. Interstitial pregnancies account for 2-4% of all ectopic pregnancies and have been reported to have an associated 2% to 2.5% maternal mortality rate. The traditional treatment for interstitial pregnancy using surgical cornual resection may cause infertility or uterine rupture in subsequent pregnancies. Recently, the early identification of intact interstitial pregnancy has been made possible in many cases with high resolution transvaginal ultrasound as well as more sensitive assays for betahuman chorionic gonadotropin ({beta}-hCG). The treatment includes: hysteroscopic transcervical currettage, local and systemic methotrexate (MTX) therapy and prostaglandin or potassium chloride injection of the ectopic mass under sonographic guidance. We describe a case of successful treatment of interstitial pregnancy using uterine artery embolization, after failure of methotrexate treatment.

  15. Transcatheter Arterial Embolization for Gastrointestinal Bleeding Secondary to Gastrointestinal Lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Lin [Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Department of Radiology (China); Shin, Ji Hoon, E-mail: jhshin@amc.seoul.kr; Han, Kichang; Tsauo, Jiaywei; Yoon, Hyun-Ki; Ko, Gi-Young [University of Ulsan, College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology (Korea, Republic of); Shin, Jong-Soo [Kyunghee University, College of Medicine, Kangdong Kyunghee University Hospital, Department of Radiology (Korea, Republic of); Sung, Kyu-Bo [University of Ulsan, College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology (Korea, Republic of)

    2016-11-15

    PurposeTo evaluate the effectiveness of transcatheter arterial embolization (TAE) for gastrointestinal (GI) bleeding caused by GI lymphoma.Materials and MethodsThe medical records of 11 patients who underwent TAE for GI bleeding caused by GI lymphoma between 2001 and 2015 were reviewed retrospectively.ResultsA total of 20 TAE procedures were performed. On angiography, contrast extravasation, and both contrast extravasation and tumor staining were seen in 95 % (19/20) and 5 % (1/20) of the procedures, respectively. The most frequently embolized arteries were jejunal (n = 13) and ileal (n = 5) branches. Technical and clinical success rates were 100 % (20/20) and 27 % (3/11), respectively. The causes of clinical failure in eight patients were rebleeding at new sites. In four patients who underwent repeat angiography, the bleeding focus was new each time. Three patients underwent small bowel resection due to rebleeding after one (n = 2) or four (n = 1) times of TAEs. Another two patients underwent small bowel resection due to small bowel ischemia/perforation after three or four times of TAEs. The 30-day mortality rate was 18 % due to hypovolemic shock (n = 1) and multiorgan failure (n = 1).ConclusionAngiogram with TAE shows limited therapeutic efficacy to manage GI lymphoma-related bleeding due to high rebleeding at new sites. Although TAE can be an initial hemostatic measure, surgery should be considered for rebleeding due to possible bowel ischemic complication after repeated TAE procedures.

  16. Evaluation of arterial impairment after experimental gelatin sponge embolization in a rabbit renal model

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Jung Suk; Lee, Hae Gi; Chun, Ho Jong; Choi, Byung Gil; Choi, Yeong Jin [Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2015-02-15

    Arterial stenosis is a major obstacle for subsequent interventional procedures. We hypothesized that the stenosis is caused by gelatin sponge embolization and performed an experimental study in a rabbit renal model. A total of 24 rabbits were embolized with porcine gelatin sponge particles injected into the renal arteries. Four rabbits were sacrificed on 1 day, 4 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after embolization. Microscopic evaluations were performed on hematoxylin-eosin and smooth muscle actin immunohistochemical stained sections. Gelatin sponge particles were mainly observed in the segmental and interlobar arteries. Transmural inflammation of the embolized arterial wall and mild thickening of the media were observed 1 week after embolization. Resorption of the gelatin sponge and organization of thrombus accompanied by foreign body reactions, were observed from 2 to 4 weeks after embolization. Microscopic images of the 3 weeks group showed vessel lumens filled mostly with organized thrombi, resulting in severe stenosis. Additionally, vessels showed a thickened intima that contained migrating smooth muscle cells and accompanying interruption of the internal elastic lamina. The migrating smooth muscle cells were distributed around the recanalized arterial lumen. Gelatin sponge embolization may induce arterial stenosis by causing organized thrombus and intimal hyperplasia, which consists of migrating smooth muscle cells and intimal collagen deposits.

  17. Concomitant Deep Venous Thrombosis, Femoral Artery Thrombosis, and Pulmonary Embolism after Air Travel

    Directory of Open Access Journals (Sweden)

    Salim Abunnaja

    2014-01-01

    Full Text Available The association between air travel and deep venous thrombosis and/or pulmonary embolism “economy-class syndrome” is well described. However, this syndrome does not describe any association between long duration travel and arterial thrombosis or coexistence of venous and arterial thrombosis. We present a case of concomitant deep venous thrombosis, acute femoral artery thrombosis, and bilateral pulmonary embolisms in a patient following commercial air travel. Echocardiogram did not reveal an intracardiac shunt that may have contributed to the acute arterial occlusion from a paradoxical embolus. To our knowledge, this is the first report in the literature that associates air traveling with both arterial and venous thrombosis.

  18. Transcatheter arterial embolization as therapy of renal angiomyolipomas: The evolution in 15 years of experience

    Energy Technology Data Exchange (ETDEWEB)

    Chatziioannou, A.; Gargas, D. [University of Athens, Aretaieion Hospital, Radiology Department (Greece); Malagari, K. [University of Athens, Imaging and Research Unit, Evgenidion Hospital (Greece); Kornezos, I., E-mail: kornezos@gmail.com [University of Athens, Aretaieion Hospital, Radiology Department (Greece); Ioannidis, I.; Primetis, E. [University of Athens, Aretaieion Hospital, Radiology Department (Greece); Moschouris, H. [University of Athens, Imaging and Research Unit, Evgenidion Hospital (Greece); Gouliamos, A.; Mourikis, D. [University of Athens, Aretaieion Hospital, Radiology Department (Greece)

    2012-09-15

    Objective: This study aims at presenting the evolution of the embolization technique in treating renal angiomyolipomas (AMLs) either diagnosed in patients with acute bleeding or discovered accidentally. Methods: Ten patients with renal AMLs have been through thirteen selective transcatheter arterial embolizations for 15 years. Two patients had tuberous sclerosis complex (TSC) with bilateral tumors and were embolized twice. Four embolic materials were employed: PVA particles, Gianturco coils, microspheres and microcoils. Catheterization was achieved by means of 5F Cobra 2 catheters and coaxial microcatheter systems. Results: On an emergency basis, embolization was a first-line treatment. In one case, surgery was necessary; in two patients, a second embolization was performed. When treatment was preventive, a single embolization proved to be sufficient, as well. There was no significant deterioration of the serum creatinine levels in the post-embolization period. Conclusion: Selective arterial embolization is a rather safe and effective technique to treat AMLs both urgently and preventively. Different embolic materials can be employed. Microspheres and microcatheters stand for new promising materials.

  19. Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy.

    Science.gov (United States)

    Ghoneim, Tarek P; Thornton, Raymond H; Solomon, Stephen B; Adamy, Ari; Favaretto, Ricardo L; Russo, Paul

    2011-06-01

    We describe the presentation, endovascular management and functional outcomes of 15 patients with renal arterial pseudoaneurysm following open and laparoscopic partial nephrectomy. An institutional review board approved, Health Insurance Portability and Accountability Act compliant retrospective review of a prospectively maintained database revealed that 7 of 1,160 patients who underwent open partial nephrectomy and 8 of 301 treated with laparoscopic partial nephrectomy were diagnosed with a pseudoaneurysm of a renal artery branch between 2003 and 2010. Some cases were associated with arteriovenous fistula. Diagnosis of pseudoaneurysm was made a median of 14 days after surgery. Gross hematuria was the most frequent symptom. Median estimated glomerular filtration rate measurements at the preoperative evaluation, postoperatively, on the day the vascular lesion was diagnosed, after embolization and at the last followup were 62, 55, 55, 56 and 58 ml/minute/1.73 m(2), respectively. Median followup was 7.8 months. All patients underwent angiography and superselective coil embolization of 1 or more pseudoaneurysms with or without arteriovenous fistula. Eleven patients had immediate cessation of symptoms while 4 had persistent gross hematuria after the procedure. Of these 4 patients 2 were treated with bedside care, 1 required repeat embolization with thrombin, which was successful, and the remaining patient had coagulopathy and underwent radical nephrectomy for persistent bleeding. Pseudoaneurysms and arteriovenous fistulas of the renal artery are rare complications of partial nephrectomy. Presentation is often delayed. Superselective coil embolization is a safe, minimally invasive treatment option that usually solves the clinical problem and preserves renal function. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  20. CIRCADIAN ARTERIAL TENSION PROFILE IN THE PATIENTS WITH BRONCHIAL ASTHMA AND COMORBID HYPERTENSIVE DISEASE

    Directory of Open Access Journals (Sweden)

    T. N. Zaripova

    2016-01-01

    Full Text Available The aim of research is to study the state of circadian arterial tension profile in the patients with bronchial asthma and hypertensive disease as comorbid disease. Materials and methods. The research has been performed at 76 patients with bronchial asthma and hypertensive disease as comorbid disease (the main group and 52 patients with hypertensive disease as the comparison group. The groups were comparable with respect to the gender and age sign. Investigation was performed in the period of clinical remission. The main method used in this research was the investigation of day arterial tension profile in the time of its monitoring. Results. It has been revealed the presence of frequent and expressed change from the side of the studied indexes, especially in the patients with comorbid pathology, which were characterized by more frequent and more significant disorders from the side of diastolic blood pressure, especially at night in combination with more considerable and more rapid rise in early morning hours. The day arterial tension profile was characterized either with insufficient decline of arterial pressure at night or, opposite, with its sharp decrease. Specified disorders were increased as far as heaving of main and comorbid diseases, presence of disorders from the side of lipid exchange were not related to the phase of bronchial asthma (remission, exacerbation and level of its flow control. 

  1. Suspected pulmonary embolism in central bronchial carcinoma. Verdachtsdiagnose Lungenembolie bei zentral lokalisiertem Bronchialkarzinom

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, B.; Gross-Fengels, W. (Koeln Univ. (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik)

    1991-07-01

    Case report of a 57-year old male patient suffering from a central bronchial carcinoma, causing complete unilateral non-perfusion of the left lung (v. Euler-Liljestrand reflex). Discussion of the possible diagnostic methods especially on difficulties in differential diagnosis to pulmonary embolisation. (orig.).

  2. Embolization of Life-Threatening Arterial Rupture in Patients with Vascular Ehlers–Danlos Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Takuya, E-mail: okabone@gmail.com [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Frank, Michael, E-mail: michael.frank@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Rare Vascular Diseases Reference Center (France); Pellerin, Olivier, E-mail: olivier@pellerin.as; Primio, Massimiliano Di, E-mail: massimiliano.di.primio@gmail.com; Angelopoulos, Georgios, E-mail: giorginos78@msn.com [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Boughenou, Marie-Fazia, E-mail: marie-fazia.boughenou@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Anesthesia and Surgical Intensive Care Unit (France); Pagny, Jean-Yves, E-mail: jean-yves.pagny@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Messas, Emmanuel, E-mail: emmanuel.messas@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Rare Vascular Diseases Reference Center (France); Sapoval, Marc, E-mail: marc.sapoval2@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France)

    2013-05-09

    PurposeTo evaluate the safety and efficacy of transarterial embolization of life-threatening arterial rupture in patients with vascular Ehlers–Danlos syndrome (vEDS) in a single tertiary referral center.MethodsWe retrospectively analyzed transarterial embolization for vEDS performed at our institution from 2000 to 2012. The indication of embolization was spontaneous arterial rupture or pseudoaneurysm with acute bleeding. All interventions used a percutaneous approach through a 5F or less introducer sheath. Embolic agents were microcoils and glue in 3 procedures, glue alone in 2, and microcoils alone in 2.ResultsFive consecutive vEDS patients were treated by 7 embolization procedures (4 women, mean age 29.8 years). All procedures were successfully performed. Two patients required a second procedure for newly arterial lesions at a different site from the first procedure. Four of the five patients were still alive after a mean follow-up of 19.4 (range 1–74.7) months. One patient died of multiple organ failure 2 days after procedure. Minor procedural complications were observed in 3 procedures (43 %), all directly managed during the same session. Remote arterial lesions occurred after 3 procedures (43 %); one underwent a second embolization, and the other 2 were observed conservatively. Puncture site complication was observed in only one procedure (14 %).ConclusionEmbolization for vEDS is a safe and effective method to manage life-threatening arterial rupture.

  3. Acquisition of endovascular skills for uterine artery embolization using a simulator

    DEFF Research Database (Denmark)

    McLucas, Bruce; Coats, Richard; Lönn, Lars Birger

    2009-01-01

    This study addresses endovascular training using simulators for uterine artery embolization. A review of endovascular skill training for surgeons using simulators was performed. Surgeons possess varying levels of proficiency in endovascular techniques. A simulator will improve endovascular skills...

  4. Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, Nakul [Houston Methodist Hospital (United States); Patel, Anish [The University of Texas Southwestern Medical Center (United States); Ensor, Joe [Houston Methodist Research Institute, The Houston Methodist Cancer Center (United States); Ahrar, Kamran; Ahrar, Judy; Tam, Alda; Odisio, Bruno; Huang, Stephen; Murthy, Ravi; Mahvash, Armeen; Avritscher, Rony; McRae, Stephen; Sabir, Sharjeel; Wallace, Michael [The University of Texas MD Anderson Cancer Center, Department of Interventional Radiology (United States); Matin, Surena [The University of Texas MD Anderson Cancer Center, Department of Urology (United States); Gupta, Sanjay, E-mail: sgupta@mdanderson.org [The University of Texas MD Anderson Cancer Center, Department of Interventional Radiology (United States)

    2017-02-15

    PurposeTo describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores.Materials and MethodsThe medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization.ResultsTwenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR.ConclusionA majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.

  5. Can catheter-directed thrombolysis be applied to acute lower extremity artery embolism after recent cerebral embolism from atrial fibrillation?

    Energy Technology Data Exchange (ETDEWEB)

    Si, T.-G. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China); Guo, Z. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)], E-mail: dr.guozhi@yahoo.com.cn; Hao, X.-S. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)

    2008-10-15

    Purpose: To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute limb embolism in patients with recent cerebral embolism due to atrial fibrillation. Materials and methods: Eight patients (six men, two women; mean age 63.5 years) with acute embolic occlusion of two left common iliac arteries, four femoral arteries (three left; one right), and two right popliteal arteries were treated. All patients had a history of recent cerebral embolism (mean 6 days, range 5-15 days) and all had a history of atrial fibrillation (duration 5-10 years). Catheter-directed thrombolysis started a few hours (mean 6.2 h; range 3-10 h) after the onset of arterial embolism. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 F end-hole catheter and, subsequently, two additional boluses of 5 mg rt-PA were injected into the emboli. In patients with residual emboli, infusion with rt-PA (1 mg/h) was continued. Percutaneous transluminal angioplasty was performed in three patients, and a stent was deployed in one patient. Results: Technical success was achieved in all patients. Clinical success rate was 87.5% (7/8). The one clinical failure was secondary to chronic occlusion of outflow runoff vessels. The mean duration of continuous rt-PA infusion was 3.6 h, the mean total dose of rt-PA administered was 23.6 mg (range 20-28 mg). There was no significant change in stroke scale scores during thrombolysis and no intracerebral haemorrhage was found at computed tomography (CT) after thrombolysis. Minor complications included haematomata at puncture sites (6/8), bleeding around the vascular sheath (2/8), and haematuria (1/8). During the follow-up period of 3-6 months, one patient suffered from recurrent cerebral embolism and died. Conclusions: Catheter-directed thrombolysis with rt-PA is an option for acute lower extremity arterial embolism in patients with recent cerebral embolism and a history of

  6. Transcatheter Arterial Embolization Alone for Giant Hepatic Hemangioma.

    Science.gov (United States)

    Sun, Jun-Hui; Nie, Chun-Hui; Zhang, Yue-Lin; Zhou, Guan-Hui; Ai, Jing; Zhou, Tan-Yang; Zhu, Tong-Yin; Zhang, Ai-Bin; Wang, Wei-Lin; Zheng, Shu-Sen

    2015-01-01

    Giant hepatic hemangioma is a benign liver condition that may be treated using surgery. We studied the digital subtraction angiographic (DSA) characteristics of giant hepatic hemangioma, and the effectiveness of transcatheter arterial embolization (TAE) alone for its treatment. This was a retrospective study of 27 patients diagnosed with giant hepatic hemangioma and treated with TAE alone (using lipiodol mixed with pingyangmycin) at the Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University, between January 2010 and March 2013. The feeding arteries were identified using DSA. All patients were followed up for between three weeks and 12 months. Changes in tumor diameter and symptoms were observed. The 27 patients included had giant hepatic hemangiomas ranging from 5.3 to 24.5 cm (mean, 11.24±5.08 cm) in the right (n = 13), left (n = 1) or both (n = 13) lobes. Preoperative hepatic angiography showed multiple abnormal vascular lakes in the early phase, known as the "early leaving but late returning, hanging nut on a twig" sign. On the day after TAE, hepatic transaminase levels were increased (ALT: 22.69±17.95 to 94.88±210.32 U/L; ALT: 24.00±12.37 to 99.70±211.54 U/L; both Phepatic hemangioma. TAE may be a useful alternative to surgery for the treatment of hepatic hemangioma.

  7. Clinical outcomes of symptomatic arterioportal fistulas after transcatheter arterial embolization.

    Science.gov (United States)

    Hirakawa, Masakazu; Nishie, Akihiro; Asayama, Yoshiki; Ishigami, Kousei; Ushijima, Yasuhiro; Fujita, Nobuhiro; Honda, Hiroshi

    2013-02-28

    To evaluate the complications and clinical outcomes of transcatheter arterial embolization (TAE) for symptoms related to severe arterioportal fistulas (APFs). Six patients (3 males, 3 females; mean age, 63.8 years; age range, 60-71 years) with chronic liver disease and severe APFs due to percutaneous intrahepatic treatment (n = 5) and portal vein (PV) tumor thrombosis of hepatocellular carcinoma (n = 1) underwent TAE for symptoms related to severe APFs [refractory ascites (n = 4), hemorrhoidal hemorrhage (n = 1), and hepatic encephalopathy (n = 1)]. Control of symptoms related to APFs and complications were evaluated during the follow-up period (range, 4-57 mo). In all patients, celiac angiography revealed immediate retrograde visualization of the main PV before TAE, indicating severe APF. Selective TAE for the hepatic arteries was performed using metallic coils (MC, n = 4) and both MCs and n-butyl cyanoacrylate (n = 2). Three patients underwent repeated TAEs for residual APFs and ascites. Four patients developed PV thrombosis after TAE. During the follow-up period after TAE, APF obliteration and symptomatic improvement were obtained in all patients. Although TAE for severe APFs may sometimes be complicated by PV thrombosis, TAE can be an effective treatment to improve clinical symptoms related to severe APFs.

  8. Spontaneous Hepatic Rupture Associated with Preeclampsia: Treatment with Hepatic Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Goo, Dong Erk; Chang, Yun Woo; Kim, Yong Jae; Hwang, In Cheol; Han, Hyo Sang; Yoon, Jong Hyun; Lee, Tae Il [Soonchunhyang University Hospital, Gumi (Korea, Republic of)

    2010-02-15

    Spontaneous rupture of the liver due to preeclampsia is a rare condition of pregnant women, and it can be very dangerous if not treated. We report here on a case of successfully treating spontaneous liver rupture associated with preeclampsia by performing transcatheter hepatic arterial embolization. A 41-year-old woman with spontaneous rupture of the liver associated with preeclampsia was treated by hepatic arterial embolization

  9. Uterine artery embolization: the only life saving measure in some obstetric cases

    OpenAIRE

    Asha N. Gokhale; Latika J. Chawla; Shridhar Khajindar

    2015-01-01

    Uterine artery embolization is a highly specialised and efficacious method that can be used prophylactically to reduce obstetric haemorrhage. Its use in modern obstetrics is currently limited to morbidly adherent placenta and acreta. This report presents a case where uterine artery embolization has been used as the primary treatment for obstetric haemorrhage in a patient with high risk for PPH where surgical management would not have been possible. We aim at highlighting the benefits of this ...

  10. Photodynamic Therapy of Lung Cancer With Bronchial Artery Infusion of Photofrin

    Directory of Open Access Journals (Sweden)

    Tetsuya Okunaka

    1996-01-01

    Full Text Available Photodynamic therapy (PDT utilizing Photofrin is proving to be effective for the treatment of early stage lung cancer. However, wider clinical applications of Photofrin as a photosensitizer for various cancers are hampered by potentially serious and prolonged skin photosensitivity. To prevent these side effects and reduce the hospitalization period, we recently gave reduced doses of Photofrin by bronchial arterial infusion. Five patients with endoscopically evaluated minimally invasive carcinoma of the lung were given 0.7 mg/kg of Photofrin by bronchial arterial infusion 48 hr before PDT. Complete remission was obtained in all 5 cases and no case showed skin photosensitivity when exposed to sunlight under careful surveillance at one week after PDT.

  11. Clinical Outcome of Intra-Arterial Embolization for Treatment of Patients with Pelvic Trauma

    Directory of Open Access Journals (Sweden)

    M. W. Barentsz

    2011-01-01

    Full Text Available Purpose. To analyse the technical success of pelvic embolization in our institution and to assess periprocedural hemodynamic status and morbidity/mortality of all pelvic trauma patients who underwent pelvic embolization. Methods. A retrospective analysis of patients with a pelvic fracture due to trauma who underwent arterial embolization was performed. Clinical data, pelvic radiographs, contrast-enhanced CT-scans, and angiographic findings were reviewed. Subsequently, the technical success and peri-procedural hemodynamic status were evaluated and described. Results. 19 trauma patients with fractures of the pelvis underwent arterial embolization. Initially, 10/19 patients (53% were hemodynamically unstable prior to embolization. Technical success of embolization was 100%. 14/19 patients (74% were stable after embolization, and treatment success was high as 74%. Conclusion. Angiography with subsequent embolization should be performed in patients with a pelvic fracture due to trauma and hemodynamic instability, after surgical intervention or with a persistent arterial blush indicative of an active bleeding on CT.

  12. Ischemic neuromyopathy due to peripheral arterial embolization of an adenocarcinoma in a cat.

    Science.gov (United States)

    Sykes, J E

    2003-12-01

    A case of peripheral arterial tumor embolization in a cat is described. The cat presented with signs of aortic thromboembolism, including decreased peripheral pulse quality, pallor, and coolness of the distal limbs, as well as proprioceptive deficits. Thoracic radiographs revealed a cavitary lung mass; echocardiography was unremarkable. Cytologic evaluation of aspirates of the mass suggested malignancy. The left hindlimb was amputated, and histopathology confirmed embolization of an adenocarcinoma. Although rare, peripheral arterial tumor embolization should be considered as a differential in cats presenting with signs of thromboembolic disease.

  13. Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Soyer, Philippe; Fargeaudou, Yann; Boudiaf, Mourad; Le Dref, Olivier; Rymer, Roland [Hopital Lariboisiere-AP-HP Universite Paris 7, Department of Abdominal Imaging, Paris cedex 10 (France); Morel, Olivier [Hopital Lariboisiere-AP-HP Universite Paris 7, Department of Obstetrics, Paris cedex 10 (France)

    2008-06-15

    The purpose of this retrospective study was to evaluate the role of transcatheter arterial embolization in the management of severe postpartum haemorrhage due to a ruptured pseudoaneurysm and to analyse the clinical symptoms that may suggest a pseudoaneurysm as a cause of postpartum haemorrhage. A retrospective search of our database disclosed seven women with severe postpartum haemorrhage in whom angiography revealed the presence of a uterine or vaginal artery pseudoaneurysm and who were treated using transcatheter arterial embolization. Clinical files were reviewed for possible clinical findings that could suggest pseudoaneurysm as a cause of bleeding. Angiography revealed extravasation of contrast material in five out of seven patients. Transcatheter arterial embolization allowed to control the bleeding in all patients and subsequently achieve vaginal suture in four patients with vaginal laceration. No complications related to transcatheter arterial embolization were noted. Only two patients had uterine atony, and inefficiency of sulprostone was observed in all patients. Transcatheter arterial embolization is an effective and secure technique for the treatment of severe postpartum haemorrhage due to uterine or vaginal artery pseudoaneurysm. Ineffectiveness of suprostone and absence of uterine atony should raise the possibility of a ruptured pseudoaneurysm. (orig.)

  14. Emborrhoid: A New Concept for the Treatment of Hemorrhoids with Arterial Embolization: The First 14 Cases

    Energy Technology Data Exchange (ETDEWEB)

    Vidal, V., E-mail: vincent.vidal@ap-hm.fr [Hôpital de la Timone, Department of Radiology (France); Sapoval, M., E-mail: marc.sapoval@gmail.com [Hopital Européen Georges Pompidou, Department of Radiology (France); Sielezneff, Y., E-mail: igor.sielezneff@ap-hm.fr [Hôpital de la Timone, Department of Digestive and General Surgery (France); Parades, V. De, E-mail: v.deparades@gmail.com [Hopital Saint Joseph, Department of Proctology (France); Tradi, F., E-mail: farouk.tradi@ap-hm.fr; Louis, G., E-mail: guillaume.louis@ap-hm.fr; Bartoli, J. M., E-mail: jean-michel.bartoli@ap-hm.fr [Hôpital de la Timone, Department of Radiology (France); Pellerin, O., E-mail: olivier.pellerin@egp.aphp.fr [Hopital Européen Georges Pompidou, Department of Radiology (France)

    2015-02-15

    PurposeThe ‘emborrhoid’ technique consists of the embolization of the hemorrhoidal arteries. The endovascular arterial occlusion is performed using coils placed in the terminal branches of the superior rectal arteries. The emborrhoid technique has been modeled after elective transanal Doppler-guided hemorrhoidal artery ligation which has been shown to be effective in hemorrhoidal disease. We report the first 14 cases of our experience with emborrhoid technique.Materials and MethodsFourteen patients with disabling chronic rectal bleeding were treated using the emborrhoid technique (3 women, 11 men). The stage of the hemorrhoidal disease was II (10 patients), III (3), and IV (1). This treatment was decided by a multidisciplinary team (proctologist, visceral surgeon, and radiologist). Seven patients underwent previous proctological surgery. Ten patients had coagulation disorders (anticoagulants or cirrhosis). Superior rectal arteries were embolized with pushable microcoils (0.018).ResultsTechnical success of the embolization procedure was 100 %. Clinical success at 1 month was 72 % (10/14). Of the 4 patients who experienced rebleeding, two underwent additional embolization of the posterior rectal arteries with success. No pain or ischemic complications were observed in 13 patients. One patient experienced a temporary painful and edematous, perianal reaction.ConclusionOur case studies suggest that coil embolization of the superior rectal arteries is technically feasible, safe and well tolerated. Additional studies are needed to evaluate the efficacy of this new ‘emborrhoid’ technique in the management of hemorrhoidal disease.

  15. Role of selective intra-arterial embolization in benign liver tumors.

    Science.gov (United States)

    Ferrer Puchol, M D; Parra Casado, C La; Cervera Araez, A; Sala López, R; Esteban Hernández, E; Cremades Mira, A; Ramiro Gandia, R

    To present cases of symptomatic benign liver tumors diagnosed and treated with intra-arterial embolization before surgery. We present the cases of 7 patients diagnosed with symptomatic benign liver tumors that required treatment: 1 focal nodular hyperplasia, 2 giant cavernous hemangiomas, 1 hepatic adenomatosis, and 3 hepatic adenomas. Once the feeding arteries were identified, tumors were embolized with polyvinyl alcohol particles (500μm-700μm) and then the feeding artery was plugged with coils if there was an arterial pedicle to ensure the total vascular exclusion of the tumor. The surgical intervention took place 4 to 7 days after embolization. All 7 patients were women (age range, 23-74 years); presurgical intra-arterial embolization was done in 6. In 1 patient with adenomatosis, embolization was done to control intraparenchymal hepatic hemorrhage. In the 6 patients who underwent surgery, the tumor was completely excised and no intraoperative bleeding events or postoperative complications occurred. Provided there is a consensus among the multidisciplinary team, embolization is a useful option in the perioperative management of giant and/or symptomatic benign liver tumors. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. A case of an unruptured hepatic aneurysm on the common hepatic artery at the junction of the gastroduodenal and proper hepatic arteries treated with transcatheter arterial embolization.

    Science.gov (United States)

    Imai, Yusuke; Hirooka, Masashi; Koizumi, Yohei; Nakamura, Yoshiko; Watanabe, Takao; Yoshida, Osamu; Tokumoto, Yoshio; Takeshita, Eiji; Abe, Masanori; Hiasa, Yoichi

    2017-01-01

    Hepatic aneurysms are rare, but can prove fatal once they rupture. Transcatheter arterial embolization (TAE) is performed as a prophylactic treatment. The position of the aneurysm determines the degree of difficulty of TAE. Maintaining blood flow to the liver can become difficult, particularly when the aneurysm is at an arterial junction. The patient was a 72-year-old man diagnosed with a hepatic aneurysm. The aneurysm was situated on the common hepatic artery at the junction of the gastroduodenal and proper hepatic arteries. TAE was performed with framing, followed by coil embolization. Blood flow to the liver was maintained via the gastroduodenal artery. Appropriate framing is important for safe and efficient TAE.

  17. Transcatheter Arterial Embolization Alone for Giant Hepatic Hemangioma.

    Directory of Open Access Journals (Sweden)

    Jun-Hui Sun

    Full Text Available Giant hepatic hemangioma is a benign liver condition that may be treated using surgery. We studied the digital subtraction angiographic (DSA characteristics of giant hepatic hemangioma, and the effectiveness of transcatheter arterial embolization (TAE alone for its treatment. This was a retrospective study of 27 patients diagnosed with giant hepatic hemangioma and treated with TAE alone (using lipiodol mixed with pingyangmycin at the Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University, between January 2010 and March 2013. The feeding arteries were identified using DSA. All patients were followed up for between three weeks and 12 months. Changes in tumor diameter and symptoms were observed. The 27 patients included had giant hepatic hemangiomas ranging from 5.3 to 24.5 cm (mean, 11.24±5.08 cm in the right (n = 13, left (n = 1 or both (n = 13 lobes. Preoperative hepatic angiography showed multiple abnormal vascular lakes in the early phase, known as the "early leaving but late returning, hanging nut on a twig" sign. On the day after TAE, hepatic transaminase levels were increased (ALT: 22.69±17.95 to 94.88±210.32 U/L; ALT: 24.00±12.37 to 99.70±211.54 U/L; both P<0.05, but not total bilirubin. Six patients complained of abdominal pain, and 12 experienced transient fever. In the months after TAE, tumor size decreased (baseline: 11.24±5.08; 3 months: 8.95±4.33; 6 months: 7.60±3.90 cm; P<0.05, and the patients' condition improved. These results indicated that TAE was effective and safe for treating giant hepatic hemangioma. TAE may be a useful alternative to surgery for the treatment of hepatic hemangioma.

  18. Uterine artery embolization: The interventional treatment of female genital diseases

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Woong Hee [Dept. of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of); Yang, Seung Boo [Dept. of Radiology, Soonchunhyang University Gumi Hospital, Gumi (Korea, Republic of); Goo, Dong Erk; Kim, Yong Jae [Dept. of Radiology, Soonchunhyang University Seoul Hospital, Seoul (Korea, Republic of); Lee, Jae Myeong [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Kang, Chae Hoon [Dept. of Radiology, Gangneung Asan Hospital, Gangneung (Korea, Republic of); Ohm, Joon Young [Dept. of Radiology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon (Korea, Republic of); Kim, Young Jun [Dept. of Radiology, Presbyterian Medical Center, Jeonju (Korea, Republic of)

    2017-01-15

    The uterus is the major female sex organ and is essential for pregnancy. The organ is located in the pelvic cavity. It is usually fist-sized with its volume changing from 75 to 200 cc depending on the menstrual cycle. There are various diseases associated with the uterus, including malignancy, uterine myoma, postpartum hemorrhage, and vascular malformation. The conventional surgical treatment for these diseases is hysterectomy. However, hysterectomy has some risk, and there may be complications associated with the surgery and anesthesia. In addition, hysterectomy results in loss of fertility and loss of female characteristics, both of which may lead to emotional problems. After uterine artery embolization (UAE) was performed for post-partum bleeding in 1979 and for uterine myoma in 1995, interventional treatment of UAE replaced the existing surgical treatment of hysterectomy. UAE is performed widely as a minimally invasive treatment modality that can preserve the uterus, make pregnancy and childbirth possible and resolve emotional problems. The interventional treatment has become increasingly popular to treat various female genital diseases.

  19. Resolution of hydronephrosis after uterine artery embolization for fibroids.

    Science.gov (United States)

    Alyeshmerni, Daniel; Banovac, Filip; Pehlivanova, Marieta; McCullough, Michael; Hansford, Barry; Spies, James

    2011-06-01

    To determine the prevalence, predisposing factors, and resolution of hydronephrosis among patients undergoing uterine artery embolization (UAE) for fibroids. From October 2004 to May 2008, 1,114 patients underwent UAE at an academic medical center. Hydronephrosis was found on angiographic images in 101 patients. In 34 of these patients, 3-month ultrasound follow-up was available. The angiographic images were graded for hydronephrosis severity by three interventional radiologist reviewers. The degree of residual hydronephrosis was obtained from ultrasound images or reports in 3-month follow-up imaging. Descriptive statistics summarizing outcomes and interobserver agreement regarding hydronephrosis grade were calculated. In a parallel assessment, prospectively gathered baseline data available from 776 patients undergoing UAE were analyzed to identify predisposing factors to hydronephrosis. Among the 34 patients with hydronephrosis and appropriate follow-up, resolution occurred in 28 of 34 (82%) patients. Among the entire study group, 9.0% (101 of 1,114) of patients had unilateral or bilateral hydronephrosis. Hydronephrosis was less frequent in left kidneys (4.5% [35 of 776]) than right kidneys (6.3% [49 of 776]; P = .013). The mean uterine volume in the group with hydronephrosis was greater than in the group without hydronephrosis (1,041 cm(3) vs 609 cm(3); P fibroid volume was also greater (233 cm(3) vs 147 cm(3); P fibroid size was associated with hydronephrosis. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  20. TRANS-ARTERIAL EMBOLIZATION WITH N-BUTYL CYANOACRYLATE GLUE FOR RENAL BLEEDING: Case Report

    Directory of Open Access Journals (Sweden)

    Benny Young

    2014-08-01

    Full Text Available Background: The objectivity in management of renal bleeding is to preserve a significant renal parenchyma tissue and prevent associated morbidities like anemic shock or renal impairment from substantial nephron demise or obstructed uropathy. Trans-arterial embolization therapy by interventional radiology offers a high success rate with potential of reserving normal renal tissue. The selection material for renal arterial embolization largely depends on vasculature anatomy and end-point of procedure. N-butyl cyanoacrylate glue in our experience is applied in lesion supplied by small size of end-artery

  1. Iatrogenic central retinal artery occlusion after carotid body tumor embolization and excision

    Directory of Open Access Journals (Sweden)

    Rangel, Carlos M.

    2017-03-01

    Full Text Available Objective: To report a case of iatrogenic central retinal artery occlusion after embolization and surgical resection of carotid body paraganglioma.Methods: Case report Results: One adult female patient presented with persistent unilateral visual loss after embolization with Embosphere and Contour microparticles of carotid body tumor. Fluorescein angiography revealed intraluminal microspheres in the central retinal artery ramifications. OCT revealed intraretinal spherical, hyporeflective particles with posterior shadowing. Conclusions: Central retinal artery occlusion should be assessed as a possible complication after surgical repair of head and neck paragangliomas.

  2. Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Qi, E-mail: wqtjmu@gmail.com; Xiong, Bin, E-mail: herrxiong@126.com; Zheng, ChuanSheng, E-mail: hqzcsxh@sina.com; Liang, Ming, E-mail: whliangming@163.com; Han, Ping, E-mail: cjr.hanping@vip.163.com [Huazhong University of Science and Technology, Department of Radiology, Union Hospital, Tongji Medical College (China)

    2016-03-15

    ObjectiveThis retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.MethodsFrom August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed.ResultsIn 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.ConclusionsSplenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.

  3. Pelvic artery embolization in gynecological bleeding; Beckenarterienembolisationen bei gynaekologischen Blutungen

    Energy Technology Data Exchange (ETDEWEB)

    Hausegger, K.A.; Schreyer, H.; Bodhal, H. [Universitaetsklinik fuer Radiologie Graz Univ., Graz (Austria)

    2002-07-01

    The most common reasons for gynecological bleeding are pregnancy-related disorders, fibroids of the uterus, and gynecological malignances. Transarterial embolization is an effective treatment modality for gynecological bleeding regardless of its etiology. Depending on the underlying disease, a different technique of embolization is applied. In postpartal bleeding a temporary effect of embolization is desired, therefore gelatine sponge is used as embolizing agent. In fibroids and malignant tumors the effect should permanent, therefore PVA particles are used. Regardless the etiology, the technical and clinical success of transarterial embolization is at least 90%. In nearly every patient a post-embolization syndrome can be observed, represented by local pain and fever. This post-embolization syndrome usually does not last longer than 3 days. If embolization is performed with meticulous attention to angiographic technique and handling of embolic material, ischemic damage of adjacent organs is rarely observed. Transarterial embolization should be an integrative modality in the treatment of gynecological bleeding. (orig.) [German] Gynaekologische Blutungen koennen schwangerschaftsbedingt sein, oder durch Myome oder maligne Tumore hervorgerufen werden. In allen Faellen ist die Transkatheterembolisation ein effektives therapeutisches Verfahren. Die angewandte Embolisationstechnik haengt von der Aetiologie der Blutung ab. Bei schwangerschaftsbedingten Blutungen ist ein temporaerer Embolisationseffekt erwuenscht, die Embolisation erfolgt daher mit Spongostan. Bei Myomen und Malignomen wird ein permanenter Embolisationseffekt durch die Verwendung von PVA-Partikeln angestrebt. Der technische und klinische Erfolg der Embolisation liegt unabhaengig von der Aetiologie der Blutungen ueber 90%. In der Regel wird bei Embolisationen von Myomen und Malignomen ein Postembolisationssyndrom mit Schmerzen und Fieber beobachtet. Diese Symptome bilden sich jedoch meist innerhalb von 2

  4. Assessment of Organ Radiation Dose Associated with Uterine Artery Embolization

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    Glomset, O.; Hellesnes, J.; Heimland, N.; Hafsahl, G.; Smith, H.J. [Rikshospitalet Univ. Hospital, Oslo (Norway). Dept. of Radiology and the Interventional Centre

    2006-03-15

    Purpose: To evaluate the radiation dose to the skin, uterus, and ovaries during uterine artery embolization. Material and Methods: Guided uterine artery embolization for leiomyomata and two types of X-ray equipment with different dose levels were utilized during fluoroscopy in 20 women (ages ranging from 32 to 52 years, body weights from 55 to 68 kg). The first 13 women were treated using a non-pulsed system A, with 3.3 mm Al filtering and, for simplicity, a fixed peak voltage 80 kV. During treatment of the other 7 women, a pulsed system B with 5.4 mm Al filtering and an identical fixed voltage was used. The dose area product (DAP) was recorded. The vaginal dose of the first 13 patients and the peak skin dose of all patients were measured with thermoluminescent dosimeters (TLDs). TLDs were placed in the posterior vaginal fornix and on the skin at the beam entrance site. The uterine and ovarian doses were estimated based on the measured skin doses, normalized depth dose, and organ depth values. The effective dose (D eff ) was estimated based on the observed DAP values. The measured vaginal doses and the corresponding estimated uterine doses were compared statistically, as were the DAP values from systems A and B. Results: For system A, the mean fluoroscopic time was 20.9 min (range 12.7-31.1), and for system B 35.9 min (range 16.4-55.4). The mean numbers of angiographic exposures for systems A and B were 82 (range 30-164) and 37 (range 20-72), respectively. The mean peak skin dose for system A was 601.5 mGy (range 279-1030) and for system B 453 mGy (range 257-875). The mean DAP for system A was 88.6 Gy cm{sup 2} (range 41.4-161.0) and for system B 52.5 Gy cm{sup 2} (range 20.1-107.9). Statistical analysis showed a significant difference between the DAP values, the DAP for system B being the lower one. The mean estimated effective doses from systems A and B were 32 mSv (range 15.1-58.4) and 22 mSv (range 9-46), respectively. The mean estimated maximum uterine and

  5. Management of Bleeding Uterine Arteriovenous Malformation with Bilateral Uterine Artery Embolization

    OpenAIRE

    Kim, Taehwan; Shin, Ji Hoon; Kim, Jinoo; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong-Il; Yang, Heechul; Sung, Kyu-Bo

    2014-01-01

    Purpose To evaluate the technical feasibility and clinical outcome of bilateral uterine artery embolization (UAE) as a first-line therapeutic option for bleeding uterine arteriovenous malformation (AVM). Materials and Methods Between 2002 and 2012, 19 patients were diagnosed with acquired uterine AVM clinically and through imaging studies. The clinical characteristics, angiographic features, technical success rate of embolization, procedure-related complications, imaging, and clinical follow-...

  6. [Spontaneous recanalization after embolization of the renal artery with an Amplatzer vascular plug 4].

    Science.gov (United States)

    Gómez-Martínez, Pablo; Ciampi Dopazo, Juan José; González Fejás, Ariel; Lanciego, Carlos

    2014-01-01

    The Amplatzer vascular plug (AVP) is an occluding device used in vascular embolizations. Thanks to its excellent maneuverability and effectiveness, it is being used more and more often. The latest version, the AVP 4, enables access to smaller and more tortuous vessels. To date, the only cases of spontaneous recanalization published occurred with earlier versions of the AVP. We present a case of recanalization after renal artery embolization with an AVP 4. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

  7. [Stent-assisted mechanical removal of tromboembolism after embolization of middle cerebral artery aneurysm].

    Science.gov (United States)

    Poncyljusz, Wojciech; Falkowski, Aleksander; Rać, Monika; Sagan, Leszek; Kojder, Ireneusz

    2012-01-01

    Thrombotic occlusion of the middle cerebral artery's branch occurred just after embolization of a nonruptured cerebral aneurysm. Bail-out stent-assisted mechanical thrombectomy of the clot was performed. DSA revealed normal vessel patency at the end of the procedure. There were no adverse events related to this thrombectomy, and the patient recovered from the embolization with minor neurologic deficit. There was no neurologic deficit after 90 days follow-up.

  8. Expulsion of dominant submucosal fibroids after uterine artery embolization

    Energy Technology Data Exchange (ETDEWEB)

    Radeleff, Boris, E-mail: Boris_radeleff@med.uni-heidelberg.d [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Eiers, Michael; Bellemann, Nadine; Ramsauer, Stefanie [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Rimbach, Stefan [Department of Gynecology, University of Konstanz (Germany); Kauczor, Hans-Ulrich [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Richter, Goetz M. [Department of Diagnostic and Interventional Radiology, University of Heidelberg (Germany); Clinic of Diagnostic and Interventional Radiology, Katharinenhospital, Stuttgart (Germany)

    2010-07-15

    Purpose: Purpose of this study was to evaluate the frequency, probability, and factors associated with expulsion of submucosal fibroids after uterine artery embolization (UAE) in addition to the technical and clinical results at 1-year follow-up. Materials and methods: We determined the preinterventional volume of each dominant submucosal fibroid using the commonly used ellipsoid formula and a 3D volumetry in the MRI to define a threshold value in milliliters that indicates the probability for a fibroid expulsion. Assessment of fibroid expulsion was done by MRI at 3-month intervals for a year. Assessment of clinical mid term success was achieved by applying questionnaires at 1-year follow-up. Results: Technical success was observed in all 20 patients (mean age of 41.4 {+-} 5.6 years; range: 29.2-51.1 years). Two (10%) minor and one (5%) major complications occurred. 10/20 dominant submucosal fibroids were completely expelled during the follow-up. Using 3D MRI volumetry the preinterventional mean volume of the later expelled fibroids was 56.8 {+-} 57.0 ml (range 2.3-198.0 ml) and the mean volume of non-expelled fibroids was 123.8 {+-} 147.3 ml (range 24.0-531.8 ml). This difference was statistically significant, but weak (p = 0.0494). Fibroids with a volume equal or less than the threshold value (66.0 ml) were 73% likely to be expelled and fibroids larger than 66.0 ml were 78% likely not to be expelled. All 20 patients demonstrated a significant reduction in the fibroid related symptoms. Conclusion: In our study the complication rate was low despite increased rates of fibroid expulsion (50%); simultaneously the rate of treatment satisfaction was very high. Patients with a dominant submucosal fibroid under 66.0 ml should be informed about the probability of fibroid expulsion and the accompanying symptoms.

  9. Selective arterial embolization of 36 aneurysmal bone cysts of the skeleton with N-2-butyl cyanoacrylate

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Giuseppe [Rizzoli Orthopaedic Institute, Department of Interventional Angiographic Radiology, Bologna (Italy); Rimondi, Eugenio; Vanel, Daniel [Rizzoli Orthopaedic Institute, Department of Radiology, Bologna (Italy); Bartalena, Tommaso [University of Bologna, Bologna (Italy); Gerardi, Antonio [Rizzoli Orthopaedic Institute, Department of Anatomical Human Science and Physiopathology of the Musculoskeletal System, Bologna (Italy); Alberghini, Marco [Rizzoli Orthopaedic Institute, Department of Pathological Anatomy, Bologna (Italy); Staals, Eric Lodwijk; Errani, Costantino; Bianchi, Giuseppe; Toscano, Angelo; Mercuri, Mario [Rizzoli Orthopaedic Institute, V Division of Musculoskeletal Tumors, Bologna (Italy)

    2010-02-15

    Aneurysmal bone cyst (ABC) is a lytic benign bone lesion representing about 1% of all primary bone tumors. The lesion causes pain and swelling, which are generally present for less than 3 months. From April 2003 to April 2008 36 patients affected by aneurysmal bone cysts were treated by selective arterial embolization with N-2-butyl cyanoacrylate. The study population comprised 20 male and 16 female patients with an age range of 3.3-60.8 years. Nine lesions were localized in the appendicular skeleton (1 in the upper and 8 in the lower limb), 4 in the thoracic cage (1 rib lesion and 3 scapular lesions), 17 in the pelvis and 6 in the spine (1 thoracic and 5 sacral localizations). A total of 55 embolizations were performed: in 22 cases (61%) only one embolization was needed, whilst two embolizations were necessary in 9 cases (25%) and 3 in the remaining 5 patients (14%). The treatment was effective in 32 patients (94%): follow-up was 0.9-5 years. In one patient, previously surgically treated, only the cyanoacrylate embolization turned out to be useful for healing the lesion. Another 7 patients underwent surgery during the study period. In the 55 procedures we performed we had 3 complications (5%): 2 cases of skin necrosis and 1 of transient paresis. Arterial embolization with cyanoacrylate may be the treatment of choice for aneurysmal bone cysts. Embolization is a less invasive, lower cost, simpler procedure than surgery and is easily repeatable. (orig.)

  10. Experimental study on the appropriate emboilic site during superior mesenteric artery embolization : using coil and gelfoam

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dong Won; Jin, Gong Yong; Oh, Hee Sul; Lim, Yeong Su; Lee, Sang Yong; Lee, Jeong Min; Kim, Chong Soo; Han, Young Min; Lee, Dong Geun [Chonbuk National Univ. Medical School, Chonju (Korea, Republic of)

    1998-07-01

    To determine the effective embolic material and appropriate embolic site by comparing bowel changes after arterial embolization in dogs in which the proximal or distal level of the superior mesenteric artery had been occluded with gelfoam particles or a coil. Material and Methods : Using the coaxial catheter system,super selective arterial embolization was performed at sixteen sites in four dogs. In groups A and B, each site was occluded at the proximal or distal marginal artery, respectively, with gelfoam particles and in groups C and D, at the proximal or distal artery, respectively, with a coil. All dogs were sacrificed one day after the procedure, and gross and microscopic histologic findings were evaluated. Results : In all dogs, the procedure was successful. In group B, significant mucosal destruction, lymphocyte proliferation in submucosa and mucosa, and diffuse swelling in all layers of the intestine were found at all sites. The vessel in the submucosal layer was completely obstructed by red blood cells and gelfoam.At three sites, the intestine showed diffuse ischemic change, and at one other site, focal ischemic change was observed. In group D, exudation with destruction of mucosa and submucosal hemorrhage occurred at one site, but in groups A and C, intestinal layers were found to be normal. Conclusion :Using a coil, super selective arterial embolization was successful, even up to the distal level of the intestinal artery, and the intestine showed no ischemic change. Embolization with gelfoam must be performed carefully at the proximal level, and since it can cause severe intestinal necrosis, must be avoided at the distal level.

  11. A case of central retinal artery occlusion following embolization procedure for juvenile nasopharyngeal angiofibroma

    Science.gov (United States)

    Ramezani, Alireza; Haghighatkhah, Hamidreza; Moghadasi, Habibollah; Taheri, Morteza S; Parsafar, Hiva

    2010-01-01

    A 23-year-old male patient with right nasal Juvenile Nasopharyngeal Angiofibroma (JNA) developed Central Retinal Artery Occlusion (CRAO) during embolization of the tumor using polyvinyl alcohol particles before endoscopic excision. Classic CRAO management was initiated by an ophthalmologist after 12 h. Retrospective evaluation of the angiograms revealed a tiny communication between the external carotid and ophthalmic arteries which had not been noticed before embolization. During endoscopic excision, the tumor was found to originate extraordinarily from midline structures. It was concluded that CRAO might be a rare complication of JNA embolization. Careful preoperative angiographic evaluations to detect communicating arteries and immediate ophthalmologic consultation in case of developing visual symptoms during the procedure are necessary. PMID:20689199

  12. Pregnancy after Uterine Artery Embolization: A Case Report in a Woman with Leiomyomata

    Directory of Open Access Journals (Sweden)

    Helena Isabel Lopes

    2015-01-01

    Full Text Available Background. Several pregnancies have been reported after embolization of uterine artery. This procedure is an accepted nonsurgical treatment for symptomatic uterine fibroids but its safety in women desiring future childbearing is not well established. Case Report. We present a 40-year-old woman with leiomyomata who became pregnant after previously undergone uterine artery embolization for three times. The placenta was previa and the fetus was in transverse position. She had a cesarean delivery of an appropriately grown fetus at 37 weeks, which was followed by uterine atony requiring hysterectomy. Conclusion. Although pregnancy-related outcomes remain understudied, the available reports evidence that pregnancies after uterine artery embolization may be at significantly increased risk for postpartum hemorrhage, cesarean delivery, abnormal placentation, and malpresentation. In patients who are undergoing this type of treatment and contemplating pregnancy, the possibility of adverse complications should be taken in consideration and women should be appropriately advised.

  13. A case of central retinal artery occlusion following embolization procedure for juvenile nasopharyngeal angiofibroma

    Directory of Open Access Journals (Sweden)

    Ramezani Alireza

    2010-01-01

    Full Text Available A 23-year-old male patient with right nasal Juvenile Nasopharyngeal Angiofibroma (JNA developed Central Retinal Artery Occlusion (CRAO during embolization of the tumor using polyvinyl alcohol particles before endoscopic excision. Classic CRAO management was initiated by an ophthalmologist after 12 h. Retrospective evaluation of the angiograms revealed a tiny communication between the external carotid and ophthalmic arteries which had not been noticed before embolization. During endoscopic excision, the tumor was found to originate extraordinarily from midline structures. It was concluded that CRAO might be a rare complication of JNA embolization. Careful preoperative angiographic evaluations to detect communicating arteries and immediate ophthalmologic consultation in case of developing visual symptoms during the procedure are necessary.

  14. Low-pressure pulmonary artery aneurysm presenting with pulmonary embolism: a case series

    Directory of Open Access Journals (Sweden)

    Papoulidis Pavlos

    2011-04-01

    Full Text Available Abstract Introduction Pulmonary artery aneurysm is an uncommon disorder with severe complications. The diagnosis is often difficult, since the clinical manifestations are non-specific and the treatment is controversial, as the natural history of the disease is not completely understood. Case presentation We describe the cases of two patients with pulmonary artery aneurysms. The first patient was a 68-year-old Caucasian man with an idiopathic low-pressure pulmonary artery aneurysm together with a pulmonary embolism. The patient preferred a conservative approach and was stable at the 10-month follow-up visit after being placed on anti-coagulant treatment. The second patient was a 66-year-old Caucasian woman with a low-pressure pulmonary artery aneurysm also presented together with a pulmonary embolism. The aneurysm was secondary to pulmonary valve stenosis. She received anti-coagulants and, after stabilization, underwent percutaneous balloon valvuloplasty. Conclusion Pulmonary embolism may be the initial presentation of a low-pressure pulmonary artery aneurysm. No underlying cause for pulmonary embolism was found in either of our patients, suggesting a causal association with low-pressure pulmonary artery aneurysm.

  15. Ruptured Persistent Trigeminal Artery Causing Direct Cavernous Sinus Fistula Treated with Pipeline Embolization and Minimal Coiling.

    Science.gov (United States)

    Yoon, Nam K; Awad, Al-Wala; Gee, James M; Taussky, Philipp

    2018-01-01

    Rupture of a persistent trigeminal artery associated with development of a cavernous sinus fistula in a traumatic setting is rare. These arteries are typically treated with coil embolization of the cavernous sinus. We present the case of a 42-year-old woman who developed a direct cavernous carotid fistula after a motor vehicle accident. Angiographic imaging revealed a rupture point of a persistent trigeminal artery as it connected with the cavernous segment of the internal carotid artery, causing a cavernous sinus fistula. Coiling of the cavernous sinus was abandoned after placement of 1 coil because of coil herniation into the internal carotid artery. A Pipeline embolization device was placed to oppose the coil against the intima and keep the lumen open. The combination of coil embolization and flow diversion acutely decreased the fistulous flow. Surprisingly, an angiographic follow-up at 6 months showed complete fistula occlusion despite placement of only 1 coil into the cavernous sinus. We report a rare case where undercoiling of the cavernous sinus occluded a cavernous sinus fistula because of the adjunct use of a Pipeline embolization device in the presence of a traumatic rupture of a persistent trigeminal artery. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Small pulmonary artery defects are not reliable indicators of pulmonary embolism.

    Science.gov (United States)

    Miller, Wallace T; Marinari, Lawrence A; Barbosa, Eduardo; Litt, Harold I; Schmitt, James E; Mahne, Anton; Lee, Victor; Akers, Scott R

    2015-07-01

    To evaluate the rate of agreement of pulmonary embolism diagnosis in computed tomography (CT) pulmonary angiogram studies and to evaluate the rate of inaccurate interpretations in the community hospital setting. Using the keywords "pulmonary embolism/embolus/emboli," the radiology information system was searched for CT pulmonary angiograms performed over a 3-year period at three U.S. community hospitals. Studies containing probable or definite pulmonary emboli were independently reviewed by four subspecialty thoracic radiologists. Agreement about the presence of pulmonary embolism progressively decreased with decreasing diameter of pulmonary vascular lesions (P pulmonary embolism of subsegmental lesions (P pulmonary embolism diagnosis of subsegmental and/or small pulmonary arterial defects. The probability of a false-positive diagnosis and indeterminate examinations progressively increased with: (1) more peripheral location of the lesion, (2) decreased size (short-axis diameter) of the lesion, and (3) diminishing quality of the CT examination. Forty-eight of 177 (27%) of subsegmental vascular defects identified by community radiologists were deemed indeterminate, and 27 of 177 (15%) of subsegmental vascular defects were judged to be false positive for pulmonary embolism by the consensus diagnosis. Fifty-four of 274 (20%) vascular defects with short axis less than 6 mm were indeterminate for pulmonary embolism, and 37 of 274 (14%) of vascular defects with short axis less than 6 mm were false positive for pulmonary embolism. Eleven of 13 (85%) of vascular lesions identified as pulmonary emboli on the lowest-quality CT examinations were false positive or indeterminate for pulmonary embolism. False-positive examinations were most often due to respiratory motion artifact (19/38, 50%). There is relatively poor interobserver agreement for subsegmental and/or small pulmonary artery defects, especially in CT pulmonary angiograms degraded by technical artifacts. These

  17. MRI Assessment of Uterine Artery Patency and Fibroid Infarction Rates 6 Months after Uterine Artery Embolization with Nonspherical Polyvinyl Alcohol

    Energy Technology Data Exchange (ETDEWEB)

    Das, Raj, E-mail: rajdas@nhs.net; Gonsalves, Michael; Vlahos, Ioannis [St George' s Healthcare NHS Trust, Blackshaw, Department of Radiology (United Kingdom); Manyonda, Issac [St George' s Healthcare NHS Trust, Department of Gynaecology (United Kingdom); Belli, Anna-Maria [St George' s Healthcare NHS Trust, Blackshaw, Department of Radiology (United Kingdom)

    2013-10-15

    Purpose: We have observed significant rates of uterine artery patency after uterine artery embolization (UAE) with nonspherical polyvinyl alcohol (nsPVA) on 6 month follow-up MR scanning. The study aim was to quantitatively assess uterine artery patency after UAE with nsPVA and to assess the effect of continued uterine artery patency on outcomes. Methods: A single centre, retrospective study of 50 patients undergoing bilateral UAE for uterine leiomyomata was undertaken. Pelvic MRI was performed before and 6 months after UAE. All embolizations were performed with nsPVA. Outcome measures included uterine artery patency, uterine and dominant fibroid volume, dominant fibroid percentage infarction, presence of ovarian arterial collaterals, and symptom scores assessed by the Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL). Results: Magnetic resonance angiographic evidence of uterine artery recanalization was demonstrated in 90 % of the patients (64 % bilateral, 26 % unilateral) at 6 months. Eighty percent of all dominant fibroids demonstrated >90 % infarction. The mean percentage reduction in dominant fibroid volume was 35 %. No significant difference was identified between nonpatent, unilateral, and bilateral recanalization of the uterine arteries with regard to percentage dominant fibroid infarction or dominant fibroid volume reduction. The presence of bilaterally or unilaterally patent uterine arteries was not associated with inferior clinical outcomes (symptom score or UFS-QOL scores) at 6 months. Conclusion: The high rates of uterine artery patency challenge the current paradigm that nsPVA is a permanent embolic agent and that permanent uterine artery occlusion is necessary to optimally treat uterine fibroids. Despite high rates of uterine artery recanalization in this cohort, satisfactory fibroid infarction rates and UFS-QOL scores were achieved.

  18. Non-invasive renal artery embolization for renal dysplasia accompanied by hypertension.

    Science.gov (United States)

    Yanagida, Hidehiko; Tabata, Nobutada; Sugimoto, Keisuke; Izu, Akane; Wada, Norihisa; Sakata, Naoki; Okada, Mitsuru; Takemura, Tsukasa

    2014-02-01

    Renovascular hypertension caused by renal dysplasia often is resistant to drug therapy. For a 14-year-old girl with such refractory hypertension, a non-invasive right renal ablation by embolization with anhydrous ethanol using a shepherd 's-crook' balloon catheter, was done. Blood pressure then rapidly normalized. Apart from mild fever after the procedure, no adverse effects occurred. In patients with mild renal artery stenosis and hypertension resistant to anti-hypertensive drug therapy, renal artery embolization may be a useful option. © 2014 The Authors. Pediatrics International © 2014 Japan Pediatric Society.

  19. Post-traumatic hepatic artery pseudoaneurysm treated with endovascular embolization and thrombin injection.

    Science.gov (United States)

    Francisco, Lloret Estañ; Asunción, López Conesa; Antonio, Capel Alemán; Ricardo, Robles Campos; Manuel, Reus Pintado; Caridad, Marín Hernández

    2010-02-27

    Post-traumatic hepatic artery pseudoaneurysm is uncommon, appearing in approximately 1% of hepatic trauma cases. Most are extrahepatic (80%) and have a late onset. Although they are usually asymptomatic, they should always be treated becasue of the high risk of complications, especially breakage. Currently the treatment of choice is endovascular embolization with coils or the exclusion of the pseudoaneurysm using other intravascular devices. Recently there have been accounts of a treatment that combines embolization with coils and image-guided percutaneous human thrombin injection. We present a case of post-traumatic hepatic artery pseudoaneurysm that was successfully treated using this combined technique.

  20. Transcatheter arterial embolization with ethylene vinyl alcohol copolymer (Onyx) for the treatment of hemorrhage due to uterine arteriovenous malformations.

    Science.gov (United States)

    Barral, P-A; Saeed-Kilani, M; Tradi, F; Dabadie, A; Izaaryene, J; Soussan, J; Bartoli, J-M; Vidal, V

    2017-05-01

    The purpose of this study was to evaluate the effectiveness of ethylene vinyl alcohol copolymer (Onyx) as a single embolic agent for percutaneous arterial treatment of hemorrhage due to uterine arteriovenous malformations (AVMs). Twelve women (mean age, 33 years) with metrorrhagia due to uterine AVMs who were treated by percutaneous arterial embolization using Onyx as a single embolic agent were retrospectively included. The diagnosis of uterine AVM was suggested by pelvic ultrasound and/or magnetic resonance imaging findings and further confirmed by angiography. Clinical files and angiographic examinations were reviewed for angiographic findings, technical and clinical success, procedure complication and further pregnancies. Clinical success was defined by absence of metrorrhagia at 1 month following embolization. Sixteen arterial embolization procedures were performed. Angiographically, 6 women had high flow AVM and 6 had low flow AVM. The rate of technical and clinical success was 92% (11/12 patients). One woman with early repeat hemorrhage underwent two embolization procedures and further hysterectomy. No severe complications were observed after embolization. Three women (3/12; 25%) became pregnant following embolization including one full term pregnancy. In women with metrorrhagia due to AVM, arterial embolization with Onyx is effective and safe. Additional research is needed to confirm the possibility of future pregnancy after Onyx embolization. Copyright © 2016 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  1. Venous Fragment Embolism to the Pulmonary Artery: A Rare Occurrence - Case Report and Literature Review of Venous Fragment Embolization to the Pulmonary Artery

    Science.gov (United States)

    2009-09-01

    approx 8x9mm. Angiography revealed a left popliteal artery aneurysm and left popliteal vein disruption. Whether the fragment originated from the...complications such as hemorrhage at insertion site, cardiac dysrhythmias, and ruptured aortic aneurysm . Technique failure requiring venotomy can occur...embolization in childhood: report of a case, literature review, and recommendations for management. J Pediatr Surg. 1990 Dec;25(12):1292-4. 28 Shannon FL

  2. The efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury

    Energy Technology Data Exchange (ETDEWEB)

    Kwack, Kyu Sung; Kim, Young Ju; Lee, Myung Sub; Kim, Dong Jin; Hong, In Soo [Wonju Christian Hospital, College of Medicine, Yonsei University, Wonju (Korea, Republic of)

    2000-07-01

    To evaluate the efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury after blunt abdominal trauma. We retrospectively analyzed the results of transcatheter arterial embolization in 23 patients who suffered splenic injury after blunt abdominal trauma. Fourteen of the patients were male, and 9 were female; 13 were adults, and 10 were children. Transcatheter arterial embolization was performed in patients with hypotension, tachycardia, evidence of hemodynamic instability due, for example, to low levels of Hgb and Hct, or those who needed fluid therapy or blood transfusion. After embolization the patients' progress was monitored by CT scanning, abdominal sonography, or {sup 99m}Tc-sulfur colloid scintigraphy. The degree of splenic injury was classified according to the system devised by Mirvis et al.; nine cases were CT grade III, and 14 were grade IV. After demonstrating angiographically the site of contrast leakage, embolization was performed; for this, a coil only was used in 16 cases, gelfoam only in four, and both coil and gelfoam in three. There were three sites of vascular embolization: 16 procedures were performed in the proximal part of the main trunk of the splenic artery, four in a superselected branch of this same artery, and three in both the splenic artery and one of its superselected branches. Of the 23 cases, 18 recovered without splenectomy after embolization, three adult patients died from coexisting conditions (spinal or cerebral injuries, liver cirrhosis, or pelvic bone fracture) or complications (acute renal failure or disseminated intravascular coagulation). Due to co-existing pancreatic and mesenteric vessel injury, two of the adult patients who underwent TAE also underwent delayed surgery; intraoperatively, there was no evidence of splenic rebleeding. In all patients who did not undergo surgery, follow-up observation revealed a decreased volume of hemoperitoneum, increased uptake of

  3. Atrial tachycardia treated by coil embolization of a giant coronary artery fistula.

    Science.gov (United States)

    Alihanoglu, Yusuf Izzettin; Uludag, Burcu; Kilic, Ismail Dogu; Yildiz, Bekir Serhat; Kocyigit, Ali; Evrengul, Harun

    2014-10-01

    Coronary artery fistulas are the second most frequently seen coronary anomaly following abnormalities of coronary artery origin and distribution. A coronary fistula is defined as a direct communication between a coronary artery and any cardiac chamber or vessel. Treatment options include percutaneous embolization and surgical intervention. Herein, we present a case of a giant coronary artery fistula and right atrial tachycardia that was induced during a diagnostic electrophysiologic study but was not inducible after the successful treatment of the fistula. This is the first case indicating this association. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  4. Cerebral Arterial Air Embolism Associated with Mechanical Ventilation and Deep Tracheal Aspiration

    Directory of Open Access Journals (Sweden)

    S. Gursoy

    2012-01-01

    Full Text Available Arterial air embolism associated with pulmonary barotrauma has been considered a rare but a well-known complication of mechanical ventilation. A 65-year-old man, who had subarachnoid hemorrhage with Glasgow coma scale of 8, was admitted to intensive care unit and ventilated with the help of mechanical ventilator. Due to the excessive secretions, deep tracheal aspirations were made frequently. GCS decreased from 8–10 to 4-5, and the patient was reevaluated with cranial CT scan. In CT scan, air embolism was detected in the cerebral arteries. The patient deteriorated and spontaneous respiratory activity lost just after the CT investigation. Thirty minutes later cardiac arrest appeared. Despite the resuscitation, the patient died. We suggest that pneumonia and frequent tracheal aspirations are predisposing factors for cerebral vascular air embolism.

  5. Bilateral Superselective Arterial Microcoil Embolization in Post-Traumatic High-Flow Priapism: A Case Report

    Directory of Open Access Journals (Sweden)

    Yung-Chin Lee

    2003-02-01

    Full Text Available Priapism is a prolonged penile erection unrelated to sexual stimulation. High-flow arteriogenic priapism is uncommon and usually occurs after genitoperineal trauma, which may damage a feeding cavernosal artery, leading to an arteriovenous fistula and, occasionally, to an associated pseudoaneurysm. The defects rarely occur bilaterally. Herein, we report successful treatment of high-flow priapism secondary to a traumatic pseudoaneurysm fed from the bilateral cavernosal artery. Diagnosis was made after cavernosal blood gas analysis, color Doppler ultrasonography, and superselective angiography. Treatment consisted of superselective arterial embolization using metallic microcoils and resulted in simultaneous detumescence of the penis with no complications. The patient regained morning erection on the second postoperative day and erectile function remained normal 8 months after treatment. This case shows that bilateral arteriocavernosal fistulae can be successfully treated with superselective arterial embolization without affecting potency and highlights the importance of warning men about the possibility of developing high-flow priapism following a perineal trauma.

  6. Short-Term Effects of Ankaferd Hemostat for Renal Artery Embolization: An Experimental Study

    Energy Technology Data Exchange (ETDEWEB)

    Ozbek, Orhan, E-mail: orhan.ozbek@gmail.com [Selcuk University, Department of Radiology, Meram School of Medicine (Turkey); Acar, Kadir [Selcuk University, Division of Hematology, Department of Internal Medicine, Meram School of Medicine (Turkey); Koc, Osman [Selcuk University, Department of Radiology, Meram School of Medicine (Turkey); Saritas, Kadir [Afyon Kocatepe University, Department of General Surgery, Veterinary Faculty (Turkey); Toy, Hatice [Selcuk University, Department of Pathology, Meram School of Medicine (Turkey); Solak, Yalcin [Selcuk University, Division of Nephrology, Department of Internal Medicine, Meram School of Medicine (Turkey); Ozbek, Seda [Selcuk University, Department of Radiology, Selcuklu School of Medicine (Turkey); Kucukapan, Ahmet; Guler, Ibrahim [Selcuk University, Department of Radiology, Meram School of Medicine (Turkey); Gaipov, Abduzhappar; Turk, Suleyman [Selcuk University, Division of Nephrology, Department of Internal Medicine, Meram School of Medicine (Turkey); Haznedaroglu, Ibrahim Celaleddin [Hacettepe University, Division of Hematology, Department of Internal Medicine, Faculty of Medicine (Turkey)

    2013-04-15

    Renal artery embolization (RAE) is a minimally invasive therapeutic technique that is utilized in a number of disorders. Ankaferd is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We used Ankaferd for RAE in a sheep model. Seven adult female sheep were included in the study. Selective renal arteriogram using 5-F diagnostic catheter was performed to make sure that each kidney was fed by a single renal artery and the animal had normal renal vasculature. Coaxial 2.7-F microcatheter was advanced to the distal main renal artery. Under fluoroscopic guidance, 2 mL of Ankaferd mixed with 2 mL of nonionic iodinated contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration of flow and stagnation. Control renal angiograms were performed just after embolization. After the procedure, the animals were observed for 1 day and then sacrificed with intravenous sodium thiopental. The technical success was observed in seven of the seven animals.. After embolization procedure, none of the animals died or experienced a major systemic adverse event. On macroscopic examination of the embolized kidneys, thrombus at the level of main renal artery formed after Ankaferd embolization was more compact compared with the thrombi that was not Ankaferd-associated, which was observed elsewhere. Microscopically, majority of the renal tubular cells (80-90 %) were necrotic, and there was epithelial cell damage in a small portion of the cells (10-20 %). RAE was safe and effective in the short-term with Ankaferd in studied animals. Further studies should be conducted to better delineate the embolizing potential of this novel hemostatic agent.

  7. Percutaneous transhepatic venous embolization of pulmonary artery aneurysm in Hughes-Stovin syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Ah; Kim, Man Deuk; Oh, Do Yun; Park, Pil Won [Bundang CHA General Hospital, Pochon CHA University, Seongnam (Korea, Republic of)

    2007-08-15

    Hughes-Stovin syndrome is an extremely rare entity. We present a case of a 42-year-old man, who developed deep vein and inferior vena cava (IVC) thrombosis, repeated internal bleeding and pulmonary artery aneurysms (PAAs). The patient presented with massive hemoptysis and with PAAs of a 2.5 cm maximum diameter. We describe the successful percutaneous transhepatic venous embolization of the PAAs due to occluded common vascular pathways to the pulmonary artery.

  8. Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis

    Energy Technology Data Exchange (ETDEWEB)

    Upasani, Anand, E-mail: anand.upasani@gosh.nhs.uk [Great Ormond Street Hospital, Department of Paediatric Urology (United Kingdom); Barnacle, Alex, E-mail: alex.barnacle@gosh.nhs.uk; Roebuck, Derek, E-mail: derek.roebuck@gosh.nhs.uk; Cherian, Abraham, E-mail: abraham.cherian@gosh.nhs.uk [Great Ormond Street Hospital (United Kingdom)

    2017-03-15

    Conventionally, xanthogranulomatous pyelonephritis is treated with antibiotics and drainage of abscess followed by nephrectomy for definitive treatment. Surgical excision of the affected kidney carries risk of significant complications. An alternative treatment modality is described in the form of embolization of the renal artery to devascularise the renal parenchyma and ablate the renal tissue, thus avoiding a major surgical procedure and the significant risks involved.

  9. Successful Control of Liver Metastases From Pancreatic Solid-Pseudopapillary Neoplasm (SPN) Using Hepatic Arterial Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Violari, Elena G., E-mail: eviolari@live.com; Brody, Lynn A.; Covey, Anne M.; Erinjeri, Joseph P.; Getrajdman, George I.; Sofocleous, Constantinos T. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, Interventional Radiology Service (United States); Reidy, Diane L. [Memorial Sloan-Kettering Cancer Center, Department of Medicine, Gastrointestinal Oncology Service (United States); Jarnagin, William R. [Memorial Sloan-Kettering Cancer Center, Department of Surgery, Hepatopancreatobiliary Service (United States); Brown, Karen T. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, Interventional Radiology Service (United States)

    2015-04-15

    No systemic agents that are known to be effective for the treatment of solid-pseudopapillary neoplasm (SPN) are available. We report the prolonged and sustained control of metastatic pancreatic SPN to the liver using hepatic arterial embolization (HAE), where a total of 13 HAE sessions were performed over a 6-year period.

  10. Significance of transcatheter arterial embolization in the treatment of pseudoaneurysm complicating pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Gyee; Joo, Jung Hyun; Kim, Young Cheol; Kim, Jae Kyu; Jeong, Yong Yeon; Kang, Heoung Keun [Chonnam Univ. School of Medicine, Kwangju (Korea, Republic of); Oh, Hee Yeon [Namkwang Hospital, Kwangju (Korea, Republic of)

    1998-11-01

    To evaluate the significance of transcatheter arterial embolization(TAE) of pseudoaneurysm complicating pancreatitis. This study was based on a retrospective analysis of eight cases, in which TAE for control of pseudoaneurysm complicating pancreatitis was attempted. All patients were males, and were aged between 35 and 65(mean, 47) years. Seven had a history of episodes of chronic pancreatitis and one case was the result of acute pancreatitis. All patients underwent diagnostic angiography and superselective embolization. Arteries in which pseudoaneurysm had occurred were the gastroduodenal (n=3D5), inferior pancreaticoduodenal (n=3D1), superior mesenteric artery root (n=3D1), and the celiac axis (n=3D1). Six cases were treated successfully without complications, but in two, embolization failed due to a wide aneurysmal neck arising from the superior mesenteric artery root and celiac axis. In four successful cases, pseudoaneurysms were completely resolved within three to six months of embolization. One of the other two remained as a pseudocyst, while in the other, also a pseudocyst, surgery was performed. Because TAE in patients with pseudoaneurysm complicating pancreatitis has a high success rate, and also leads to absolute resorption of a pseudocyst, TAE is the preferred pre-surgical treatment mode.=20.

  11. Amenorrhea due to partial uterine necrosis after uterine artery embolization for control of refractory postpartum hemorrhage.

    Science.gov (United States)

    Chitrit, Yvon; Zafy, Sylvie; Pelage, Jean P; Ledref, Olivier; Khoury, Rames; Caubel, Patrick

    2006-07-01

    We report a case of a woman in whom selective embolization of both uterine arteries was performed using gelatin sponge for control of refractory postpartum hemorrhage. Ten months after delivery, the women had not resumed noticeable menstruation. Examination and investigation were consistent with partial uterine necrosis and complete obliteration of the cavity.

  12. Ovarian thrombosis and uterine synechiae after arterial embolization for a late postpartum haemorrhage

    Directory of Open Access Journals (Sweden)

    Françoise Vendittelli

    2015-01-01

    Conclusions: This case teaches us that one rare complication can hide another! It is important to consider the diagnosis of subinvolution of the placental bed in cases of late PPH and to know the complications associated with vascular artery embolization in order to provide the most rapid and least invasive treatment.

  13. Inflammatory response in patients undergoing uterine artery embolization as compared to patients undergoing conventional hysterectomy

    DEFF Research Database (Denmark)

    Brøchner, A C; Mygil, B; Elle, B

    2009-01-01

    BACKGROUND: Uterine fibroids are benign tumors seen in 20-40% of women of childbearing age, and these fibroids are usually treated by hysterectomy. During the last decade, embolization of the uterine arteries with polyvinyl alcohol microparticles has become an alternative treatment. PURPOSE...

  14. Prospective sonographic assessment of uterine artery embolization for the treatment of fibroids.

    Science.gov (United States)

    Tranquart, F; Brunereau, L; Cottier, J P; Marret, H; Gallas, S; Lebrun, J L; Body, G; Herbreteau, D; Pourcelot, L

    2002-01-01

    To evaluate sonographic features following uterine artery embolization and to assess using ultrasound the efficacy of embolization as the primary treatment of fibroids. Fifty-eight women (mean age, 44.5 years; range, 33-65 years) suffering from symptoms due to fibroids (menometrorrhagia, bulk-related symptoms, pelvic pain) were followed-up after uterine artery embolization by ultrasound examination at 3 months, 6 months, 1 year and 2 years with assessment of volume and vascularization of fibroids as well as uterine vascularization. Fifty-eight patients were examined at 3 months, 46 at 6 months, 36 at 1 year and 19 at 2 years. Most patients were improved or free of symptoms at 3 months (90%), 6 months (92%) and 1 year (87%) and all monitored patients were free of symptoms at 2 years. Clinical failure of treatment occurred in only two cases (3%). Progressive significant reduction in fibroid size with reference to the baseline was demonstrated during follow-up from 3 months (-29%) to 24 months (-86%). Absence of intrafibroid vessels was observed in all except three cases as early as 3 months, whereas perifibroid vessels persisted in 21 cases. No changes in uterine vascularization or uterine artery resistance were noted. Uterine artery embolization is a valuable endovascular method for the treatment of fibroids, resulting in marked reduction in fibroid size and disappearance of intrafibroid vessels without reduction in uterine vascularization which is well depicted by sonography.

  15. Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France); Eveno, Clarisse, E-mail: clarisse.eveno@lrb.aphp.fr [Université Paris-Diderot, Sorbonne Paris Cité (France); Dautry, Raphael, E-mail: raphael.dautry@lrb.aphp.fr; Guerrache, Youcef, E-mail: docyoucef05@yahoo.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France); Camus, Marine, E-mail: marine.camus@lrb.aphp.fr [Université Paris-Diderot, Sorbonne Paris Cité (France); Boudiaf, Mourad, E-mail: mourad.boudiaf@lrb.aphp.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France); Gayat, Etienne, E-mail: etienne.gayat@lrb.aphp.fr [Université Paris-Diderot, Sorbonne Paris Cité (France); Dref, Olivier Le, E-mail: olivier.ledref@lrb.aphp.fr; Sirol, Marc, E-mail: marc.sirol@lrb.aphp.fr; Soyer, Philippe, E-mail: philippe.soyer@lrb.aphp.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France)

    2015-08-15

    PurposeTo assess the role and effectiveness of percutaneous arterial embolization (TAE) in patients with hemodynamic instability due to hypovolemic shock secondary to ruptured splanchnic artery pseudoaneurysms (SAPA).Materials and MethodsSeventeen patients (11 men, 6 women; mean age, 53 years) with hemodynamic instability (systolic blood pressure <90 mmHg) due to hypovolemic shock secondary to ruptured SAPA were treated by TAE. Clinical files, multidetector row computed tomography angiography, and angiographic examinations along with procedure details were reviewed.ResultsSeventeen SAPAs were present, predominantly located on gastroduodenal or pancreatic arteries (9/17; 53 %). Angiography showed extravasation of contrast medium from SAPA in 15/17 patients (88 %). Technical success rate of TAE was 100 %. TAE was performed using metallic coils in all patients (100 %), in association with gelatin sponge in 5/17 patients (29 %). TAE allowed controlling the bleeding and returning to normal hemodynamic status in 16/17 patients (94 %). In 1/17 patient (6 %), surgery was needed to definitively control the bleeding. The mortality and morbidity rate of TAE at 30 days were 0 and 12 %, respectively. Morbidity consisted in coil migration in 1/17 patient (6 %) and transient serum liver enzyme elevation in 1/17 patient (6 %).ConclusionTAE is an effective and safe treatment option for ruptured SAPA in hemodynamically unstable patients, with a success rate of 94 %. Our results suggest that TAE should be the favored option in patients with hemodynamic instability due to ruptured SAPA.

  16. Coronary-to-bronchial artery fistula in a patient with multivessel coronary disease treated by percutaneous coronary intervention.

    Science.gov (United States)

    Rigattieri, Stefano; Fedele, Silvio; Sperandio, Massimiliano; Martuscelli, Eugenio; Simonetti, Giovanni; Altamura, Giuliano; Loschiavo, Paolo

    2010-08-01

    We describe the case of a 78-year-old patient, admitted to our hospital with an acute coronary syndrome. Coronary angiography showed multivessel coronary artery disease and an anomalous coronary vessel branching from the right coronary artery. After successful percutaneous revascularization and discharge, the anomalous vessel was diagnosed by contrast enhanced 64-multidetector computed tomography as a coronary-to-bronchial fistula. Since the patient was asymptomatic, conservative treatment was selected.

  17. Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Ghelfi, Julien, E-mail: JGhelfi@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France); Brichon, Pierre-Yves, E-mail: PYBrichon@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Chirurgie Thoracique, Vasculaire et Endocrinienne (France); Frandon, Julien, E-mail: Julien.frandon@chu-nimes.fr [CHU de Nîmes, Clinique Universitaire de Radiologie et Imagerie Médicale (France); Boussat, Bastien, E-mail: BBoussat@chu-grenoble.fr [CHU de Grenoble, Département d’Information Médicale, Pôle de Santé Publique (France); Bricault, Ivan, E-mail: IBricault@chu-grenoble.fr; Ferretti, Gilbert, E-mail: GFerretti@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France); Guigard, Sébastien, E-mail: SGuigard@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Chirurgie Thoracique, Vasculaire et Endocrinienne (France); Sengel, Christian, E-mail: CSengel@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France)

    2017-05-15

    PurposeSurgical esophagectomy is the gold standard treatment of early-stage esophageal cancer. The procedure is complicated with significant morbidity; the most severe complication being the anastomotic leakage. Anastomotic fistulas are reported in 5–25% of cases and are mainly due to gastric transplant ischemia. Here, we report our experience of ischemic pre-conditioning using preoperative arterial embolization (PreopAE) before esophagectomy.Materials and MethodsThe medical records of all patients who underwent oncologic esophagectomy from 2008 to 2015 were retrospectively reviewed. Patients were divided into two groups: patients who received PreopAE, and a control group of patients who did not benefit from ischemic pre-conditioning. The target arteries selected for PreopAE were the splenic artery, left gastric artery, and right gastric artery. Evaluation of the results was based on anastomotic leakage, postoperative mortality, technical success of PreopAE, and complications related to the embolization procedure.ResultsForty-six patients underwent oncologic esophagectomy with PreopAE and 13 patients did not receive ischemic conditioning before surgery. Thirty-eight PreopAE were successfully performed (83%), but right gastric artery embolization failed for 8 patients. Anastomotic leakage occurred in 6 PreopAE patients (13%) and in 6 patients (46%) in the control group (p = 0.02). The mortality rate was 2% in the PreopAE group and 23% in the control group (p = 0.03). Eighteen patients suffered from partial splenic infarction after PreopAE, all treated conservatively.ConclusionPreoperative ischemic conditioning by arterial embolization before oncologic esophagectomy seems to be effective in preventing anastomotic leakage.

  18. Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate for the Treatment of Acquired Uterine Vascular Malformations

    Energy Technology Data Exchange (ETDEWEB)

    Picel, Andrew C., E-mail: apicel@ucsd.edu [University of California, San Diego, Department of Radiology (United States); Koo, Sonya J. [University of Texas Southwestern Medical Center, Department of Radiology (United States); Roberts, Anne C. [University of California, San Diego, Department of Radiology (United States)

    2016-08-15

    PurposeThe purpose of the study was to evaluate the technique and outcomes of transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA) for the treatment of acquired uterine arteriovenous malformations (AVMs).Materials and methodsA retrospective review identified five women treated for suspected acquired uterine AVMs with TAE at our institution. Four women (80 %) presented with heavy or intermittent vaginal bleeding after obstetric manipulation. One woman (20 %) was treated for an incidental AVM discovered on ultrasound after an uncomplicated cesarean section. Three women underwent one embolization procedure and two women required two procedures. Embolization material included NBCA in six procedures (80 %) and gelatin sponge in one procedure (20 %).ResultsEmbolization resulted in angiographic stasis of flow in all seven procedures. Four women (80 %) presented with vaginal bleeding which was improved after treatment. One woman returned 24 days after unilateral embolization with recurrent bleeding, which resolved after retreatment. One woman underwent two treatments for an asymptomatic lesion identified on ultrasound. There were no major complications. Three women (60 %) experienced mild postembolization pelvic pain that was controlled with non-steroidal anti-inflammatory drugs. Three women (60 %) had pregnancies and deliveries after embolization.ConclusionsTAE is a safe alternative to surgical therapy for acquired uterine AVMs with the potential to maintain fertility. Experience from this case series suggests that NBCA provides predictable and effective occlusion.

  19. Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate for the Treatment of Acquired Uterine Vascular Malformations.

    Science.gov (United States)

    Picel, Andrew C; Koo, Sonya J; Roberts, Anne C

    2016-08-01

    The purpose of the study was to evaluate the technique and outcomes of transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA) for the treatment of acquired uterine arteriovenous malformations (AVMs). A retrospective review identified five women treated for suspected acquired uterine AVMs with TAE at our institution. Four women (80 %) presented with heavy or intermittent vaginal bleeding after obstetric manipulation. One woman (20 %) was treated for an incidental AVM discovered on ultrasound after an uncomplicated cesarean section. Three women underwent one embolization procedure and two women required two procedures. Embolization material included NBCA in six procedures (80 %) and gelatin sponge in one procedure (20 %). Embolization resulted in angiographic stasis of flow in all seven procedures. Four women (80 %) presented with vaginal bleeding which was improved after treatment. One woman returned 24 days after unilateral embolization with recurrent bleeding, which resolved after retreatment. One woman underwent two treatments for an asymptomatic lesion identified on ultrasound. There were no major complications. Three women (60 %) experienced mild postembolization pelvic pain that was controlled with non-steroidal anti-inflammatory drugs. Three women (60 %) had pregnancies and deliveries after embolization. TAE is a safe alternative to surgical therapy for acquired uterine AVMs with the potential to maintain fertility. Experience from this case series suggests that NBCA provides predictable and effective occlusion.

  20. Coil embolization of ruptured frontopolar artery aneurysm: case report.

    Science.gov (United States)

    Castaño-Leon, Ana M; Cicuendez, Marta; Paredes, Igor; Alen, Jose F; Navia, Pedro; Lagares, Alfonso

    2014-01-01

    Distal anterior cerebral artery aneurysms are infrequent. The most common location is at the bifurcation of the pericallosal and callosomarginal arteries. Cerebral artery anomalies can sometimes, at least partially, explain aneurysm formation in less common locations in relation to hemodynamic stress caused on the vascular wall. We report a very rare case of subarachnoid hemorrhage due to a ruptured frontopolar artery aneurysm as a part of an anomalous anterior cerebral artery complex that was, for the first time, treated with endovascular coiling. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  1. Pulmonary Embolism

    Science.gov (United States)

    A pulmonary embolism is a sudden blockage in a lung artery. The cause is usually a blood clot in the ... and travels through the bloodstream to the lung. Pulmonary embolism is a serious condition that can cause Permanent ...

  2. Preoperative embolization of the graft superior mesenteric artery assists graft enterectomy in intestinal transplant recipients.

    Science.gov (United States)

    Fan, Ji; Tekin, Akin; Nishida, Seigo; Moon, Jang; Selvaggi, Gennaro; Levi, David; Weppler, Debbie; Tzakis, Andreas G

    2012-07-15

    Graft enterectomy after intestinal graft failure is challenging. We report our experience in preoperative embolization of graft superior mesenteric artery (SMA) to facilitate intestinal graft removal. A total of 22 isolated intestinal transplant recipients underwent graft enterectomy from July 1997 to February 2011 at the Miami Transplant Institute, Miller School of Medicine, University of Miami, of whom 6 patients underwent embolization of graft SMA seven times before graft enterectomy. The mean (SD) estimated blood loss in patients with or without embolization was 600 (173) versus 1437 (328) mL, respectively (P=0.02). The mean operation time in patients with or without embolization was 5.2 (1.2) versus 8.7 (1.3) hr, respectively (P=0.04). The mean change between preoperative and postoperative serum creatinine in patients with or without embolization was 0.2 (0.05) versus 0.16 (0.04), respectively (P=0.12). In patients with embolization, the warm ischemia time (from embolization to removal of the graft) was 6.9 (1.1) hr (range, 6-8.5 hr). Intraoperative and postoperative (24 hr) pH values were 7.36 (0.1) and 7.34 (0.1), respectively (P=0.71); intraoperative and postoperative (24 hr) lactate levels were 1.77 (0.8) and 1.56 (0.5) mmol/L, respectively (P=0.57). Preoperative embolization of graft SMA is a useful alternative to assist graft enterectomy in intestinal transplant recipients without causing severe acidosis, renal impairment, and hemodynamic instability.

  3. Mortality in trauma patients with active arterial bleeding managed by embolization or surgical packing

    DEFF Research Database (Denmark)

    Froberg, Lonnie; Helgstrand, Frederik; Clausen, Caroline

    2016-01-01

    and blood product consumption in trauma patients with active arterial haemorrhage in the abdominal and/or pelvic region treated with either angiography and embolization or explorative laparotomy and surgical packing. MATERIAL AND METHODS: From January 1(st) 2006 to December 31(st) 2011 2,173 patients...... with an ISS of >9 were admitted to the Trauma Centre of Copenhagen University Hospital, Rigshospitalet, Denmark. Of these, 66 patients met the inclusion criteria: age above 15 years and active arterial haemorrhage from the abdominal and/or pelvic region verified by a CT scan at admission. Gender, age, initial......OBJECTIVE: Exsanguination due to coagulopathy and vascular injury is a common cause of death among trauma patients. Arterial injury can be treated either by angiography and embolization or by explorative laparotomy and surgical packing. The purpose of this study was to compare 30-day mortality...

  4. Coil embolization of internal mammary artery injured during central vein catheter and cardiac pacemaker lead insertion

    Energy Technology Data Exchange (ETDEWEB)

    Chemelli, A.P. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria)], E-mail: Andreas.Chemelli@i-med.ac.at; Chemelli-Steingruber, I.E. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria); Bonaros, N. [Department of Cardiovascular Surgery, Innsbruck Medical University (Austria); Luckner, G. [Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University (Austria); Millonig, G. [Department of Gastroenterology and Hepatology, Innsbruck Medical University (Austria); Seppi, K. [Department of Neurology, Innsbruck Medical University (Austria); Lottersberger, C.; Jaschke, W. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria)

    2009-08-15

    Purpose: This study describes several cases of endovascular coil embolization of the proximal internal mammary artery injured by blind approach to the subclavian vein for central venous catheter or pacemaker lead insertion. Materials and methods: We conducted a retrospective analysis of five patients with iatrogenic arterial lesions of the internal mammary artery (IMA). The lesions occurred in three patients from a puncture of the subclavian vein during insertion of a central venous catheter and in two patients from a puncture of the subclavian vein for insertion of a pacemaker lead. Four patients had acute symptoms of bleeding with mediastinal hematoma and hematothorax and one patient was investigated in a chronic stage. A pseudoaneurysm was detected in all five patients. All four acute and hemodynamic unstable patients required hemodynamic support. Results: In all patients, embolization was performed using a coaxial catheter technique, and a long segment of the IMA adjacent distally and proximally to the source of bleeding was occluded with pushable microcoils. In one patient, additional mechanically detachable microcoils were used at the very proximal part of the IMA. Microcoil embolization of the IMA was successful in all patients, and the source of bleeding was eliminated in all patients. Conclusion: Transarterial coil embolization is a feasible and efficient method in treating acute bleeding and pseudoaneurysm of the IMA and should be considered if mediastinal hematoma or hemathorax occurs after blind puncture of the subclavian vein.

  5. Uterine Artery Embolization: An Analysis of Online Patient Information Quality and Readability with Historical Comparison.

    Science.gov (United States)

    Murray, Timothy E; Mansoor, Tayyaub; Bowden, Dermot J; O'Neill, Damien C; Lee, Michael J

    2018-01-10

    Investigators aimed to assess online information describing uterine artery embolization (UAE) to examine the quality and readability of websites patients are accessing. A list of applicable, commonly used searchable terms was generated, including "Uterine Artery Embolization," "Fibroid Embolization," "Uterine Fibroid Embolization," and "Uterine Artery Embolisation." Each possible term was assessed across the five most-used English language search engines to determine the most commonly used term. The most common term was then investigated across each search engine, with the first 25 pages returned by each engine included for analysis. Duplicate pages, nontext content such as video or audio, and pages behind paywalls were excluded. Pages were analyzed for quality and readability using validated tools including DISCERN score, JAMA Benchmark Criteria, HONcode Certification, Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Gunning-Fog Index. Secondary features such as age, rank, author, and publisher were recorded. The most common applicable term was "Uterine Artery Embolization" (492,900 results). Mean DISCERN quality of information provided by UAE websites is "fair"; however, it has declined since comparative 2012 studies. Adherence to JAMA Benchmark Criteria has reduced to 6.7%. UAE website readability remains more difficult than the World Health Organization-recommended 7-8th grade reading levels. HONcode-certified websites (35.6%) demonstrated significantly higher quality than noncertified websites. Quality of online UAE information remains "fair." Adherence to JAMA benchmark criteria is poor. Readability is above recommended 7-8th grade levels. HONcode certification was predictive of higher website quality, a useful guide to patients requesting additional information. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  6. Prostatic Artery Embolization After Failed Urological Interventions for Benign Prostatic Obstruction: A Case Series of Three Patients

    Energy Technology Data Exchange (ETDEWEB)

    Bhatia, Shivank S., E-mail: sbhatia1@med.miami.edu; Dalal, Ravi, E-mail: rdalal@med.miami.edu [University of Miami – Miller School of Medicine, Department of Radiology (United States); Gomez, Christopher, E-mail: Cgomez7@med.miami.edu [University of Miami – Miller School of Medicine, Department of Urology (United States); Narayanan, Govindarajan, E-mail: gnarayanan@med.miami.edu [University of Miami – Miller School of Medicine, Department of Radiology (United States)

    2016-08-15

    Benign prostate obstruction with associated lower urinary tract symptoms is a common diagnosis with multiple minimally invasive treatment options available. Herein, the authors describe three patients who failed prior different urological interventions who underwent prostate artery embolization with a subsequent improvement in symptoms. The positive response suggests that embolization may be an effective treatment alternative in this subset of patients.

  7. Antibody response to a T-cell-independent antigen is preserved after splenic artery embolization for trauma

    NARCIS (Netherlands)

    Olthof, D. C.; Lammers, A. J. J.; van Leeuwen, E. M. M.; Hoekstra, J. B. L.; ten Berge, I. J. M.; Goslings, J. C.

    2014-01-01

    Splenic artery embolization (SAE) is increasingly being used as a nonoperative management strategy for patients with blunt splenic injury following trauma. The aim of this study was to assess the splenic function of patients who were embolized. A clinical study was performed, with splenic function

  8. Uterine Artery Embolization Versus Laparoscopic Uterine Artery Occlusion: The Outcomes of a Prospective, Nonrandomized Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Mara, Michal; Kubinova, Kristyna, E-mail: kristyna.kubinova@gmail.com [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic); Maskova, Jana [Aberdeen Royal Infirmary, Department of Radiology (United Kingdom); Horak, Petr [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic); Belsan, Tomas [Central Military Hospital, Department of Radiology (Czech Republic); Kuzel, David [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic)

    2012-10-15

    Purpose: To compare outcomes of two different types of occlusive therapy of uterine fibroids. Methods: Women with fibroid(s) unsuitable for laparoscopic myomectomy (LM) were treated with uterine artery embolization (UAE) or laparoscopic uterine artery occlusion (LUAO). Results: Before the procedure, patients treated with UAE (n = 100) had a dominant fibroid greater in size (68 vs. 48 mm) and a mean age lower (33.1 vs. 34.9 years) than surgically treated patients (n = 100). After 6 months, mean shrinkage of fibroid volume was 53 % after UAE and 39 % after LUAO (p = 0.063); 82 % of women after UAE, but only 23 % after LUAO, had complete myoma infarction (p = 0.001). Women treated with UAE had more complications (31 vs. 11 cases, p = 0.006) and greater incidence of hysteroscopically verified intrauterine necrosis (31 vs. 3 %, p = 0.001). Both groups were comparable in markers of ovarian functions and number of nonelective reinterventions. The groups did not differ in pregnancy (69 % after UAE vs. 67 % after LUAO), delivery (50 vs. 46 %), or abortion (34 vs. 33 %) rates. The mean birth weight of neonates was greater (3270 vs. 2768 g, p = 0.013) and the incidence of intrauterine growth restriction lower (13 vs. 38 %, p = 0.046) in post-UAE patients. Conclusion: Both methods are effective in the treatment of women with future reproductive plans and fibroids not suitable for LM. UAE is more effective in causing complete ischemia of fibroids, but it is associated with greater risk of intrauterine necrosis. Both methods have low rate of serious complications (except for a high abortion rate).

  9. Incidence, risk factors, treatment and prognosis of popliteal artery embolization in the superficial femoral artery interventions.

    Directory of Open Access Journals (Sweden)

    Weiwei Wu

    Full Text Available OBJECTIVE: Percutaneous transluminal angioplasty and stenting (PTA + stent has gained acceptance as a primary treatment modality for the superficial femoral artery (SFA diseases. Popliteal artery embolization (PAE is a severe complication in SFA interventions. The purpose of this study was to evaluate the incidence, risk factors, treatment and prognosis of PAE in primary SFA PTA + stent. METHODS: Chronic SFA arteriosclerosis cases that underwent primary PTA + stent were reviewed from a retrospectively maintained database. Runoff vessels were evaluated in all cases before and after the interventions for PAE detection. The primary patency, secondary patency and limb salvage rates were calculated using Kaplan-Meier analysis and compared using log-rank analysis. Cox multivariate regression was performed to evaluate predictors of patency and limb salvage rates. RESULTS: There were 436 lesions treated in 388 patients with 10 PAE events (2.3% in total. PAE rate was significantly higher in Transatlantic Inter-Society Consensus (TASC C/D group compared with TASC A/B group (OR = 8.91, P = .002, in chronic total occlusion (CTO lesions compared with stenotic lesions (P<.0001, and in group with history of cerebral ischemic stroke (OR = 6.11, P = .007. PAE rates were not significantly affected by age, sex, smoking, hypertension, diabetes, hyperlipidemia and runoff status. The binary logistic regression showed that only the TASC C/D was an independent predictor of PAE (P = .031. The 12-month and 24-month primary patency, secondary patency and limb salvage rates in PAE group showed no significant differences comparing with non-PAE group. CONCLUSIONS: PAE is a rare event in primary SFA PTA + stent. TASC C/D lesion, CTO and cerebral ischemic stroke history are risk factors for PAE. PAE is typically reversible by comprehensive techniques. If the popliteal flow is restored in time, PAE has no significant effect on long-term patency and limb

  10. Pipeline embolization of posterior communicating artery aneurysms associated with a fetal origin posterior cerebral artery.

    Science.gov (United States)

    Wallace, Adam N; Kayan, Yasha; Austin, Matthew J; Delgado Almandoz, Josser E; Kamran, Mudassar; Cross, DeWitte T; Moran, Christopher J; Osbun, Joshua W; Kansagra, Akash P

    2017-09-01

    Flow diversion may have advantages in the treatment of posterior communicating artery (PComA) aneurysms associated with a fetal origin posterior cerebral artery (PCA), which can be challenging to treat with conventional techniques. However, a PComA incorporated into the aneurysm may prevent or delay aneurysm occlusion. Also, coverage of a fetal origin PCA risks infarction of a large vascular territory. The purpose of this study was to examine the safety and effectiveness of using the Pipeline Embolization Device (PED) to treat PComA aneurysms associated with a fetal origin PCA. Retrospective review of PComA aneurysms associated with a fetal origin PCA treated with the PED at two neurovascular centers was performed. Periprocedural complications and clinical and angiographic outcomes were reviewed. Seven female patients underwent a total of seven PED procedures to treat seven PcomA aneurysms associated with a fetal origin PCA. The symptomatic complication rate was 14% (1/7) per patient and 13% (1/8) per procedure. Angiographic follow up was obtained for 6 of 7 aneurysms. Follow-up DSA at 5-7 months after treatment demonstrated complete occlusion of 17% (1/6) of aneurysms. One aneurysm was retreated with a second PED and occlusion was demonstrated 36 months after the second treatment, yielding an overall complete occlusion rate of 33% (2/6). PED treatment was largely ineffective at treating PComA aneurysms associated with a fetal origin PCA, and should only be considered when conventional treatment options, including microsurgical clipping, are not feasible. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. The use of ultrasound contrast to evaluation the effectiveness of superselective embolization of arteries prostate of benign hyperplasia

    Directory of Open Access Journals (Sweden)

    O. B. Zhukov

    2015-01-01

    Full Text Available The article presents the first Russian and international experience in the application of ultrasound contrast to evaluation the effectiveness of superselective embolization of arteries prostate benign hyperplasia her. Thoroughly describes the methodology of the arteries embolization prostate hyperplasia her. Given a clear algorithm and the necessary tools in this type of operations. Presented rationale for the use of microspheres Embozene as the most innovative embolization material. These microspheres exhibit shape memory, which allows them to shrink to 35 % and immediately recover its original volume after the release of the microcatheter. Studies have shown that the microspheres Embozene retain its original volume is not fragmented, which is a very important fact for the target artery embolization and radical prostate. Attentive readership presents the rationale and mechanical properties of ultrasound contrast, which is only selectively within the lumen of blood vessels and eliminates early relapse of prostate adenoma after embolization her arteries in its application. This area will allow the use of ultrasound contrast followed by researchers to determine the nature of the blood supply to the prostate and its changes after embolization of the arteries of the prostate. The article presents the clinical and uroflowmetry results of patients who underwent embolization. Denotes the vector of this technology in the elimination of the continued growth of the local and local recurrence of prostate cancer. 

  12. The use of ultrasound contrast to evaluation the effectiveness of superselective embolization of arteries prostate of benign hyperplasia

    Directory of Open Access Journals (Sweden)

    O. B. Zhukov

    2015-04-01

    Full Text Available The article presents the first Russian and international experience in the application of ultrasound contrast to evaluation the effectiveness of superselective embolization of arteries prostate benign hyperplasia her. Thoroughly describes the methodology of the arteries embolization prostate hyperplasia her. Given a clear algorithm and the necessary tools in this type of operations. Presented rationale for the use of microspheres Embozene as the most innovative embolization material. These microspheres exhibit shape memory, which allows them to shrink to 35 % and immediately recover its original volume after the release of the microcatheter. Studies have shown that the microspheres Embozene retain its original volume is not fragmented, which is a very important fact for the target artery embolization and radical prostate. Attentive readership presents the rationale and mechanical properties of ultrasound contrast, which is only selectively within the lumen of blood vessels and eliminates early relapse of prostate adenoma after embolization her arteries in its application. This area will allow the use of ultrasound contrast followed by researchers to determine the nature of the blood supply to the prostate and its changes after embolization of the arteries of the prostate. The article presents the clinical and uroflowmetry results of patients who underwent embolization. Denotes the vector of this technology in the elimination of the continued growth of the local and local recurrence of prostate cancer. 

  13. Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors: variables affecting response rates and survival

    National Research Council Canada - National Science Library

    Gupta, Sanjay; Johnson, Marcella M; Murthy, Ravi; Ahrar, Kamran; Wallace, Michael J; Madoff, David C; McRae, Stephen E; Hicks, Marshall E; Rao, Sujaya; Vauthey, Jean-Nicolas; Ajani, Jaffer A; Yao, James C

    2005-01-01

    The objective of this study was to determine the prognostic variables that influence response and survival in patients with metastatic neuroendocrine tumors who are treated with hepatic arterial embolization (HAE...

  14. Conservative Management of Invasive Placenta Using Combined Prophylactic Internal Iliac Artery Balloon Occlusion and Immediate Postoperative Uterine Artery Embolization.

    Science.gov (United States)

    D'Souza, Donna L; Kingdom, John C; Amsalem, Hagai; Beecroft, John R; Windrim, Rory C; Kachura, John R

    2015-05-01

    The objective of the study was to evaluate the efficacy and safety of combined prophylactic intraoperative internal iliac artery balloon occlusion and postoperative uterine artery embolization in the conservative management (uterine preservation) of women with invasive placenta undergoing scheduled caesarean delivery. Ten women (mean age 35 years) with invasive placenta choosing caesarean delivery without hysterectomy had preoperative insertion of internal iliac artery occlusion balloons, intraoperative inflation of the balloons, and immediate postoperative uterine artery embolization with absorbable gelatin sponge. A retrospective review was performed with institutional review board approval. Outcome measures were intraoperative blood loss, transfusion requirement, hysterectomy rate, endovascular complications, surgical complications, and postoperative morbidity. All women had placenta increta or percreta, and concomitant complete placenta previa. Mean gestational age at delivery was 36 weeks. In 6 women the placenta was left undisturbed in the uterus, 2 had partial removal of the placenta, and 2 had piecemeal removal of the whole placenta. Mean estimated blood loss during caesarean delivery was 1.2 L. Only 2 patients (20%) required blood transfusion. There were no intraoperative surgical complications, endovascular complications, maternal deaths, or perinatal deaths. Three women developed postpartum complications necessitating postpartum hysterectomy; the hysterectomy rate was therefore 30% and uterine preservation was successful in 70%. Combined bilateral internal iliac artery balloon occlusion and uterine artery embolization may be an effective strategy to control intraoperative blood loss and preserve the uterus in patients with invasive placenta undergoing caesarean delivery. Copyright © 2015 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  15. Arterial Embolization in the Management of Mesenteric Bleeding Secondary to Blunt Abdominal Trauma

    Energy Technology Data Exchange (ETDEWEB)

    Ghelfi, Julien, E-mail: JGhelfi@chu-grenoble.fr; Frandon, Julien, E-mail: JFrandon2@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France); Barbois, Sandrine, E-mail: SBarbois@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Chirurgie Digestive et d’Urgences (France); Vendrell, Anne, E-mail: AVendrell@chu-grenoble.fr; Rodiere, Mathieu, E-mail: MRodiere@chu-grenoble.fr; Sengel, Christian, E-mail: CSengel@chu-grenoble.fr; Bricault, Ivan, E-mail: IBricault@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France); Arvieux, Catherine, E-mail: CArvieux@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Chirurgie Digestive et d’Urgences (France); Ferretti, Gilbert, E-mail: GFerretti@chu-grenoble.fr; Thony, Frédéric, E-mail: FThony@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France)

    2016-05-15

    IntroductionMesenteric bleeding is a rare but potentially life-threatening complication of blunt abdominal trauma. It can induce active hemorrhage and a compressive hematoma leading to bowel ischemia. Emergency laparotomy remains the gold standard treatment. We aimed to study the effectiveness and complications of embolization in patients with post-traumatic mesenteric bleeding.Materials and MethodsThe medical records of 7 consecutive patients with active mesenteric bleeding treated by embolization in a level-one trauma center from 2007 to 2014 were retrospectively reviewed. All patients presented with active mesenteric bleeding on CT scans without major signs of intestinal ischemia. We focused on technical success, clinical success, and the complications of embolization.ResultsSix endovascular procedures were successful in controlling hemorrhage but 1 patient had surgery to stop associated arterial and venous bleeding. One patient suffered from bowel ischemia, a major complication of embolization, which was confirmed by surgery. No acute renal failure was noted after angiography. For 1 patient we performed combined management as the endovascular approach allowed an easier surgical exploration.ConclusionIn mesenteric trauma with active bleeding, embolization is a valuable alternative to surgery and should be considered, taking into account the risk of bowel ischemia.

  16. Arterial Embolization in the Management of Mesenteric Bleeding Secondary to Blunt Abdominal Trauma.

    Science.gov (United States)

    Ghelfi, Julien; Frandon, Julien; Barbois, Sandrine; Vendrell, Anne; Rodiere, Mathieu; Sengel, Christian; Bricault, Ivan; Arvieux, Catherine; Ferretti, Gilbert; Thony, Frédéric

    2016-05-01

    Mesenteric bleeding is a rare but potentially life-threatening complication of blunt abdominal trauma. It can induce active hemorrhage and a compressive hematoma leading to bowel ischemia. Emergency laparotomy remains the gold standard treatment. We aimed to study the effectiveness and complications of embolization in patients with post-traumatic mesenteric bleeding. The medical records of 7 consecutive patients with active mesenteric bleeding treated by embolization in a level-one trauma center from 2007 to 2014 were retrospectively reviewed. All patients presented with active mesenteric bleeding on CT scans without major signs of intestinal ischemia. We focused on technical success, clinical success, and the complications of embolization. Six endovascular procedures were successful in controlling hemorrhage but 1 patient had surgery to stop associated arterial and venous bleeding. One patient suffered from bowel ischemia, a major complication of embolization, which was confirmed by surgery. No acute renal failure was noted after angiography. For 1 patient we performed combined management as the endovascular approach allowed an easier surgical exploration. In mesenteric trauma with active bleeding, embolization is a valuable alternative to surgery and should be considered, taking into account the risk of bowel ischemia.

  17. Management of bleeding uterine arteriovenous malformation with bilateral uterine artery embolization.

    Science.gov (United States)

    Kim, Taehwan; Shin, Ji Hoon; Kim, Jinoo; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong-Il; Yang, Heechul; Sung, Kyu-Bo

    2014-03-01

    To evaluate the technical feasibility and clinical outcome of bilateral uterine artery embolization (UAE) as a first-line therapeutic option for bleeding uterine arteriovenous malformation (AVM). Between 2002 and 2012, 19 patients were diagnosed with acquired uterine AVM clinically and through imaging studies. The clinical characteristics, angiographic features, technical success rate of embolization, procedure-related complications, imaging, and clinical follow-up data were assessed. Clinical success was defined as immediate symptomatic resolution with disappearance of vascular abnormality on subsequent imaging studies. A total of 20 bilateral UAE, with or without embolization of extra-uterine feeders, were performed as the first-line treatment. Technical and clinical success rate was 90.0% (18/20) and 89.5% (17/19), respectively. Embolization was incomplete in two patients who had residual extra-uterine fine feeders to the AVM or a procedure- related complication (ruptured uterine artery); the former showed slow regression of the vascular malformation during the observation period, while the latter underwent a successful second bilateral UAE. Immediate clinical success was achieved in the remaining 17 patients after a single session and no recurrence of bleeding was found. Recovery to normal menstrual cycle was seen in all 17 patients with clinical success within one or two months, two of whom subsequently had uneventful intrauterine pregnancies carried to term. Bilateral UAE is a safe and effective first-line therapeutic option for the management of bleeding uterine AVMs. However, incomplete embolization due to unembolizable feeders or difficult access into the uterine artery may lead to suboptimal treatment.

  18. Leiomyoma Infarction after Uterine Artery Embolization: Influence of Embolic Agent and Leiomyoma Size and Location on Outcome.

    Science.gov (United States)

    Lacayo, Eduardo A; Richman, Danielle L; Acord, Michael R; Wolfman, Darcy J; Caridi, Theresa M; Desale, Sameer Y; Spies, James B

    2017-07-01

    To study the factors that might impact infarction of individual uterine leiomyomas and total tumor burden after uterine artery embolization (UAE). This retrospective study included 91 patients (mean age, 44 y [range, 34-54 y]) who underwent UAE with tris-acryl gelatin microspheres (TAGMs) or nonspherical polyvinyl alcohol (PVA) particles. Twenty-one patients were treated with PVA (23%) and 70 were treated with TAGMs (77%). A total of 356 uterine leiomyomas were assessed, with a median uterine volume of 533 cm(3) (range, 321-848 cm(3)). A reader masked to demographic and technical details reviewed contrast-enhanced magnetic resonance images before and 3 months after UAE to estimate the extent of tumor infarction. There was no significant difference in global or individual tumor infarction rate between embolizations with TAGMs and PVA particles (P = .73 and P = .3, respectively). Global infarction was not affected by age (P = .53), race (P = .12), number of leiomyomas (P = .72), or uterine volume (P = .74). Leiomyoma size did not influence individual tumor infarction (P = .41). Leiomyoma location was the sole factor that influenced individual tumor infarction rates, with pedunculated serosal tumors significantly less likely to show complete infarction than transmural tumors (odds ratio, 0.24; P = .01). Nonspherical PVA particles and TAGMs produce similar rates of uterine leiomyoma infarction. Complete infarction of individual tumors is less likely in serosal and pedunculated serosal tumors. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  19. Impact of spontaneous fibroid expulsion of uterine leiomyoma on pregnancy outcome after uterine arteries embolization

    Directory of Open Access Journals (Sweden)

    Medvediev M.V.

    2015-09-01

    Full Text Available Uterine leiomyoma (UL is common benign tumor of female genitals. Uterine artery embolization (UAE is widely used method of organ-sparing UL treatment. Safe ty of this procedure for future fertility and labor is controversial. We present a case of pregnancy in woman who previously underwent uterine artery embolization. During 12-months’ follow-up period patient periodically noted vaginal di¬scharge. No signs of UL have been found on ultrasound in 12 months of follow-up. Normal pregnancy occurred 1.5 years after UAE procedure which ended in normal labor without complications. Most authors report increased risk of pregnancy complications such as postpartum hemorrhage, preterm delivery, malpresentation after UAE. Our point of view is that a lot of pregnancy complications are possibly associated with persistence of necrotic leiomyoma tissue in uterine wall after UAE. Presented case allowed to draw preliminary conclusions that complete disappearance of UL nodule after UAE could improve pregnancy outcomes.

  20. Postpartum Hemorrhage Resulting from Pelvic Pseudoaneurysm: A Retrospective Analysis of 588 Consecutive Cases Treated by Arterial Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr; Soyer, Philippe, E-mail: philippe.soyer@lrb.aphp.fr; Subhani, Aqeel, E-mail: drsubhani07@gmail.com [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France); Hequet, Delphine, E-mail: delphine.hequet@gmail.com [Universite Paris-Diderot (France); Fargeaudou, Yann, E-mail: yannfargeaudou4@hotmail.com [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France); Morel, Olivier, E-mail: olivier.morel17@gmail.com [Maternite Universitaire de Nancy, Universite Henri Poincare Nancy 1 (France); Boudiaf, Mourad, E-mail: mourad.boudiaf@lrb.aphp.fr [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France); Gayat, Etienne, E-mail: etienne.gayat@9online.fr [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Anesthesiology and Intensive Care Medicine (France); Barranger, Emmanuel, E-mail: emmanuel.barranger@lrb.aphp.fr [Universite Paris-Diderot (France); Dref, Olivier Le, E-mail: olivier.ledref@lrb.aphp.fr; Sirol, Marc, E-mail: marc.sirol@lrb.aphp.fr [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France)

    2013-10-15

    Objective: This study was designed to determine the incidence of arterial pseudoaneurysm in patients presenting with postpartum hemorrhage (PPH), to analyze the angiographic characteristics of pseudoaneurysms that cause PPH, and to evaluate the effectiveness of pelvic arterial embolization for the treatment of this condition.Study designEighteen women with pelvic arterial pseudoaneurysm were retrieved from a series of 588 consecutive patients with PPH treated by arterial embolization. Clinical files, angiographic examinations, and procedure details were reviewed. Results: The incidence of pseudoaneurysm was 3.06 % (18/588; 95 % confidence interval (CI): 1.82-4.8 %). A total of 20 pseudoaneurysms were found; 15/20 (75 %) were located on the uterine arteries. Angiography revealed extravasation of contrast material from pseudoaneurysm indicating rupture in 9 of 18 (50 %) patients. Arterial embolization was performed using gelatin sponge alone in 12 of 18 (67 %) patients or in association with metallic coils in 5 of 18 (28 %) patients or n-butyl-2-cyanoacrylate in 1 of 18 (6 %) patients. Arterial embolization allowed controlling the bleeding in all patients after one or two embolization sessions in 17 of 18 (94 %) and 1 of 18 patients (6 %) respectively, without complications, obviating the need for further surgery. Conclusions: Pseudoaneurysm is rarely associated with PPH. Arterial embolization is an effective and safe procedure for the treatment of PPH due to uterine or vaginal artery pseudoaneurysm. Our results suggest that gelatin sponge is effective for the treatment of ruptured pseudoaneurysms, although we agree that our series does not contain sufficient material to allow drawing definitive conclusions with respect to the most effective embolic material.

  1. Perforation of Transverse Colon: A Catastrophic Complication of Uterine Artery Embolization for Fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Acharya, Jyotsna, E-mail: jyoacharya@yahoo.com; Bancroft, Karen; Lay, James [Royal Bolton Hospital (United Kingdom)

    2012-12-15

    We report a case of a 43-year-old woman who underwent uterine artery embolization (UAE) for a symptomatic large fibroid uterus and had spontaneous perforation of the transverse colon 3 months after embolisation with near-fatal consequences. We believe this is the first reported case in the literature of this serious complication of UAE. We briefly review the literature on bowel complications after UAE and discuss lessons to be learned regarding patient selection and postprocedure follow-up.

  2. Radiodermitis after prostatic artery embolization: case report and review of the literature.

    Science.gov (United States)

    Laborda, Alicia; De Assis, Andre Moreira; Ioakeim, Ignatios; Sánchez-Ballestín, María; Carnevale, Francisco Cesar; De Gregorio, Miguel Angel

    2015-06-01

    Prostate artery embolization (PAE) is a technically demanding new treatment option for benign prostatic hyperplasia. We present a case of radiation-induced dermitis in a 63-year-old patient after a technically successful PAE, due to high radiation exposure (KAP: 8,023,949 mGy cm(2)) and long fluoroscopy time (72 min). Anatomical and technical aspects are discussed, as well as recommendations to decrease radiation exposure in these procedures.

  3. Spontaneous Rupture of a Giant Hepatic Hemangioma ? Sequential Management with Transcatheter Arterial Embolization and Resection

    OpenAIRE

    Jain Vaibhav; Ramachandran Vijay; Garg Rachana; Pal Sujoy; Gamanagatti Shivanand; Srivastava Deep

    2010-01-01

    Hemangioma is the most common benign tumor of liver and is often asymptomatic. Spontaneous rupture is rare but has a catastrophic outcome if not promptly managed. Emergent hepatic resection has been the treatment of choice but has high operative mortality. Preoperative transcatheter arterial embolization (TAE) can significantly improve outcome in such patients. We report a case of spontaneous rupture of giant hepatic hemangioma that presented with abdominal pain and shock due to hemoperitoneu...

  4. Radiodermitis After Prostatic Artery Embolization: Case Report and Review of the Literature

    Energy Technology Data Exchange (ETDEWEB)

    Laborda, Alicia, E-mail: alaborda@unizar.es [Universidad de Zaragoza, Group of Research in Minimally Invasive Techniques (GITMI), Facultad de Veterinaria (Spain); Assis, Andre Moreira De, E-mail: andre.maa@gmail.com [University of Sao Paulo Medical School, Interventional Radiology and Endovascular Surgery Department, Radiology Institute (Brazil); Ioakeim, Ignatios, E-mail: ignacio.ioakim@hotmail.es; Sánchez-Ballestín, María, E-mail: mirisanba@gmail.com [Universidad de Zaragoza, Group of Research in Minimally Invasive Techniques (GITMI), Facultad de Veterinaria (Spain); Carnevale, Francisco Cesar, E-mail: fcarnevale@uol.com.br [University of Sao Paulo Medical School, Interventional Radiology and Endovascular Surgery Department, Radiology Institute (Brazil); Gregorio, Miguel Angel De, E-mail: mgregori@unizar.es [Universidad de Zaragoza, Group of Research in Minimally Invasive Techniques (GITMI), Facultad de Veterinaria (Spain)

    2015-06-15

    Prostate artery embolization (PAE) is a technically demanding new treatment option for benign prostatic hyperplasia. We present a case of radiation-induced dermitis in a 63-year-old patient after a technically successful PAE, due to high radiation exposure (KAP: 8,023,949 mGy cm{sup 2}) and long fluoroscopy time (72 min). Anatomical and technical aspects are discussed, as well as recommendations to decrease radiation exposure in these procedures.

  5. [Cesarean scar ectopic pregnancies: combined modality therapies with uterine artery embolization before surgical procedure].

    Science.gov (United States)

    Le Gall, J; Fichez, A; Lamblin, G; Philip, C A; Huissoud, C

    2015-03-01

    To offer a therapeutic management of cesarean scar pregnancies (GSC) in the first trimester of pregnancy with a first approach by uterine artery embolization (UAE) PATIENTS AND METHODS: This study describes seven cases of GSC diagnosed between 2009 and 2013 in the clinic of the University Hospital of the Hospital of Croix-Rousse. We present the symptoms and how imagery has led to the diagnosis and the therapeutic management conducted. The mean gestational age at diagnosis was 9 weeks gestation. There were ongoing pregnancies with cardiac activity present for each patient. An additional MRI was performed in five patients. Five patients were treated with methotrexate injection, two patients received the Mifegyne. All patients then received a selective uterine artery embolization. Finally within 48hours, suction curettage was performed in 6 patients. A patient at 13 WA+1 required a subtotal hysterectomy for placenta accreta. Intra-operative complications were represented by a bladder injury, two bleeding of 1000mL in patients at 13 WA+1 and 12 WA. For the 6 cases of GSC with a gestational age less than 10 WA, average blood loss was less than 500mL. Three patients underwent resection of scar isthmocele confirmed by EVAC. An intrauterine pregnancy was carried to term after care. Cesarean scar pregnancies is a diagnostic and therapeutic challenge, which should be diagnosed as early as soon as possible with care in a medical facility with a uterine artery embolization technical platform. Our protocol combining Mifegyne and methotrexate for termination of pregnancy and uterine artery embolization (UAE) followed by curettage for evacuation of pregnancy allows conservative treatment while minimizing the risk of bleeding (for GSC diagnosed before 10 WA). Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  6. Cerebral arterial gas embolism after pre-flight ingestion of hydrogen peroxide.

    Science.gov (United States)

    Smedley, Ben L; Gault, Alan; Gawthrope, Ian C

    2016-06-01

    Cerebral arterial gas embolism (CAGE) is a feared complication of ambient depressurisation and can also be a complication of hydrogen peroxide ingestion. We present an unusual case of CAGE in a 57-year-old woman exposed to both of these risk factors. We describe her subsequent successful treatment with hyperbaric oxygen, despite a 72-hour delay in initial presentation and diagnosis, and discuss the safety of aero-medical transfer following hydrogen peroxide ingestions.

  7. Pre-operative Arterial Embolization of Symptomatic Giant Hemangioma of the Liver

    Directory of Open Access Journals (Sweden)

    Mustafa Kayan

    2012-01-01

    Full Text Available The cavernous hemangiomas of the liver are usually small sized and asymptomatic. Most of them are incidentally diagnosed and a very small portion requires therapy. Giant hemangioma can be symptomatic, and this condition is the indication for treatment. The striking complication of surgical treatment of cavernous hemangiomas is intra-operative bleeding. In this case, we aimed to demonstrate that the risk of intraoperative bleeding can be eliminated with the preoperative percutaneous trans-catheter arterial embolization technique.

  8. Endovascular embolization of intermittent massive epistaxis secondary to posttraumatic carotid artery pseudoaneurysms.

    Science.gov (United States)

    Tarkan, O; Akgül, E; Cekiç, E; Erdoğan, M; Ozdemir, S; Kiroğlu, M

    2012-01-01

    Epistaxis is a very common medical problem in otolaryngology practice and can usually be controlled with conservative interventions. Rarely, uncontrolled and life threatening epistaxis occurs. We present the case of a 29-year-old male who developed intractable intermittent epistaxis due to post-traumatic pseudoaneurysms arising from the cavernous segment of the left internal carotid artery. The patient was successfully treated with endovascular embolization.

  9. The Role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs in the Management of the Post-Embolization Symptoms after Uterine Artery Embolization

    Directory of Open Access Journals (Sweden)

    Tiago Bilhim

    2010-05-01

    Full Text Available Uterine artery embolization (UAE is usually a very painful procedure. Although pain after the procedure can occur as a single symptom, it usually is associated with other symptoms such as nausea, vomiting, pelvic pain, general malaise, fever and leukocytosis that characterize the post-embolization syndrome. Management of the post-embolization symptoms and of pain in particular, is paramount if UAE is to be performed as an outpatient procedure. Different protocols have used analgesic and/or anti-inflammatory agents to control these symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs are frequently used in association with analgesic drugs to control post-embolization symptoms. In our institution the patients start oral medication with NSAIDs the day before the procedure and continue it during and after UAE. We also mix NSAIDs with the embolizing particles. This enables a reduction in the inflammation present in the uterine fibroids and helps controlling the pain. The purpose of this paper is to review the importance of NSAIDs in the management of the post-embolization symptoms. We describe the protocol that we use in our institution that enables us to perform the procedure on an outpatient basis with same day discharge and good control of the post-embolization symptoms with oral NSAIDs and analgesics.

  10. Magnetic Resonance Signal Intensity Ratio Measurement Before Uterine Artery Embolization

    DEFF Research Database (Denmark)

    Duvnjak, Stevo; Ravn, Pernille; Green, Anders

    2017-01-01

    PURPOSE: To evaluate whether the magnetic resonance imaging (MRI) signal intensity (SI) ratio between the dominant fibroid and the periphery striated muscle can predict fibroid volume reduction >50% after uterine fibroid embolization (UFE). MATERIALS AND METHODS: From October 2013 until May 2016......, 52 patients were included in this prospective study. The SI ratio before UFE was calculated using circular region of interests placed on the dominant fibroid and the iliac muscle. The SI fibroid-to-iliac muscle ratio was calculated as SI of the dominant fibroid/SI of the iliac muscle on T1-, T2......-, and T1 post-contrast-weighted sequences. The dominant fibroid volume was measured and analyzed before and after UFE. RESULTS: In all, 46 patients who completed the three-month follow-up MRI were available for analysis. The correlation between SI fibroid-to-muscle ratio at the T2-weighted sequence...

  11. Efficacy and Safety of Prophylactic Uterine Artery Embolization in Pregnancy Termination with Placenta Previa

    Energy Technology Data Exchange (ETDEWEB)

    Pei, Renguang, E-mail: mediprg@bjmu.edu.cn; Wang, Guoxiang; Wang, Heping; Huang, Xinyu; Yan, Xiaoxing; Yang, Xiaohua [Yijishan Hospital of Wannan Medical College, Department of Interventional Therapy (China)

    2017-03-15

    PurposeTo appraise the efficacy and safety of prophylactic uterine artery embolization in pregnancy termination with placenta previa.MethodsA cohort of 54 consecutive patients with placenta previa underwent prophylactic uterine artery embolization before vaginal delivery from February 2012 to March 2015. Vaginal delivery was attempted in all patients. Cesarean section or hysterectomy was introduced when vaginal delivery failed.ResultsVaginal delivery succeeded in 50 patients (93.6%) and failed in 4 patients (6.4%), thereupon converted to cesarean delivery. No patients resorted to hysterectomy. Six patients (11.1%) underwent blood transfusion. None of clinical characteristics, including maternal age, gestational age, history of abortion, history of cesarean delivery, and volume of vaginal bleeding, was significantly associated with complete placenta previa (P > 0.05). However, patients with complete placenta previa had a significantly lower successful rate of vaginal delivery than did patients without complete placenta previa (81 vs 100%, P = 0.038). The rate of complications was 3.7%. No major complications were observed.ConclusionUterine artery embolization is an effective and safe technique to assist pregnancy termination with placenta previa, which may lower the risk of cesarean section, hysterectomy, and blood transfusion.

  12. Effect of uterine arterial embolization on symptomatic uterine fibroids and ovarian function

    Directory of Open Access Journals (Sweden)

    Li Zhang

    2016-04-01

    Full Text Available Objective: To investigate the effect of uterine artery embolization (UAE in the treatment of symptomatic uterine fibroids and the effect on ovarian function. Methods: Clinical data of 20 UAE cases admitted from August 2014 to August 2015 were retrospectively analyzed. They had uterine leiomyoma, and received UAE after menstruation 3-7 d. Seldinger technology was used to puncture the right femoral artery, microspheres was alginated or polyvinyl alcohol particles were injected into the target vessel embolism vascular leiomyoma. Broken Gelfoam embolization of uterine artery was used to stop fibroids blood supply; imaging examination of symptomatic uterine fibroids was performed before and 3 months, 6 months, 12 months after UAE. The volume of uterus myoma volume changes was observed; luteinizing hormone (LH, prolactin (PRL, follicle stimulating hormone (FSH, progesterone (PROG, estradiol (E2 changes were detected before and 3 months, 6 months, 12 months after UAE. Results: Three months, 6 months, 12 months after UAE surgery, all patients were followed up for 3 months. The volume of uterus and tumor volume were significantly reduced, and the degree of reduction was moresignificant (P0.05. Conclusions: UAE has definite efficacy, and it has little effect on ovarian function.

  13. Effect of uterine arterial embolization on the ovarian function in puerpera with postpartum hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Yan-Xian Deng

    2017-01-01

    Objective:To observe the hemostatic effect of uterine arterial embolization in the treatment of postpartum hemorrhage and the effect on menstruation, sex hormone level, ovarian function, and pelvic floor function.Methods:A total of 45 patients with postpartum hemorrhage who were admitted in the Department of Obstetrics of our hospital from January, 2014 to June, 2016 for uterine arterial embolization were included in the study and served as the treatment group. The postoperative menstruation recovery was recorded. The hormone levels, ovarian function, and pelvic floor function before and after treatment were recorded. A total of 42 normal puerpera were served as the control group. The menstrual status of the two groups after menstruation was compared.Results: Rapid and effective hemostasis could be obtained from patients in the treatment group after treatment with hemostasis success rate of 100%. The comparison of menstruation cycle and menstruation days after treatment between the two groups was not statistically significant. The levels of E2, P, FSH, LH and PRL, ovarian function index RI and PI, pelvic floor muscle fatigue and vaginal dynamic pressure before and after 3 and 6 months had no significant difference, and there was no significant difference between the 2 groups.Conclusions: Uterine arterial embolization in the treatment of postpartum hemorrhage is effective, and has no influence on the patient's menstrual conditions, sex hormone levels, ovarian and pelvic floor functions; therefore, it is worthy of clinical application.

  14. Endovascular Embolization of Distal Anterior Choroidal Artery Aneurysms Associated with Moyamoya Disease

    Science.gov (United States)

    Yang, S.; Yu, J.-L.; Wang, H.-L.; Wang, B.; Luo, Q.

    2010-01-01

    Summary We evaluated the feasibility of endovascular embolization for the management of distal anterior choroidal artery (AChA) aneurysms associated with moyamoya disease and performed a literature review to summarize their clinical features and treatment. We describe two cases of moyamoya disease-associated distal AChA aneurysms treated by endovascular embolization. In both cases, a good outcome was observed. We performed a MEDLINE (1980-2010) search which identified 13 similar cases. Our analysis of the clinical data from these 15 cases led us to conclude that (i) endovascular embolization is an effective and feasible treatment for distal AChA aneurysms associated with moyamoya disease; (ii) aneurysm location and the preservation of the parent artery are two major prognostic factors for moyamoya disease-associated distal AChA aneurysms subjected to craniotomy or endovascular therapy; (iii) the parent artery should be preserved when the aneurysm is located in the temporal horn of the lateral ventricle, but sacrificed when it is located in the trigone of the lateral ventricle. PMID:21162774

  15. Effect of uterine arterial embolization on the ovarian function in puerpera with postpartum hemorrhage

    Directory of Open Access Journals (Sweden)

    Yan-Xian Deng

    2017-06-01

    Full Text Available Objective: To observe the hemostatic effect of uterine arterial embolization in the treatment of postpartum hemorrhage and the effect on menstruation, sex hormone level, ovarian function, and pelvic floor function. Methods: A total of 45 patients with postpartum hemorrhage who were admitted in the Department of Obstetrics of our hospital from January, 2014 to June, 2016 for uterine arterial embolization were included in the study and served as the treatment group. The postoperative menstruation recovery was recorded. The hormone levels, ovarian function, and pelvic floor function before and after treatment were recorded. A total of 42 normal puerpera were served as the control group. The menstrual status of the two groups after menstruation was compared. Results: Rapid and effective hemostasis could be obtained from patients in the treatment group after treatment with hemostasis success rate of 100%. The comparison of menstruation cycle and menstruation days after treatment between the two groups was not statistically significant. The levels of E2, P, FSH, LH and PRL, ovarian function index RI and PI, pelvic floor muscle fatigue and vaginal dynamic pressure before and after 3 and 6 months had no significant difference, and there was no significant difference between the 2 groups. Conclusions: Uterine arterial embolization in the treatment of postpartum hemorrhage is effective, and has no influence on the patient's menstrual conditions, sex hormone levels, ovarian and pelvic floor functions; therefore, it is worthy of clinical application.

  16. Uterine arteriovenous malformation with positive serum beta-human chorionic gonadotropin: Embolization of both uterine arteries and extra-uterine feeding arteries.

    Science.gov (United States)

    Kim, Su Mi; Ahn, Hee Young; Choi, Min Jeong; Kang, Yun Dan; Park, Jin Wan; Park, Choong Hak; Kim, Jong Soo

    2016-11-01

    The incidence of uterine arteriovenous malformation (AVM) is rare. However, it is clinically significant in that it can cause life-threatening vaginal bleeding. We report a case of a large uterine AVM with positive serum beta-human chorionic gonadotropin. A presumptive diagnosis was made; a uterine AVM accompanied by, early pregnancy or retained product of conception. Because this uterine AVM was extensive, transcatheter arterial embolization of both uterine arteries and extra-uterine feeding arteries was performed. Three months after undergoing transcatheter arterial embolization, complete resolution of the uterine AVM was confirmed without major complication.

  17. EFFICACY AND SAFETY OF AMLODIPINE MALEATE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND BRONCHIAL ASTHMA WITH CONCOMITANT ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    N. A. Karoli

    2010-01-01

    Full Text Available Aim. To evaluate efficacy and safety of amlodipine maleate in patients with chronic obstructive pulmonary disease (COPD, bronchial asthma (BA and concomitant arterial hypertension.Methods. Patients (n=40 with COPD (n=20 or BA (n=20 and hypertension of 1-2 degree were examined. Amlodipine maleate was used as antihypertensive drug. The spirometry, ambulatory blood pressure monitoring, vascular oscillometry (evaluation of arterial stiffness, vascular Doppler imaging (evaluation of endothelial function was performed initially and in 6 months of treatment.Results. The high efficacy of amlodipine maleate as antihypertensive drug was found in patients with COPD or BA and hypertension without dependence on bronchial obstruction severity. The positive influence of amlodipine on endothelial function and vascular rigidity was also observed.Conclusion: study results confirm the rationales of amlodipine use in patients with COPD or BA and hypertension.

  18. Covered Stent and Coils Embolization of a Pulmonary Artery Pseudoaneurysm After Gunshot Wound

    Energy Technology Data Exchange (ETDEWEB)

    Huet, Nicolas, E-mail: nhuet@chu-grenoble.fr; Rodiere, Mathieu, E-mail: mrodiere@chu-grenoble.fr [Hôpital Universitaire de Grenoble and Université Grenoble Alpes, Department of Radiology and Medical Imaging (France); Badet, Michel, E-mail: michel.badet@ch-chambery.fr [Centre Hospitalier Métropôle Savoie, site de Chambéry, Intensive Care Unit (France); Michoud, Marie, E-mail: marie.michoud@ch-chambery.fr [Centre Hospitalier Métropôle Savoie, Site de Chambéry, Department of Radiology (France); Brichon, Pierre-Yves, E-mail: pybrichon@chu-grenoble.fr [Hôpital Universitaire de Grenoble and Université Grenoble Alpes, Department of Thoracic and Vascular Surgery (France); Ferretti, Gilbert, E-mail: gferretti@chu-grenoble.fr; Thony, Frédéric, E-mail: fthony@chu-grenoble.fr [Hôpital Universitaire de Grenoble and Université Grenoble Alpes, Department of Radiology and Medical Imaging (France)

    2016-05-15

    We report the first case of endovascular covered stent implantation for the treatment of a large pulmonary artery pseudoaneurysm (PAPA) following a right thoracic gunshot wound. After resuscitation and hemodynamic stabilization, a CT angiography was performed to analyze the neck size of the PAPA and its position relative to the branches of the parent artery. Covered stent implantation with additional coil embolization was successfully performed. At the 4-year follow-up, the stents remained patent and there was neither pseudoaneurysm recurrence nor treatment-related complication.

  19. Intestinal necrosis in young patient due to arterial tumour embolism

    DEFF Research Database (Denmark)

    Dahle, Einar; Gögenur, Ismail; Nørgaard, Peter

    2012-01-01

    of intestinal necrosis. Histological examination showed several arterial tumour emboli, morphologically similar to the primary sarcoma. The patient died 1 year after successful surgery. Because of the improved survival of patients with osteosarcoma, acute mesenteric ischaemia should be considered in acute...

  20. Electrocardiography-Gated Computed Tomography of the Bronchial Arteries With Iterative Image Reconstruction: Clinical Evaluation and Image Quality.

    Science.gov (United States)

    Gang, Qiangqiang; Xu, Jun; Wang, Junling; Hao, Peng; Xu, Yikai

    The aim of this study was to apply electrocardiography (ECG)-gated prospective-triggered multidetector row computed tomography angiography with iterative model reconstruction (IMR) to optimize imaging of the bronchial arteries in patients with the chief complaint of hemoptysis. This was a prospective observational study. Between August 2015 and June 2016, we enrolled 31 consecutive patients with the chief complaint of hemoptysis who were scheduled to undergo computed tomography of the bronchial artery. Patients were randomly divided into 3 groups: group A, with filtered back-projection reconstruction; group B, with iDose reconstruction; and group C, with ECG-gated prospective-triggered multidetector row computed tomography angiography with IMR. Image quality, visibility, and traceability were compared. Image quality, including signal-to-noise and contrast-to-noise ratios, visibility, and traceability, was best in group C. With the help of IMR and ECG-synchronized prospective-triggered technology, the bronchial artery anatomy can be accurately depicted in patients with massive hemoptysis.

  1. Hemophilic Chronic Synovitis: Therapy of Hemarthrosis using Endovascular Embolization of Knee and Elbow Arteries

    Energy Technology Data Exchange (ETDEWEB)

    Galli, E., E-mail: emgalli1@yahoo.com.ar [CABA, Hospital de Agudos ' Juan A. Fernandez' (Argentina); Baques, A.; Moretti, N.; Candela, M. [CABA, Fundacion de la Hemofilia de Buenos Aires (Argentina); Caviglia, H. [CABA, Hospital de Agudos ' Juan A. Fernandez' (Argentina)

    2013-08-01

    PurposeCongenital hemophilia is a hereditary bleeding disorder that affects 1 in 5,000 males and is characterized by repetitive musculoskeletal bleeding episodes. Selective embolization of the knee and elbow arteries can prevent bleeding episodes. To evaluate the long-term efficacy of these procedures, we assessed the outcomes of 30 procedures performed in our center.MethodsWe performed 30 procedures in 27 hemophilic patients, including 23 knee, and 7 elbow procedures. To evaluate the efficacy of selective embolization of knee and elbow arteries in people with hemophilia, we analyzed the number of bleeding episodes during 12 months before the procedure compared with the amount of episodes that occurred 3, 6, and 12 months after embolization.ResultsTwenty-nine of 30 procedures were classified as successful. The median of 1.25 episodes per month (range 0-3) observed before the procedure was reduced to 0 (range 0-1.67; p < 0.001) at 3 months, 0.17 (range 0-1.67; p < 0.001) at 6 months, and 0.33 (range 0-1.67; p = 0.024) at 12 months. Three patients remained free of bleeding events for more than 6 months. Additionally, after the procedure there was a significant reduction in factor FVIII usage that sustained up to 12 months after the procedures. No serious adverse events were observed.ConclusionsSelective angiographic embolization of knee and elbow arteries is a feasible procedure that can prevent repetitive bleedings, which would translate in better joint outcomes for these patients.

  2. Embolization of an Internal Iliac Artery Aneurysm after Image-Guided Direct Puncture

    Energy Technology Data Exchange (ETDEWEB)

    Heye, S., E-mail: sam.heye@uzleuven.be; Vaninbroukx, J. [University Hospitals Leuven, Department of Radiology (Belgium); Daenens, K.; Houthoofd, S. [University Hospitals Leuven, Department of Vascular Surgery (Belgium); Maleux, G. [University Hospitals Leuven, Department of Radiology (Belgium)

    2012-08-15

    Objective: To evaluate the feasibility, safety, and efficacy of embolization of internal iliac artery aneurysm (IIAA) after percutaneous direct puncture under (cone-beam) computed tomography (CT) guidance. Methods: A retrospective case series of three patients, in whom IIAA not accessible by way of the transarterial route, was reviewed. CT-guided puncture of the IIAA sac was performed in one patient. Two patients underwent puncture of the IIAA under cone-beam CT guidance. Results: Access to the IIAA sac was successful in all three patients. In two of the three patients, the posterior and/or anterior division was first embolized using platinum microcoils. The aneurysm sac was embolized with thrombin in one patient and with a mixture of glue and Lipiodol in two patients. No complications were seen. On follow-up CT, no opacification of the aneurysm sac was seen. The volume of one IIAA remained stable at follow-up, and the remaining two IIAAs decreased in size. Conclusion: Embolization of IIAA after direct percutaneous puncture under cone-beam CT/CT-guidance is feasible and safe and results in good short-term outcome.

  3. Therapeutic Effect of Transcatheter Arterial Embolization for Hypervascular Hepatocellular Carcinoma: Web-based Multicenter Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Baik, Jun Hyun [St. Vincent' s Hospital, The Catholic University of Korea, Seoul (Korea, Republic of); Song, Kyung Sup [St. Paul' s Hospital, The Catholic University of Korea, Seoul (Korea, Republic of); Han, Joon Koo [Seoul National University Hospital, Seoul (Korea, Republic of)

    2011-06-15

    To evaluate the therapeutic effect of transcatheter arterial embolization (TAE) as a first treatment course for hypervascular hepatocellular carcinoma (HCC), using nationwide web-based multicenter data in Korea. Eight hundred eighty eight HCC patients who were registered in the internet homepage of primary liver cancer registry (www.plcr.or.kr) from August 2003 to August 2005 were enrolled in this study, and they were investigated till February 2007. The patients were divided into three groups according to the following treatments after first TAE; TAE only, TAE + SL (any surgical resection, transplantation or percutaneous ablation followed), TAE + RC (any radiation therapy or chemotherapy followed). The clinical and tumor characteristics, embolization factors and survival periods were analyzed. The 5-year survival rates of the groups of TAE only, TAE + SL and TAE + RC were 21.6%, 57.4%, and 13.1%, respectively. In all cases and in the TAE only group, more selective and complete embolization increased survival rates. There were tendencies that as smaller tumor and the tumor in earlier stage, more selective and complete embolizations were performed in the TAE only group, and independent prognostic factors of this group were Child-Pugh classification, tumor size and Modified 4th UICC stage. This study is the first nationwide multicenter analysis for TAE using an online registration system in Korea. Selective and complete TAE increases patient's survival, and decisive combined treatment after TAE such as surgical resection, transplantation or percutaneous ablation increases patient's survival.

  4. Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

    Energy Technology Data Exchange (ETDEWEB)

    Jae, Hwan Jun; Chung, Jin Wook; Jung, Ah Young; Lee, Whal; Park, Jae Hyung [Seoul National University Hospital, Institute of Radiation Medicine, Seoul (Korea, Republic of)

    2007-02-15

    To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding. Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated. The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18). TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy.

  5. Combined Endovascular Treatment with Distal Radial Artery Coil Embolization and Angioplasty in Steal Syndrome Associated with Forearm Dialysis Fistula

    Energy Technology Data Exchange (ETDEWEB)

    Tercan, Fahri, E-mail: ftercan@yahoo.com; Koçyiğit, Ali, E-mail: alkoc@yahoo.com [Pamukkale University, Department of Radiology, School of Medicine (Turkey); Güney, Bünyamin [Muğla Sıtkı Kocman University, Department of Radiology, School of Medicine (Turkey)

    2016-09-15

    PurposeThe present study was performed to define the results of the endovascular treatment with angioplasty and distal radial artery embolization in ischemic steal syndrome associated with forearm arteriovenous accesses.MethodThe cases referred to our interventional radiology unit with symptoms and physical examination findings suggestive of ischemic steal syndrome were retrospectively evaluated first by Doppler ultrasonography, and then by angiography. Cases with proximal artery stenosis were applied angioplasty, and those with steal syndrome underwent coil embolization to distal radial artery.ResultsOf 589 patients who underwent endovascular intervention for dialysis arteriovenous fistulae (AVF)-associated problems, 6 (1.01 %) (5 female, 1 males; mean age 62 (range 41–78) with forearm fistula underwent combined endovascular treatment for steal syndrome. In addition to steal phenomenon, there were stenosis and/or occlusion in proximal radial and/or ulnar artery in 6 patients concurrently. Embolization of distal radial artery and angioplasty to proximal arterial stenoses were performed in all patients. Ischemic symptoms were eliminated in all patients and the AVF were in use at the time of study. In one patient, ischemic symptoms recurring 6 months later were alleviated by repeat angioplasty of ulnar artery.ConclusionIn palmar arch steal syndrome affecting forearm fistulae, combined distal radial embolization and angioplasty is also an effective treatment method in the presence of proximal radial and ulnar arterial stenoses and occlusions.

  6. Usefulness of modified intravenous analgesia: initial experience in uterine artery embolization for leiomyomata

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Jung, Young Jin [Soonchunhyang University, Gumi Hospital, Gumi (Korea, Republic of); Goo, Dong Erk; Jang, Yun Woo [Soonchunhyang University Hospital, Seoul (Korea, Republic of)

    2006-04-15

    We wanted to evaluate the usefulness of modified intravenous analgesia for the management of pain during uterine artery embolization for leiomyomata. Between April 2004 and July 2004, 15 patients with symptomatic fibroids underwent uterine artery embolization and pain management. Except the three patients for whom the Visual Analogue Scale (VAS) score was not obtained, twelve patients were included in this study. For pain management, epidural PCA (Patient Controlled Analgesia) was used in two patients, intravenous PCA was used in two patients and modified intravenous analgesia injection was used in eight patients. For all the patients, we used the 2.8 Fr coaxial microcatheter and 500-710 {mu} m PVA particles for the embolic materials. The protocol of the modified intravenous analgesia injection was as follow, 1) prior to femoral artery puncture, 30 mg of ketorolac tromethamine (Tarasyn)was injected via an intravenous route. 2) At the time that the one side uterine artery embolization was finished, normal saline mixed 150 mg meperidine (Demerol) was administered through the side port of the intravenous line that was used for hydration. 3) Additional ketorolac tromethamine 30 mg was injected after 6 hour. The VAS score and side effects were then checked. After 12 hours, the VAS score was rechecked. If the VAS score was above 4, this was considered as failure of pain management. The VAS scores, complications and side effects for the modified intravenous analgesia injection were compared with that of IV PCA and epidural PCA. The average VAS score of the modified intravenous analgesia injection, intravenous PCA and epidural PCA was 1.4, 1 and 0, respectively; the number of additional intramuscular injections of analgesia was 0.5, 0.5 and 0, respectively. All the patients who underwent epidural PCA had back pain at the puncture site and 1 patient who underwent modified intravenous analgesia injection experienced mild dyspnea, but they easily recovered with such

  7. Massive hemoptysis in a patient with pulmonary embolism, a real therapeutic conundrum

    Directory of Open Access Journals (Sweden)

    Yiolanda Herodotou

    2017-01-01

    Full Text Available Massive Hemoptysis and pulmonary embolism are two very severe and potentially fatal pulmonary emergencies requiring completely different treatments. We present the case of a 45-year old male transmitted to our Hospital for massive hemoptysis who at the same time was found to suffer from pulmonary embolism. Hemoptysis was treated with bronchial artery embolization which resulted in cessation of haemorrhage and allowed the administration of anticoagulant therapy a few days later. This case report gives an answer on how to manage a real therapeutic conundrum which is the coexistence of a massive hemoptysis and a concomitant pulmonary embolism.

  8. Intra-arterial tirofiban infusion for thromboembolic complication during coil embolization of ruptured intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Dae, E-mail: aronnn@naver.com [Department of Radiology, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 425 Sindaebang-dong, Dongjak-gu, Seoul 156-707 (Korea, Republic of); Lee, Jong Young, E-mail: gen78@naver.com [Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Seo, Jung Hwa, E-mail: jhseo34@gmail.com [Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Kang, Hyun-Seung, E-mail: hsk4428@yahoo.com [Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Kim, Jeong Eun, E-mail: eunkim@snu.ac.kr [Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Jung, Keun Hwa, E-mail: jungkh@gmail.com [Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Han, Moon Hee, E-mail: hanmh@snuh.org [Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of)

    2012-10-15

    Introduction: Intra-arterial (IA) thrombolytic intervention for acute thrombosis has been challenged due to the risk of bleeding during the endovascular treatment of ruptured aneurysms. We present the results of IA tirofiban infusion for thromboembolic complications during coil embolization in patients with ruptured intracranial aneurysms. Methods: Thromboembolic events requiring thrombolytic intervention occurred in 39 (10.5%) cases during coil embolization of 372 consecutive ruptured intracranial aneurysms. Maximal aneurysm diameters of 39 patients (mean age, 54.7 ± 13.2 years; 23 female, 16 male) ranged from 2.1 to 13.1 mm (mean, 6.6 ± 3.0 mm). The anterior communicating artery was the most common site (n = 13), followed by the middle cerebral artery (n = 9) and the posterior communicating artery (n = 7). In this series, we used intracranial stents in 10 patients during the procedure. Superselective IA tirofiban infusion through a microcatheter was performed to resolve thrombi and emboli. We assessed the efficacy and safety of IA tirofiban infusion in patients with ruptured aneurysms. Results: Intraarterially administered tirofiban doses ranged from 0.25 to 1.25 mg (mean, 0.71 ± 0.26 mg). Effective thrombolysis or recanalization was achieved in 34 patients (87.2%), and three patients (7.7%) suffered distal migration of clots with partial recanalization. The rest (5.1%) had no recanalization. Nonconsequent intracerebral hemorrhage occurred in two patients (5.1%) after the procedure. Thromboemboli-related cerebral infarction developed in eight patients, and only two patients remained infarction related disabilities. Conclusion: IA tirofiban infusion seems to be efficacious and safe for thrombolysis during coil embolization in patients with ruptured intracranial aneurysms.

  9. Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to N-Butyl Cyanoacrylate

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    Tanahashi, Yukichi; Goshima, Satoshi, E-mail: gossy@par.odn.ne.jp [Gifu University Hospital, Department of Radiology (Japan); Kondo, Hiroshi [Teikyo University School of Medicine, Department of Radiology (Japan); Ando, Tomohiro; Noda, Yoshifumi; Kawada, Hiroshi; Kawai, Nobuyuki [Gifu University Hospital, Department of Radiology (Japan); Kotoku, Junichi [Teikyo University School of Medicine, Department of Radiological Technology, Faculty of Medical Technology (Japan); Furui, Shigeru [Teikyo University School of Medicine, Department of Radiology (Japan); Matsuo, Masayuki [Gifu University Hospital, Department of Radiology (Japan)

    2017-02-15

    PurposeTo identify predictive factors for embolic material conversion to N-butyl cyanoacrylate (NBCA) for the treatment of primary postpartum hemorrhage (PPH) after failed transcatheter arterial embolization (TAE) using gelatin sponge (GS).Materials and MethodsInstitutional review board approval was obtained. We retrospectively studied 62 consecutive women with primary PPH who underwent TAE between January 2006 and March 2015. Five of them were excluded for the following: cardiopulmonary arrest at arrival (n = 1), uterine inversion (n = 1), and hysterectomy after TAE (n = 3). Remaining 57 women (age range, 21–43 years; mean, 32.6 years) comprised study population. TAE was initially performed using GS in all cases and then converted to NBCA after two embolizations using GS with persistent hemodynamic instability or vaginal bleeding. The patients’ background, uterine height, vital signs, laboratory tests, disseminated intravascular coagulation score, and details of procedure were reviewed. Univariate and multivariate analyses were performed to determine factors related to embolic material conversion.ResultsTechnical success rate was 100%. Fourteen patients (25%) needed embolic material conversion to NBCA. Univariate analysis showed that uterine height, systolic blood pressure (sBP), and hemoglobin level were significantly related to embolic material conversion to NBCA (P = 0.029, 0.030, and 0.042). Logistic regression analysis showed that uterine height (odds ratio, 1.37; P = 0.025) and sBP (odds ratio, 0.96; P = 0.003) were associated with embolic material conversion to NBCA.ConclusionUterine height and sBP can be predictive factors for embolic material conversion to NBCA for the treatment of PPH.Level of EvidenceLevel 4, Case Control Study.

  10. Prostatic Tissue Elimination After Prostatic Artery Embolization (PAE): A Report of Three Cases

    Energy Technology Data Exchange (ETDEWEB)

    Leite, Leandro Cardarelli; Assis, Andre Moreira de; Moreira, Airton Mota [University of Sao Paulo, Department of Radiology (Brazil); Harward, Sardis Honoria [The Dartmouth Institute for Health Policy and Clinical Practice (United States); Antunes, Alberto Azoubel [University of Sao Paulo, Discipline of Urology (Brazil); Carnevale, Francisco Cesar, E-mail: francisco.carnevale@criep.com.br [University of Sao Paulo, Department of Radiology (Brazil)

    2017-06-15

    PurposeWe report three cases of spontaneous prostatic tissue elimination through the urethra while voiding following technically successful prostatic artery embolization (PAE) as a treatment for lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH).MethodsAll patients were embolized with 100- to 300-μm microspheres alone or in combination with 300- to 500-μm microspheres.ResultsDuring follow-up prior to eliminating the tissue fragments, the three patients all presented with intermittent periods of LUTS improvement and aggravation. After expelling the prostatic tissue between 1 and 5 months of follow-up, significant improvements in LUTS and urodynamic parameters were observed in all patients.ConclusionsUrethral obstruction after PAE caused by sloughing prostate tissue is a potential complication of the procedure and should be considered in patients with recurrent LUTS in order to avoid inappropriate management.

  11. Role of magnetic resonance imaging in patient selection for uterine artery embolization

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    Cura, M.; Cura, A.; Bugnone, A. [Univ. of Texas Health Science Center, San Antonio, TX (United States). Dept. of Radiology

    2006-12-15

    Uterine fibroids are common tumors of the female pelvis. Uterine artery embolization (UAE) is an effective treatment of symptomatic uterine leiomyoma in the appropriate candidates, reducing or eliminating leiomyoma-related symptoms of bleeding, bulk, and/or pain. Magnetic resonance imaging (MRI) can be used to assess women with symptoms potentially attributable to uterine leiomyomas, and help to determine who is an appropriate candidate for UAE. Because of soft tissue characterization, multiplanar imaging capabilities, and enhancement, MR imaging not only accurately detects and characterizes uterine leiomyomas but also may predict who will benefit from the embolization. MRI ability to detect coexistent uterine or pelvic pathology may change the diagnosis and treatment management of patients being evaluated for UAE.

  12. A Retrograde Transvenous Embolization Technique with Balloon-Assisted Arterial Aspiration for a Peripheral Arteriovenous Malformation with a Venous Pouch

    Energy Technology Data Exchange (ETDEWEB)

    Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp; Tanaka, Norimitsu; Koganemaru, Masamichi; Kugiyama, Tomoko [Kurume University School of Medicine, Department of Radiology (Japan); Kiyokawa, Kensuke [Kurume University School of Medicine, Department of Plastic & Reconstructive Surgery and Maxillofacial Surgery (Japan); Abe, Toshi [Kurume University School of Medicine, Department of Radiology (Japan)

    2017-05-15

    Management of arteriovenous malformations (AVMs) is challenging, and there is no consensus regarding either the ideal approach or the treatment timing. Percutaneous embolization is the most frequent approach currently used and is considered the first-line technique for AVMs. There is an ongoing discussion about the best technical approach to embolize AVMs. AVMs associated with a dominant outflow vein (DOV) are rare. Embolization of both the DOV and the nidus is considered more effective. Herein, we report a novel technique of transvenous embolization of a DOV under negative pressure from an arterial balloon catheter in a case of a peripheral AVM. This technique allows the embolization of the DOV and the nidus retrogradely.

  13. Pulmonary artery catheter-directed thrombolysis for intermediate high risk acute pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Abhijeet Singh

    2017-01-01

    Full Text Available A case of 60-year-old male with acute pulmonary embolism without hypotension but signs of right ventricular dysfunction and elevated cardiac biomarkers is reported in this study. The patient comes under intermediate high-risk category and was successfully thrombolysed with alteplase infused through pulmonary artery catheter. Catheter-directed thrombolysis (CDT can be considered as much safer and effective alternative to systemic thrombolysis in such patients with lower risk of bleeding. This novel bedside method of pulmonary artery CDT with the advantage of no radiation exposure and real time monitoring of pulmonary artery pressures as an end-point of thrombolysis can be utilized in the near future.

  14. Superselective Arterial Embolization of Pseudoaneurysm and Arteriovenous Fistula Caused by Transurethral Resection of the Prostate

    Science.gov (United States)

    Celtikci, Pinar; Ergun, Onur; Tatar, Idil Gunes; Conkbayir, Isik; Hekimoglu, Baki

    2014-01-01

    Summary Background Pelvic vascular lesions such as pseudoaneurysms and arteriovenous fistulas associated with the internal pudendal artery are uncommon. The most common cause is traumas including those of iatrogenic origin. Surgical treatment is complicated due to location of the lesions and endovascular approach is usually the first choice among the treatment options. Case Report A 79-year-old patient was admitted with massive hematuria following transurethral resection of prostate for benign prostatic hyperplasia. Doppler US and angiography revealed a pseudoaneurysm and arteriovenous fistula originating from the right internal pudendal artery. It was successfully treated with coil embolization. Conclusions Arteriovenous fistulas and pseudoaneurysms concerning internal pudendal artery may occur as complications of prostate operations. Minimally invasive endovascular methods provide safe and efficient treatment and today should be considered as the first line of choice. PMID:25324913

  15. Subclavian artery occlusion and pseudoaneurysm caused by lung apex mucormycosis: successful treatment with transcatheter embolization.

    Science.gov (United States)

    Economopoulos, Nikolaos; Kelekis, Dimitris; Papadopoulos, Antonios; Kontopoulou, Christina; Brountzos, Elias N

    2007-01-01

    Subclavian artery pseudoaneurysm and occlusion in young patients are usually post-traumatic. We report the case of a 33-year-old diabetic woman with subclavian artery occlusion and pseudoaneurysm formation caused by pulmonary mucormycosis infection. The patient presented with diabetic ketoacidosis, Horner's syndrome, and absent left arm pulses. A cystic lesion of the left lung apex was found by imaging, was surgically resected, and was histologically diagnosed as mucormycosis infection. Magnetic resonance angiography depicted a left subclavian artery pseudoaneurysm and occlusion adjacent to the mucormycosis lesion. To protect against thromboembolic complications and rupture, the pseudoaneurysm was embolized with coils. The patient is clinically well 1 year after the intervention with no perfusion of the pseudoaneurysm.

  16. Pseudoaneurysm of the renal artery following partial nephrectomy: Imaging findings and coil embolization

    Energy Technology Data Exchange (ETDEWEB)

    Cohenpour, M. [Department of Diagnostic Imaging, Assaf Harofeh Medical Center, Zerifin (Israel)], E-mail: mehrzad@bezeqint.net; Strauss, S.; Gottlieb, P.; Peer, A. [Department of Diagnostic Imaging, Assaf Harofeh Medical Center, Zerifin (Israel); Rimon, U. [Department of diagnostic imaging, Sheba Medical Center, Tel Hashomer (Israel); Stav, K. [Department of Urology, Assaf Harofeh Medical Center, Zerifin (Israel); Gayer, G. [Department of Diagnostic Imaging, Assaf Harofeh Medical Center, Zerifin (Israel)

    2007-11-15

    Aim: To present the imaging findings of five patients with renal artery pseudoaneurysm (RAP) after partial nephrectomy. Methods: Five patients (four men and one woman) with RAP as a complication of partial nephrectomy were studied. The diagnosis of RAP was established using contrast-enhanced computed tomography (CT) in three patients and renal angiography in two patients. In two cases, the diagnosis was evident on ultrasound with colour Doppler. Results: The indication for partial nephrectomy (open approach in four patients and laparoscopic in one patient) was a space-occupying lesion, which proved to be a renal cell carcinoma. All patients presented with macroscopic haematuria, 1-21 days (mean 12.2 days) after surgery. In three of patients the definitive diagnostic imaging method was contrast-enhanced CT. The arterial phase of CT showed a well-circumscribed dense collection of contrast material located within the renal parenchyma. In two other patients the initial and conclusive diagnostic imaging method was renal angiography. All patients underwent selective renal angiography with therapeutic coil embolization. The procedure failed in one patient, which necessitated nephrectomy. Conclusions: Pseudoaneurysm of the renal artery should be considered in patients presenting with macrohaematuria after nephron-sparing surgery. The diagnosis can be established using contrast-enhanced CT, ultrasound with colour Doppler, or angiography. Renal angiography with selective embolization is a safe and efficacious technique for managing the condition.

  17. Ischemic uterine rupture and hysterectomy 3 months after uterine artery embolization.

    Science.gov (United States)

    Shashoua, Abraham R; Stringer, Nelson H; Pearlman, Julie B; Behmaram, Behnaz; Stringer, Erica A

    2002-05-01

    The exact frequency and extent of complications after uterine artery embolization (UAE) have yet to be documented in the literature. Ischemic necrosis and rupture of the uterus is a theoretical concern of this procedure. Rupture of the uterus from any cause is a very serious gynecologic complication requiring immediate surgical intervention to prevent death. Ischemic necrosis and rupture of the uterus can occur months after UAE. In our patient they occurred 3 months after UAE for treatment of symptomatic uterine myomas, and required hysterectomy. To our knowledge, this is the first report of ischemic uterine rupture after UAE in the United States.

  18. Holmium Laser Enucleation of the Prostate and Iatrogenic Arteriovenous Fistula Treated by Superselective Arterial Embolization

    Directory of Open Access Journals (Sweden)

    Anastasios D. Asimakopoulos

    2016-01-01

    Full Text Available Iatrogenic pelvic pseudoaneurysm with concomitant arteriovenous fistula has been described as a rare and challenging complication, which may occur during transurethral resection of the prostate. We provide the first report of this complication after holmium laser enucleation of the prostate for the treatment of benign prostatic hyperplasia. The attempt to control the bleeding by conversion to open surgery and placement of haemostatic stitches into the prostatic fossa failed. Angiography with superselective arterial embolization proved to be a modern, quick, safe, and efficient treatment of this uncommon complication.

  19. Optimizing Hemodynamics with Transcatheter Arterial Embolization in Adrenal Pheochromocytoma Rupture: A Case Report.

    Science.gov (United States)

    Edo, Naoki; Yamamoto, Takahiro; Takahashi, Satoshi; Mashimo, Yamato; Morita, Koji; Saito, Koji; Kondo, Hiroshi; Sasajima, Yuko; Kondo, Fukuo; Okinaga, Hiroko; Tsukamoto, Kazuhisa; Ishikawa, Toshio

    2018-02-28

    Pheochromocytoma rupture is rare, and emergent adrenalectomy is associated with a high mortality. We herein report a patient with pheochromocytoma rupture who was stabilized by transcatheter arterial embolization (TAE) and subsequently underwent elective surgery. A 45-year-old man presented with the sudden onset of left lateral abdominal pain, headache, chest discomfort, high blood pressure, and adrenal hemorrhaging on enhanced abdominal computed tomography. TAE was performed under a provisional diagnosis of pheochromocytoma rupture. Following oral doxazosin, he underwent elective left adrenalectomy four and a half months after TAE. Stabilizing the hemodynamic status by TAE before adrenalectomy is a viable option for treating pheochromocytoma rupture.

  20. Spontaneous Rupture of a Giant Hepatic Hemangioma – Sequential Management with Transcatheter Arterial Embolization and Resection

    Science.gov (United States)

    Jain, Vaibhav; Ramachandran, Vijay; Garg, Rachana; Pal, Sujoy; Gamanagatti, Shivanand R.; Srivastava, Deep N.

    2010-01-01

    Hemangioma is the most common benign tumor of liver and is often asymptomatic. Spontaneous rupture is rare but has a catastrophic outcome if not promptly managed. Emergent hepatic resection has been the treatment of choice but has high operative mortality. Preoperative transcatheter arterial embolization (TAE) can significantly improve outcome in such patients. We report a case of spontaneous rupture of giant hepatic hemangioma that presented with abdominal pain and shock due to hemoperitoneum. Patient was successfully managed by TAE, followed by tumor resection. TAE is an effective procedure in symptomatic hemangiomas, and should be considered in such high risk patients prior to surgery. PMID:20339183

  1. Spontaneous rupture of a giant hepatic hemangioma - sequential management with transcatheter arterial embolization and resection.

    Science.gov (United States)

    Jain, Vaibhav; Ramachandran, Vijay; Garg, Rachana; Pal, Sujoy; Gamanagatti, Shivanand R; Srivastava, Deep N

    2010-01-01

    Hemangioma is the most common benign tumor of liver and is often asymptomatic. Spontaneous rupture is rare but has a catastrophic outcome if not promptly managed. Emergent hepatic resection has been the treatment of choice but has high operative mortality. Preoperative transcatheter arterial embolization (TAE) can significantly improve outcome in such patients. We report a case of spontaneous rupture of giant hepatic hemangioma that presented with abdominal pain and shock due to hemoperitoneum. Patient was successfully managed by TAE, followed by tumor resection. TAE is an effective procedure in symptomatic hemangiomas, and should be considered in such high risk patients prior to surgery.

  2. Successful spontaneous pregnancy and delivery following myomectomy and uterine artery embolization (UAE – A case report

    Directory of Open Access Journals (Sweden)

    Z.K. Balghari

    2011-03-01

    Full Text Available Uterine artery embolization has emerged as an effective treatment for symptomatic uterine fibroids. Nevertheless because of the uncertainty about the effects of UAE on fertility, women who still want to become pregnant are sometimes excluded from treatment. Pregnancy after UAE has been described in the published literature in the form of case reports, case series and retrospective cohort studies. We present an interesting case of a successful spontaneous pregnancy and delivery in a 42year old woman, who was diagnosed to have fibroids and endometriosis. She had a myomectomy followed by two procedures of UAE for recurrent fibroids and was treated for extensive endometriosis.

  3. Successful term pregnancy after selective arterial embolization of symptomatic arteriovenous malformation in the setting of gestational trophoblastic tumor.

    Science.gov (United States)

    Garner, Elizabeth I O; Meyerovitz, Michael; Goldstein, Donald P; Berkowitz, Ross S

    2003-01-01

    Patients with arteriovenous malformations (AVMs) are at risk for significant vaginal hemorrhage, and are traditionally managed surgically. In the patient desiring future fertility, conservative management via selective arterial embolization is a reasonable option. Only a few cases have been previously reported of successful pregnancy after this procedure in the setting of gestational trophoblastic disease (GTD). A 31-year-old gravida 1 para 0 was treated for persistent gestational trophoblastic tumor after a complete mole in 1997. She presented with heavy vaginal bleeding, and arteriogram demonstrated a large uterine AVM. The patient underwent selective uterine artery embolization with complete resolution of bleeding, as well as arteriographic cessation of flow through the AVM. After two first-trimester spontaneous abortions, the patient successfully completed a normal pregnancy, resulting in the forceps-assisted delivery of a healthy female infant. Successful term pregnancy can occur after selective uterine artery embolization in women hemorrhaging from symptomatic GTD-associated AVM.

  4. Utility of Amplatzer Vascular Plug with Preoperative Common Hepatic Artery Embolization for Distal Pancreatectomy with En Bloc Celiac Axis Resection

    Energy Technology Data Exchange (ETDEWEB)

    Toguchi, Masafumi, E-mail: e024163@yahoo.co.jp; Tsurusaki, Masakatsu; Numoto, Isao; Hidaka, Syojiro; Yamakawa, Miho [Kindai University, Department of Radiology, Faculty of Medicine (Japan); Asato, Nobuyuki [Kindai University, Department of Radiology, Faculty of Medicine, Nara Hospital (Japan); Im, SungWoon; Yagyu, Yukinobu; Matsuki, Mitsuru [Kindai University, Department of Radiology, Faculty of Medicine (Japan); Takeyama, Yoshifumi [Kindai University, Department of Surgery, Faculty of Medicine (Japan); Murakami, Takamichi [Kindai University, Department of Radiology, Faculty of Medicine (Japan)

    2017-03-15

    PurposeTo evaluate the feasibility and safety of the Amplatzer vascular plug (AVP) for preoperative common hepatic embolization (CHA) before distal pancreatectomy with en bloc celiac axis resection (DP-CAR) to redistribute blood flow to the stomach and liver via the superior mesenteric artery (SMA).Materials and MethodsFour patients (3 males, 1 female; median age 69 years) with locally advanced pancreatic body cancer underwent preoperative CHA embolization with AVP. After embolization, SMA arteriography was performed to confirm the alteration of blood flow from the SMA to the proper hepatic artery.ResultsIn three of four patients, technical successes were achieved with sufficient margin from the origin of gastroduodenal artery. In one patient, the margin was less than 5 mm, although surgery was successfully performed without any problem. Eventually, all patients underwent the DP-CAR without arterial reconstruction or liver ischemia.ConclusionsAVP application is feasible and safe as an embolic procedure for preoperative CHA embolization of DP-CAR.

  5. Massive Ischemic Stroke Due to Pulmonary Barotrauma and Cerebral Artery Air Embolism During Commercial Air Travel.

    Science.gov (United States)

    Farshchi Zarabi, Sara; Parotto, Matteo; Katznelson, Rita; Downar, James

    2017-06-13

    BACKGROUND Air embolism into the systemic arterial circulation secondary to pulmonary barotrauma has rarely been reported. Herein, we report the clinical course of an extremely rare presentation of cerebral air embolism likely due to ruptured pulmonary bullae during commercial air travel. CASE REPORT A 65-year-old man suddenly became unconscious during an airplane descent. Upon landing, he was immediately transferred to the nearest emergency department where he was intubated for airway protection. His head CT angiogram showed multiple air pockets in the right parietal lobe suspicious for multiple air emboli. His chest CT scan showed multiple large bullae in the left upper and lower lobes as well as diffusely emphysematous lung tissue. After initial stabilization, he underwent emergent hyperbaric oxygen treatment (HBOT) in the multiplace chamber at 2.8 atmospheres. The patient tolerated HBOT well with no complications. However, his neurologic status deteriorated in the following 24 hours due to progression of his cerebral edema and mass effects. The patient's clinical status was discussed with his family and the decision was made to withdraw life-sustaining measures. He died shortly after withdrawal of life support. Post-mortem examination confirmed the presence of very large bullae in the lungs bilaterally. CONCLUSIONS Spontaneous cerebral air embolism is a possible complication of ruptured pulmonary bullae during air travel. HBOT is well-tolerated and may be used with caution even in the presence of emphysematous bullae.

  6. Transcatheter Arterial Embolization for Postpartum Hemorrhage with Disseminated Intravascular Coagulation: Outcome Assessment

    Energy Technology Data Exchange (ETDEWEB)

    An, Eun Jung; Kim, Young Hwan; Kwon, Bo Ra; Kim, See Hyung [Dept. of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2011-12-15

    We evaluated the efficacy and predictors of clinical outcome after transcatheter arterial embolization (TAE) for treatment of postpartum hemorrhage with disseminated intravascular coagulation (DIC). Of 127 patients who underwent TAE for postpartum hemorrhage, 46 progressed to DIC (group 1), 81 showed normal range hematological parameters (group 2). We retrospectively evaluated etiology, embolization methods and the efficacy of TAE for intergroup comparison Pearson Chi-Square test and logistic regression model. Overall TAE failed to control bleeding in 9 patients in spite of technical success. Lower bleeding control rate was found in group 2 (82.6%) relative to group 1 (98.8%, p = 0.001). And embolization methods were not statistically different between two groups no statistically significant predictors associated with failed hemostasis except the amount of transfusion in group 1. Although bleeding control rate is lower in postpartum hemorrhage with DIC than without DIC, we believe that TAE with correction of DIC is an effective method for postpartum hemorrhage with DIC.

  7. Superselective embolization of the inferior vesical artery for the treatment of intractable hematuria from pelvic malignancy: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Jung; Jeon, Eui Yong [Hallym Univ. Sacred Heart Hospital/Hallym Univ. College of Medicine, Anyang, (Korea, Republic of); Choi, Sun Young [Ewha Womans Univ. Seoul (Korea, Republic of); Han, Kum Hyun [Inje Univ. Ilsan Paik Hospital/Inje Univ. College of Medicine, Goyang (Korea, Republic of)

    2012-05-15

    Intractable hematuria in from pelvic malignancy can be managed with conservative treatment in most patients. However, when treatment fails, surgical intervention may be required. Unfortunately, in most cases, the general condition of most patients is unfavorable for major surgery, with many patients having an inoperable status. We present two cases where intractable hematuria was successfully controlled by bilateral embolization of the inferior vesical artery with polyvinyl alcohol particles. Hematuria did not recur during the subsequent period and no complication was observed. Thus, bilateral embolization of the inferior vesical artery should be considered as an alternative method for the treatment of massive intractable hematuria caused by pelvic malignancy.

  8. Utilization of Veno-Arterial Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism.

    Science.gov (United States)

    Pasrija, Chetan; Kronfli, Anthony; George, Praveen; Raithel, Maxwell; Boulos, Francesca; Herr, Daniel L; Gammie, James S; Pham, Si M; Griffith, Bartley P; Kon, Zachary N

    2018-02-01

    The management of massive pulmonary embolism remains challenging, with a considerable mortality rate. Although veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for massive pulmonary embolism has been reported, its use as salvage therapy has been associated with poor outcomes. We reviewed our experience utilizing an aggressive, protocolized approach of VA-ECMO to triage, optimize, and treat these patients. All patients with a massive pulmonary embolism who were placed on VA-ECMO, as an initial intervention determined by protocol, were retrospectively reviewed. ECMO support was continued until organ optimization was achieved or neurologic status was determined. At that time, if the thrombus burden resolved, decannulation was performed. If substantial clot burden was still present with evidence of right ventricular (RV) strain, operative therapy was undertaken. Twenty patients were identified. Before cannulation, all patients had an RV-to-left ventricular ratio greater than 1.0 and severe RV dysfunction. The median duration of ECMO support was 5.1 days, with significant improvement in end-organ function. Ultimately, 40% received anticoagulation alone, 5% underwent catheter-directed therapy, and 55% underwent surgical pulmonary embolectomy. Care was withdrawn in 1 patient with a prolonged pre-cannulation cardiac arrest after confirmation of neurologic death. In-hospital and 90-day survival was 95%. At discharge, 18 of 19 patients had normal RV function, and 1 patient, who received catheter-directed therapy, had mild dysfunction. VA-ECMO appears to be an effective tool to optimize end-organ function as a bridge to recovery or intervention, with excellent outcomes. This approach may allow clinicians to better triage patients with massive pulmonary embolism to the appropriate therapy on the basis of recovery of RV function, residual thrombus burden, operative risk, and neurologic status. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier

  9. Transarterial Embolization of Arterial Bleeding in Patients with Pelvic Bone Fractures

    Energy Technology Data Exchange (ETDEWEB)

    Song, Ji Soo; Kwak, Hyo Sung; Han, Young Min [Chonbuk National University Hospital, Jeonju (Korea, Republic of)

    2009-11-15

    This study was designed to evaluate the usefulness of transcatheter arterial embolization (TAE) in hemodynamically unstable patients with a pelvic bone fracture. From November 2004 to July 2007, we retrospectively reviewed 211 patients with pelvic bone fractures. Of these patients, 24 patients with CT findings of active bleeding or hemodynamic instability underwent pelvic angiography. There were 13 female and 11 male patients, with an age range from 21 to 92 years (mean age, 58.3 years). To evaluate arterial injuries, angiography was performed, followed by TAE using coils, gelfoams and N-butyl-2-cyanoacrylate. The evaluation of risk factors between patients who were still alive and patients who had expired was performed statistically by use of the Student's t test and chisquared analysis. A total of 28 TAE procedures were performed in 24 patients and 50 injured arteries were occluded. Six patients (25%) died due to hypovolemic shock within 47 hours. Five of the patients were hemodynamically unstable (BP below 76/56 mmHg) prior to the angiographic procedure and one patient had a pseudoaneurysm located at the superior mesenteric artery. Dopamine usage and blood pressure before the procedure for patients showed a statistically significant difference between patients were still alive and patients who had expired (p = 0.01, p = 0.001). TAE is a safe and effective treatment for an arterial injury of a pelvic bone fracture. The outcome of patients with a hemodynamically unstable state before TAE is poor.

  10. [An unusual embolization of a projectile in the superficial femoral artery].

    Science.gov (United States)

    Roubal, P; Korger, J; Ondrůsková, O; Kratochvíl, D; Holý, M

    1997-11-01

    The authors present an account on a gunshot wound which penetrated into the lateral side of the distal chest on the right. They describe acute treatment of severe haemorrhagic shock by suture of a lacerated with liver segment and resection of the upper pole of the right kidney. The projectile was not searched for because of the patients general serious condition. After 30 days the patient was discharged in a good condition. Shortly after discharge, i.e. cca one month after the injury, the patient developed signs of chronic ischaemia of the left lower extremity-finally claudications after 150 meters. Based on peripheral arteriography, which revealed the projectile in the area of the beginning of the superficial femoral artery and an ample collateral circulation, surgery was initiated. The bullet was extracted from the lumen of the superficial femoral artery from longitudinal arteriotomy. The artery was then treated by thrombectomy and a venous patch. Peroperative arteriography indicates satisfactory passage into the periphery. The authors try to reconstruct the pathway of the shot and in particular how the projectile penetrated into the artery. They emphasize the necessity to look for the projectice at the site of the shot wound. The objective of the paper is to make readers familiar with a case of uncommon embolization of a projectile into the superficial femoral artery and mistakes which may occur during treatment of a gunshot wound. The result is that the patient is quite free from complaints, as was confirmed by repeated out-patient check-ups.

  11. Intra-Arterial Treatment in a Child with Embolic Stroke Due to Atrial Myxoma

    Science.gov (United States)

    van den Wijngaard, Ido; Wermer, Marieke; van Walderveen, Marianne; Wiendels, Natalie; Peeters-Scholte, Cacha; Lycklama à Nijeholt, Geert

    2014-01-01

    Summary Arterial ischaemic stroke is an important cause of morbidity in children. Timely diagnosis is necessary for acute stroke treatment but can be challenging in clinical practice. Due to a paucity of data there are no specific recommendations regarding the use of mechanical thrombectomy devices in current paediatric stroke guidelines. A 14-year-old boy presented with a severe acute left hemisphere stroke due to a proximal middle cerebral artery occlusion caused by emboli from an atrial myxoma. No clinical improvement was seen after administration of intravenous thrombolysis. Subsequent mechanical thrombectomy with a second-generation stent-based thrombectomy device resulted in successful recanalization and clinical improvement. To our knowledge, this is the first report of mechanical thrombectomy in a child with acute embolic stroke caused by atrial myxoma. PMID:24976098

  12. Giant tentorial dural arteriovenous fistula treated by a combination of trans-arterial embolization and surgery

    Directory of Open Access Journals (Sweden)

    Türker Karanci

    2012-01-01

    Full Text Available Tentorial dural arteriovenous fistulae are uncommon lesions but can be life-threatening. A 34-year-old male presented with intractable headache, seizures, and visual disturbance. Three-dimensional computed tomography (CT angiography and digital subtraction angiography demonstrated a right tentorial dural arteriovenous fistula supplied by both internal and external carotid systems and draining into a giant venous ampula. Transarterial embolization of the external carotid feeders with Onyx (TM, ev3, Irvine, CA was carried out. Postembolization angiography revealed persistence of a portion of the fistula supplied by the temporo-occipital branch of right middle cerebral artery. The patient underwent right temporo-occipital craniotomy, division of the feeders and resection of the entire fistula and coagulation of the leptomeningeal arterialized veins. Complete elimination of the fistula was demonstrated by angiography. Postoperative recovery was uneventful; the patient did not develop any fresh neurologic deficits. We review the relevant literature and discuss the rationale for managing these lesions.

  13. Axillary artery transection and bilateral pulmonary embolism after anterior shoulder dislocation: case report

    Directory of Open Access Journals (Sweden)

    Leclerc Betty

    2017-01-01

    Full Text Available Introduction: Anterior shoulder dislocation can be associated with vascular and neurological complications. However, axillary artery injury associated with shoulder dislocation is rare and extremely rare without bone fracture. An early diagnosis of these complications allows predicting long-term functional outcomes. Methods: This article reports the case of a 66-year-old patient who presented an anterior shoulder dislocation after a ski fall without any neurological dysfunction or pulse deficit. Results: The first reduction attempts were unsuccessful and during the new attempt, we observed a hematoma. A CT scan showed a disruption of the axillary artery and a bilateral pulmonary embolism. Conclusion: Neurovascular injury must be systematically sought before and after reduction, and a multidisciplinary approach is always necessary.

  14. Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications

    Energy Technology Data Exchange (ETDEWEB)

    Soyer, Philippe, E-mail: philippe.soyer@lrb.aphp.fr; Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr; Dautry, Raphael, E-mail: raphael-dautry@yahoo.fr; Guerrache, Youcef, E-mail: docyoucef05@yahoo.fr [Hôpital Lariboisière-AP-HP, Department of Abdominal and Interventional Imaging (France); Ricbourg, Aude, E-mail: aude.ricbourg@lrb.aphp.fr [Hôpital Lariboisière-AP-HP, Department of Obstetrics and Gynecology (France); Gayat, Etienne, E-mail: etienne.gayat@lrb.aphp.fr [Diderot-Paris 7, Université-Sorbonne Paris-Cité (France); Boudiaf, Mourad, E-mail: mourad.boudiaf@lrb.aphp.fr; Sirol, Marc, E-mail: marc.sirol@lrb.aphp.fr; Ledref, Olivier, E-mail: olivier.ledref@lrb.aphp.fr [Hôpital Lariboisière-AP-HP, Department of Abdominal and Interventional Imaging (France)

    2015-10-15

    Postpartum hemorrhage (PPH) is a potentially life-threatening condition, which needs multidisciplinary management. Uterine atony represents up to 80 % of all causes of PPH. Transcatheter arterial embolization (TAE) has now a well-established role in the management of severe PPH. TAE allows stopping the bleeding in 90 % of women with severe PHH, obviating surgery. Pledgets of gelatin sponge as torpedoes are commonly used for safe TAE, and coils, glue, and microspheres have been primarily used in specific situations such as arterial rupture, pseudoaneurysm, and arteriovenous fistula. TAE is a minimally invasive procedure with a low rate of complications, which preserves future fertility. Knowledge of causes of PPH, potential risks, and limitations of TAE is essential for a timely decision, optimizing TAE, preventing irreversible complications, avoiding hysterectomy, and ultimately preserving fertility.

  15. Prostatic Artery Embolization for Enlarged Prostates Due to Benign Prostatic Hyperplasia. How I Do It

    Energy Technology Data Exchange (ETDEWEB)

    Carnevale, Francisco C., E-mail: fcarnevale@uol.com.br [University of Sao Paulo Medical School, Interventional Radiology Unit (Brazil); Antunes, Alberto A., E-mail: antunesuro@uol.com.br [University of Sao Paulo Medical School, Division of Urology (Brazil)

    2013-12-15

    Prostatic artery embolization (PAE) has emerged as an alternative to surgical treatments for benign prostatic hyperplasia (BPH). Patient selection and refined technique are essential for good results. Urodynamic evaluation and magnetic resonance imaging are very important and technical limitations are related to elderly patients with tortuous and atherosclerotic vessels, anatomical variations, difficulty visualizing and catheterizing small diameter arteries feeding the prostate, and the potential risk of bladder and rectum ischemia. The use of small-diameter hydrophilic microcatheters is mandatory. Patients can be treated safely by PAE with low rates of side effects, reducing prostate volume with clinical symptoms and quality of life improvement without urinary incontinence, ejaculatory disorders, or erectile dysfunction. A multidisciplinary approach with urologists and interventional radiologists is essential to achieve better results.

  16. Uterine artery embolization (UAE) for diffuse leiomyomatosis of the uterus: Clinical and imaging results

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Jieun [Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul 120-752 (Korea, Republic of); Kim, Man Deuk, E-mail: mdkim@yuhs.ac [Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul 120-752 (Korea, Republic of); Jung, Dae Chul; Lee, Myungsu; Lee, Mu Sook; Won, Jong Yun; Lee, Do Yun; Park, Sung Il; Lee, Kwang Hun [Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul 120-752 (Korea, Republic of)

    2012-10-15

    Purpose: The aim of the current study was to evaluate the efficacy of uterine artery embolization (UAE) in the management of diffuse uterine leiomyomatosis with mid-term follow-up. Materials and methods: All patients who underwent UAE between 2008 and 2010 for symptomatic fibroids were analyzed. Among 360 cases, a total of 7 patients with diffuse uterine leiomyomatosis diagnosed based on MRI were included in this retrospective study. Patient ages ranged from 29 to 38 (mean 32.7) years. The median follow-up period was 16 (range; 6–31) months. The embolic agent was non-spherical polyvinyl alcohol particles. All patients underwent follow-up MRI at 3 months after UAE. Uterine volumes were calculated using MRI. Menorrhagia symptom changes were assessed at mid-term follow-up. Results: There were no technical failures to catheterize the uterine artery and no adverse events requiring therapy after UAE. Contrast-enhanced MRI showed complete necrosis of the leiomyomatous nodules in 5 patients (71%) 3 months after embolization. Two patients (28%) showed mostly leiomyomatous nodules that were necrotized, some of which were still viable. All 7 patients with menorrhagia had improvement of symptoms at the mid-term follow-up. The initial mean uterine volume was 601.30 ± 533.92 cm{sup 3} and was decreased to a mean of 278.81 ± 202.70 cm{sup 3} at 3 months follow-up, for a mean uterus volume reduction rate of 50.1% (p < 0.05). One patient became pregnant 5 months after UAE treatment. Conclusion: UAE was a highly effective treatment for diffuse uterine leiomyomatosis with mid-term durability and may be a valuable alternative to hysterectomy.

  17. Percutaneous uterine artery embolization for the treatment of symptomatic fibroids: current status

    Energy Technology Data Exchange (ETDEWEB)

    Lupattelli, Tommaso; Basile, Antonio; Garaci, Francesco Giuseppe; Simonetti, Giovanni

    2005-04-01

    Uterine artery embolization (UAE) is increasingly being used as an alternative treatment to hysterectomy for symptomatic fibroids. Symptoms of pelvic pressure, urinary frequency and menorrhagia are controlled in 73-98% of patients who undergo UAE. At the 1-year follow-up, the uterus may shrink by up to 55% but re-growth of fibroid may however occur. The rate of major complications and amenorrhoea following this procedure is low, ranging in most series from 1 to 3.5% and 1 to 7%, respectively. Nevertheless, the rate of amenorrhoea in women over 45 seems to be higher. In order to completely block the arterial supply to the fibroid, UAE is typically performed in both uterine arteries. Different embolic agents are used such as polyvinyl alcohol, gelfoam and more recently gelatine tris-acryl microspheres. After UAE, perfusion of the uterus is maintained. Uterine function is therefore conserved and although women who become pregnant after UAE seem to be at risk for malpresentation, pre-term birth, cesarean delivery and postpartum hemorrhage, successful pregnancies after UAE have been reported in some series. A major technical problem with UAE remains the possible presence of fibroid blood supply from other sources, such as the ovarian arteries or other pelvic branches, which can lead to failure of the procedure. In conclusion, although randomized trials are still underway, UAE appears a good option for those patients who wish to conserve their fertility or when surgery is contra-indicated. However, to evaluate the long-term effects of UAE longer follow up is required.

  18. Intracranial and visceral arterial embolization of a cardiac myxoma that was treated with endovascular stent-retriever therapy.

    Science.gov (United States)

    McGowan, Archie R; Thibodeau, Cheryl; McGowan, Amelia

    2016-10-01

    We report a case of a ruptured left atrial myxoma with multiple synchronous sites of embolization, including the intracranial cerebral (left middle cerebral artery (MCA) and basilar), visceral (renal, superior mesenteric artery (SMA)) and peripheral circulatory beds (aorta and lower extremities). This synchronous embolization resulted in a catastrophic neurologic and systemic event. An intracranial stent retriever was used to restore cerebral circulation in the symptomatic left MCA distribution, which resulted in resolution of the acute neurologic deficits. Endovascular and open surgical interventions were later performed to address the residual cardiac mass and other embolic sites. The patient survived the event with the loss of her right leg below the knee and a transient dialysis requirement. The purpose of this case report is to document the successful utilization of a stent-retriever device in removing an embolized myxoma from the cerebral circulation, to review the unique pathology of this source of embolic stroke and to reiterate the importance of considering embolic and non-thrombotic etiologies of acute ischemic stroke, especially in atypical patient populations and patient presentations. © The Author(s) 2016.

  19. Patient radiation exposure in uterine artery embolization of leiomyomata: calculation of organ doses and effective dose

    Energy Technology Data Exchange (ETDEWEB)

    Vetter, S.; Strecker, E.P. [Department of Radiology, Diakonissenkrankenhaus, Diakonissenstrasse 28, 76199, Karlsruhe (Germany); Schultz, F.W.; Zoetelief, J. [Interfaculty Reactor Institute, Medical Physics, Delft University of Technology, 2629 JB, Delft (Netherlands)

    2004-05-01

    The goal of this study was estimation of patient effective dose from uterine artery embolization of leiomyomata. Parameters and data relevant to patient dose were recorded for 33 consecutive procedures. Using Monte Carlo simulation of radiation transport, organ and effective doses were calculated in detail for a subset of five procedures, to estimate the effective dose for all procedures. Mean dose area product was 59.9, median 23.4, and range 8.8-317.5 Gycm{sup 2}. Mean absorbed ovarian dose was calculated as 51 mGy in the five procedures. Using the dose conversion factor estimated from the Monte Carlo simulation for all procedures a mean estimated effective dose of 34 mSv (median 13 mSv, range 5-182 mSv) results, with a tendency to lower values regarding the succession of the procedures. Patients' radiation exposure level is up to twice of that of an abdominal CT examination. Angiographic equipment related dose-reducing features and radiographic technique essentially influence organ doses and effective dose. Consistent application of dose-reducing techniques and awareness of radiation exposure justifies uterine artery embolization as a therapeutic option for the treatment of uterine fibroids. (orig.)

  20. First clinical experience with the GARDEX EPD: a novel embolic protection device for carotid artery stenting.

    Science.gov (United States)

    Werner, Martin; Scheinert, Dierk; Borghesi, Raffaello; Cremonesi, Alberto; Rosenschein, Uri; Scheinert, Susanne; Bräunlich, Sven; Bausback, Yvonne; Ulrich, Matthias; Schmidt, Andrej

    2013-01-22

    Carotid artery stenting (CAS) has become an alternative to carotid endarterectomy in the treatment of carotid artery disease. The use of an embolic protection device (EPD) can reduce the frequency of embolic events during CAS. Difficult vascular anatomy may complicate current generation EPD placement. This problem is addressed by a new EPD, the GARDEX System. The aim of this study was to assess the safety and performance of the GARDEX EPD during CAS. Thirty-eight patients underwent CAS with the GARDEX EPD in two medical centres. All patients were prospectively followed up for 30 days. Device performance and procedural details were collected and analysed prospectively. Vessel anatomy and lesion morphology were evaluated and stratified into a scoring system for anatomic difficulty. More than a third of the patients were considered to have difficult vascular anatomy for CAS. All enrolled patients were successfully treated. There was one (2.6%) minor periprocedural stroke and there were two (5.3%) periprocedural TIAs which resolved within 24 hours. No additional complications were noted during the 30-day follow-up period. In this first experience, CAS under cerebral protection with the GARDEX EPD was safe and feasible. Our data suggest that the use of the GARDEX EPD is simple and shows high success rates even in challenging anatomies. The role of this new device in CAS needs to be further confirmed in a larger patient population.

  1. Hyperbaric oxygen therapy for the prevention of arterial gas embolism in food grade hydrogen peroxide ingestion.

    Science.gov (United States)

    Hendriksen, Stephen M; Menth, Nicholas L; Westgard, Bjorn C; Cole, Jon B; Walter, Joseph W; Masters, Thomas C; Logue, Christopher J

    2017-05-01

    Food grade hydrogen peroxide ingestion is a relatively rare presentation to the emergency department. There are no defined guidelines at this time regarding the treatment of such exposures, and providers may not be familiar with the potential complications associated with high concentration hydrogen peroxide ingestions. In this case series, we describe four patients who consumed 35% hydrogen peroxide, presented to the emergency department, and were treated with hyperbaric oxygen therapy. Two of the four patients were critically ill requiring intubation. All four patients had evidence on CT or ultrasound of venous gas emboli and intubated patients were treated as if they had an arterial gas embolism since an exam could not be followed. After hyperbaric oxygen therapy each patient was discharged from the hospital neurologically intact with no other associated organ injuries related to vascular gas emboli. Hyperbaric oxygen therapy is an effective treatment for patients with vascular gas emboli after high concentration hydrogen peroxide ingestion. It is the treatment of choice for any impending, suspected, or diagnosed arterial gas embolism. Further research is needed to determine which patients with portal venous gas emboli should be treated with hyperbaric oxygen therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Life-threatening autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura: successful seletive splenic artery embolization

    Directory of Open Access Journals (Sweden)

    matteo molica

    2016-04-01

    Full Text Available Selective splenic artery embolization (SSAE is a nonsurgical intervention characterized by the transcatheter occlusion of the splenic artery and/or its branch vessels using metallic coils or other embolic devices. It has been applied for the management of splenic trauma, hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia and splenic hemangioma. We hereby describe a case of a patient affected by idiopathic thrombocytopenic purpura (ITP and warm auto-immune hemolytic anemia (AIHA both resistant to immunosuppressive and biological therapies, not eligible for a surgical intervention because of her critical conditions. She underwent SSAE and achieved a hematologic complete response within a few days without complications. SSAE is a minimally invasive procedure to date not considered a standard option in the management of AIHA and ITP. However, following the progressive improvement of the techniques, its indications have been extended, with a reduction in morbidity and mortality compared to splenectomy in patients with critical clinical conditions. SSAE was a lifesaving therapeutic approach for our patient and it may represent a real alternative for the treatment of resistant AIHA and ITP patients not eligible for splenectomy.

  3. Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Okuno, Yuji, E-mail: how-lowlow@yahoo.co.jp [Edogawa Hospital, Department of Orthopedic Surgery (Japan); Korchi, Amine Mohamed, E-mail: amine.korchi@gmail.com [Geneva University Hospitals, Department of Diagnostic and Interventional Radiology (Switzerland); Shinjo, Takuma, E-mail: shin.takuma@a7.keio.jp [Keio University, Institute for Integrated Sports Medicine, School of Medicine (Japan); Kato, Shojiro, E-mail: shojiro7@yahoo.co.jp [Edogawa Hospital, Department of Orthopedic Surgery (Japan)

    2015-04-15

    PurposeOsteoarthritis is a common cause of pain and disability. Mild to moderate knee osteoarthritis that is resistant to nonsurgical options and not severe enough to warrant joint replacement represents a challenge in its management. On the basis of the hypothesis that neovessels and accompanying nerves are possible sources of pain, previous work demonstrated that transcatheter arterial embolization for chronic painful conditions resulted in excellent pain relief. We hypothesized that transcatheter arterial embolization can relieve pain associated with knee osteoarthritis.MethodsTranscatheter arterial embolization for mild to moderate knee osteoarthritis using imipenem/cilastatin sodium or 75 μm calibrated Embozene microspheres as an embolic agent has been performed in 11 and three patients, respectively. We assessed adverse events and changes in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores.ResultsAbnormal neovessels were identified within soft tissue surrounding knee joint in all cases by arteriography. No major adverse events were related to the procedures. Transcatheter arterial embolization rapidly improved WOMAC pain scores from 12.2 ± 1.9 to 3.3 ± 2.1 at 1 month after the procedure, with further improvement at 4 months (1.7 ± 2.2) and WOMAC total scores from 47.3 ± 5.8 to 11.6 ± 5.4 at 1 month, and to 6.3 ± 6.0 at 4 months. These improvements were maintained in most cases at the final follow-up examination at a mean of 12 ± 5 months (range 4–19 months).ConclusionTranscatheter arterial embolization for mild to moderate knee osteoarthritis was feasible, rapidly relieved resistant pain, and restored knee function.

  4. Transient Ischemic Rectitis as a Potential Complication after Prostatic Artery Embolization: Case Report and Review of the Literature

    Energy Technology Data Exchange (ETDEWEB)

    Moreira, Airton Mota, E-mail: motamoreira@gmail.com [University of Sao Paulo Medical School, Division of Interventional Radiology, Department of Radiology (Brazil); Marques, Carlos Frederico Sparapan, E-mail: sparapanmarques@gmail.com [University of Sao Paulo Medical School, Colorectal Surgery Division, Department of Gastroenterology (Brazil); Antunes, Alberto Azoubel, E-mail: antunesuro@uol.com.br [University of Sao Paulo Medical School, Department of Urology (Brazil); Nahas, Caio Sergio Rizkallah, E-mail: caionahas@usp.br; Nahas, Sergio Carlos, E-mail: sergionahas@uol.com.br [University of Sao Paulo Medical School, Colorectal Surgery Division, Department of Gastroenterology (Brazil); Gregorio Ariza, Miguel Angel de, E-mail: mgregori@unizar.es [University of Zaragoza, Division of Minimally Invasive Image Guided Surgery (Spain); Carnevale, Francisco Cesar, E-mail: fcarnevale@uol.com.br [University of Sao Paulo Medical School, Division of Interventional Radiology, Department of Radiology (Brazil)

    2013-12-15

    Prostatic artery embolization (PAE) is an alternative treatment for benign prostatic hyperplasia. Complications are primarily related to non-target embolization. We report a case of ischemic rectitis in a 76-year-old man with significant lower urinary tract symptoms due to benign prostatic hyperplasia, probably related to nontarget embolization. Magnetic resonance imaging revealed an 85.5-g prostate and urodynamic studies confirmed Inferior vesical obstruction. PAE was performed bilaterally. During the first 3 days of follow-up, a small amount of blood mixed in the stool was observed. Colonoscopy identified rectal ulcers at day 4, which had then disappeared by day 16 post PAE without treatment. PAE is a safe, effective procedure with a low complication rate, but interventionalists should be aware of the risk of rectal nontarget embolization.

  5. No morphine sparing effect of ketamine added to morphine for patient-controlled intravenous analgesia after uterine artery embolization

    DEFF Research Database (Denmark)

    Jensen, Luana Leonora; Handberg, Gitte; Helbo-Hansen, H S

    2008-01-01

    BACKGROUND: Pain following embolization of the uterine arteries (UAEs) is variable and may be very severe requiring large doses of parenteral opioids for relief. The present study tested the hypothesis that the addition of ketamine to i.v. patient-controlled morphine reduces the amount of morphine...... required for pain-control during the first 24 h after UAE embolization. METHODS: Fifty-six patients undergoing UAE embolization for treatment of symptomatic uterine leiomyomata were randomized to receive either 2 mg/ml of morphine (Control group, n=30) or 2 mg/ml of both morphine and ketamine (Ketamine......, visual disturbances, anxiety, dreaming and hallucinations, if any, were recorded for 24 h after embolization. RESULTS: The mean +/- SD 24-h consumption of patient-controlled morphine was 38.3 +/- 21.0 mg in the Ketamine group vs. 33.3 +/- 18.3 mg in the Control group (NS). The difference between...

  6. Evaluation of selective arterial embolization effect by chitosan micro-hydrogels in hindlimb sarcoma rodent models using various imaging modalities

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Tai Kyoung; Kwon, Jeong Il; Na, Kyung Sook [Chonbuk National University Medical School and Hospital, Jeonju (Korea, Republic of); and others

    2015-09-15

    Embolization is mainly used to reduce the size of locally advanced tumors. In this study, selective arterial catheterization with chitosan micro-hydrogels (CMH) into the femoral artery was performed and the therapeutic effect was validated using different imaging methods. Male SD rats (n = 18, 6 weeks old) were randomly assigned into three groups: Group 1 as control, Group 2 without any ligation of distal femoral artery, and Group 3 with temporary ligation of the distal femoral artery. RR1022 sarcoma cell lines were inoculated into thigh muscle. After 1 week, CMH was injected into the proximal femoral artery. Different imaging modalities were performed during a 3-week follow-up. The tumor size was significantly (P < 0.001) decreased in both Group 2 and Group 3 (P < 0.001) after selective arterial embolization therapy. 18F-FDG-PET/CT revealed decreased intensity of 18F-FDG uptake in tumors. The accumulation status of 125I-CMH near the tumor was verified by gamma camera. Appropriate selective arterial embolization therapy with CMH was.

  7. Incidental Pulmonary Embolism After Coronary Artery Bypass Surgery: Long-Term Clinical Follow-Up.

    Science.gov (United States)

    Beck, Kyongmin Sarah; Cho, Eun Kyung; Moon, Mi Hyung; Kim, Do-Yeon; Song, Hyun; Jung, Jung Im

    2018-01-01

    The purpose of this study was to investigate the incidence and natural history of incidentally found and untreated pulmonary embolism (PE) at coronary CT angiography after coronary artery bypass grafting. We retrospectively reviewed the records of 353 patients consecutively registered between January 1, 2010, and November 11, 2015, who underwent coronary artery bypass grafting followed within 2 weeks by coronary CT angiography. All patients received 100 mg of aspirin and 75 mg of clopidogrel after surgery. We collected relevant clinical and CT data, including total follow-up duration after coronary artery bypass grafting, follow-up CT findings, mortality, and incidence of any recurrent PE. PE was diagnosed in 22 of the 353 patients (6.2%) who remained in the study after the exclusion criteria were applied. Most of the PEs occurred at the segmental or subsegmental level. All patients were in hemodynamically stable condition, had no symptoms, and underwent follow-up for a median of 53 months (range 19-74 months). Twenty of the 22 patients did not receive anticoagulation, and all but one of these patients had complete resolution of PE at second follow-up coronary CT angiography (median, 149 days after surgery). There was no associated mortality or recurrent PE. Incidental PE after coronary artery bypass grafting is found in approximately 6% of patients undergoing postoperative coronary CT angiography, and most PEs resolve spontaneously without anticoagulation. No patient in this study died or had recurrent PE during a median follow-up period of 53 months.

  8. Uterine restoration after repeated sloughing of fibroids or vaginal expulsion following uterine artery embolization

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hye Ri; Kim, Nack Keun; Lee, Mee Hwa [Pochon CHA University, Department of Obstetrics and Gynecology, Bundang CHA General Hospital, Sungnam-si, Kyonggi-do (Korea); Kim, Man Deuk; Kim, Hee Jin; Yoon, Sang-Wook [Pochon CHA University, Department of Diagnostic Radiology, Bundang CHA General Hospital, Sungnam-si, Kyonggi-do (Korea); Park, Won Kyu [Yeungnam University, Department of Diagnostic Radiology, Kyongson, Dyongbuk (Korea)

    2005-09-01

    The aim of our study is to present our experience with uterine restoration after repeated sloughing of uterine fibroids or transvaginal expulsion following uterine artery embolization (UAE) and to determine its safety and outcome. One hundred and twenty-four women (mean age, 40.3 years; age range, 29-52 years) with symptomatic uterine fibroids were included in this retrospective study. We performed arterial embolization with poly(vinyl alcohol) particles (250-710 {mu}m). Clinical symptoms and follow-up information for each patient were obtained through medical records. At an average of 3.5 months (range, 1-8 months) after embolization, magnetic resonance imaging examinations with T1- and T2-weighted and gadolinium-enhanced T1-weighted images were obtained for all patients. The mean follow-up duration was 120 days (90-240 days). Eight (6.5%) patients experienced uterine restoration after repeated sloughing of uterine fibroids or spontaneous transvaginal expulsion. The locations of the leiomyomas were submucosal (n=5), intramural (n=2) and transmural (n=1). The maximum diameter of the fibroids ranged from 3.5 to 18.0 cm, with a mean of 8.4 cm. The time interval from embolization to the uterine restoration was 7-150 days (mean 70.5 days). The clinical symptoms before and during vaginal sloughing or expulsion were lower abdominal pain (n=4), vaginal discharges (n=3), infection of necrotic myomas (n=2) and cramping abdominal pain (n=1). Gentle abdominal compression (n=1) and hysteroscopic assistance (n=1) were required to remove the whole fibroid. No other clinical sequelae, either early or delayed, were documented. Magnetic resonance images revealed the disappearance of leiomyomas, intracavitary rupture resulting in transformation of intramural or transmural myomas into submucosal myomas and localized uterine wall defects. Although the small size of this study precludes a strict conclusion, there appear to be few serious complications directly related to vaginal

  9. Arterial embolism

    Science.gov (United States)

    ... results of the following tests: Euglobulin lysis time (ELT) Factor VIII assay Isotope study of the affected ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  10. Intraarterial Lidocaine for Pain Control in Uterine Artery Embolization: A Prospective, Randomized Study.

    Science.gov (United States)

    Noel-Lamy, Maxime; Tan, Kong T; Simons, Martin E; Sniderman, Kenneth W; Mironov, Oleg; Rajan, Dheeraj K

    2017-01-01

    To assess efficacy of two different techniques of lidocaine injection in the uterine arteries to reduce pain following uterine artery embolization (UAE) for leiomyomas. This prospective randomized single-blinded study was performed with 60 patients enrolled between November 2014 and December 2015 equally randomized to 3 arms. Group A received 10 mL lidocaine 1% (100 mg) mixed with polyvinyl alcohol particles (355-500 μm). Group B received the same dose of lidocaine injected after embolization. Group C was a control group. Pain was assessed on a 100-point visual analog scale at 4, 7, and 24 hours after the procedure. Narcotic agent dose to 24 hours was recorded. Outcomes were examined by analysis of variance and pairwise comparison. Leiomyoma infarction was assessed with magnetic resonance imaging 3 months after the procedure. Technical success rate of UAE was 100%. Mean pain score at 4 hours was significantly lower in the lidocaine groups (group A, 28.6; group B, 35.8) compared with the control group (59.4; P = .001). Pain scores at 7 and 24 hours were not statistically different among the 3 arms. The mean in-hospital narcotic agent dose was significantly lower in both lidocaine groups than in the control group (group A, 8.5 mg [P = .002]; group B, 11.1 mg [P = .03]; group C, 17.4 mg). There were no adverse events related to the use of lidocaine. The number of patients with complete infarction of leiomyomas at 3 months was significantly lower in group A at 38.9% (group B, 77.8%; group C, 75%; P = .0451). Lidocaine injected in the uterine arteries reduced postprocedural pain and narcotic agent dose after UAE. There were more cases of incomplete necrosis when lidocaine was mixed with the particles. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  11. Bullet embolism of pulmonary artery: a case report; Embolia pulmonar por projetil de arma de fogo: relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Yamanari, Mauricio Gustavo Ieiri; Mansur, Maria Clara Dias; Kay, Fernando Uliana; Silverio, Paulo Rogerio Barboza; Jayanthi, Shri Krishna; Funari, Marcelo Buarque de Gusmao, E-mail: mauriciogustavo91@yahoo.com.br [Universidade de Sao Paulo (IHC-FMUSP), SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    2014-03-15

    The authors report the case of a patient victim of gunshots, with a very rare complication: venous bullet embolism from the left external iliac vein to the lingular segment of the left pulmonary artery. Diagnosis is made with whole-body radiography or computed tomography. Digital angiography is reserved for supplementary diagnosis or to be used as a therapeutic procedure. (author)

  12. Heated lipiodol as an embolization agent for transhepatic arterial embolization in VX2 rabbit liver cancer model

    Energy Technology Data Exchange (ETDEWEB)

    Cao Wei [Department of Interventional Radiology, Tangdu Hospital, Fourth Military Medical University, No.1 Xinshi Road, Shaanxi Province, Xi' an 710038 (China)], E-mail: zjfurong2008@126.com; Wan Yi [Department of Health Statistics, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China); Liang Zhihui [Department of Radiology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province 050082 (China); Duan Yunyou; Liu Xi [Department of Ultrasonography, Tangdu Hospital, Fourth Military Medical University, No. 1 Xinshi Road, Xi' an 710038 (China); Wang Zhimin; Liu Yiyong; Zhu Jia; Liu Xiongtao [Department of Interventional Radiology, Tangdu Hospital, Fourth Military Medical University, No.1 Xinshi Road, Shaanxi Province, Xi' an 710038 (China); Zhang Hongxin [Department of Interventional Radiology, Tangdu Hospital, Fourth Military Medical University, No.1 Xinshi Road, Shaanxi Province, Xi' an 710038 (China)], E-mail: cawe-001@163.com

    2010-02-15

    Purpose: To evaluate the therapeutic effect of heated (60 deg. C) lipiodol via hepatic artery administration in a rabbit model of VX2 liver cancer. Materials and methods: Thirty male New Zealand white rabbits were randomly divided into three groups with 10 rabbits assigned to each group. VX2 carcinoma cells were surgically implanted into the left hepatic lobe. The tumors were allowed to grow for 2 weeks, and studies were performed until the diameter of the tumors detected by ultrasonograph reached 2-3 cm. Under anesthesia, trans-catheter hepatic arterial embolization was performed and doxorubicin-lipiodol (37 deg. C) (1 mL), lipiodol (60 deg. C) (1 mL) or control (physiological saline (37 deg. C) (1 mL)) solution was injected into the hepatic arteries of animals in the three groups. One week later, the volume of the tumor was measured by ultrasonograph again. The serum of all rabbits was collected before injection and at 4 and 7 days after injection, and the level of aspartate aminotransferase (AST) was checked. The survival period of the three groups of rabbits after treatment was also recorded. During the last course of their disease, the rabbits were given analgesics to relieve suffering. Results: The tumor growth rate in the lipiodol (60 deg. C) group (0.92 {+-} 0.21, tumor volume from 1811 {+-} 435 to 1670 {+-} 564 mm{sup 3}) was significantly lower than that in the control group (3.48 {+-} 1.17, tumor volume from 1808 {+-} 756 to 5747 {+-} 1341 mm{sup 3}) (P < 0.05) and in the doxorubicin-lipiodol (37 deg. C) group (1.69 {+-} 0.26, tumor volume from 1881 {+-} 641 to 2428 {+-} 752 mm{sup 3}) (P < 0.05). Consequently, the survival period of the animals in the lipiodol (60 deg. C) group (41.0 {+-} 3.0 days) was significantly greater than that in the doxorubicin-lipiodol (37 deg. C) group (38.0 {+-} 2.5 days) (P < 0.05). On the other hand, there was no statistically significant difference in serum AST levels between the lipiodol (60 deg. C) group (148.2 {+-} 11

  13. Uterine arteriovenous malformation with positive serum beta-human chorionic gonadotropin: Embolization of both uterine arteries and extra-uterine feeding arteries

    OpenAIRE

    Kim, Su Mi; Ahn, Hee Young; Choi, Min Jeong; Kang, Yun Dan; Park, Jin Wan; Park, Choong Hak; Kim, Jong Soo

    2016-01-01

    The incidence of uterine arteriovenous malformation (AVM) is rare. However, it is clinically significant in that it can cause life-threatening vaginal bleeding. We report a case of a large uterine AVM with positive serum beta-human chorionic gonadotropin. A presumptive diagnosis was made; a uterine AVM accompanied by, early pregnancy or retained product of conception. Because this uterine AVM was extensive, transcatheter arterial embolization of both uterine arteries and extra-uterine feeding...

  14. Submucosal fibroids becoming endocavitary following uterine artery embolization: risk assessment by MRI.

    Science.gov (United States)

    Verma, Sachit K; Bergin, Diane; Gonsalves, Carin F; Mitchell, Donald G; Lev-Toaff, Anna S; Parker, Laurence

    2008-05-01

    The purpose of our study was to assess the relationship between the endometrium and submucosal fibroids before and after uterine artery embolization (UAE). Contrast-enhanced pelvic 1.5-T MRI was performed in 49 women before and after UAE over a 2-year period. Dominant (largest diameter) fibroids in intramural, submucosal, subserosal, pedunculated subserosal, and endocavitary locations were assessed on pre- (baseline) and postembolization MRI. Size, locations of dominant fibroids relative to endometrium and serosa before and after embolization were compared. The ratio between the largest endometrial interface and the maximum dimension of the dominant submucosal fibroid (interface-dimension ratio) was determined on baseline MRI. The infarction rate for dominant fibroids was estimated after UAE. One hundred forty dominant fibroids were identified on baseline MRI. Forty-nine (35%) were intramural, 39 (28%) were submucosal, 34 (24%) were subserosal, eight (6%) were pedunculated subserosal, and 10 (6%) were endocavitary in location on preembolization MRI. After UAE, of 39 dominant submucosal fibroids, 13 (33%) became endocavitary: complete (n = 4), partial (n = 9) on the basis of European Society of Gynaecological Endoscopy (ESGE) classification. The preembolization mean interface-dimension ratio and mean diameters for dominant fibroids that became endocavitary were significantly greater than for those that did not become endocavitary after embolization (0.65 vs 0.32, p fibroids showed 100% infarction after UAE. Submucosal fibroids with an interface-dimension ratio of greater than 0.55 are more likely to migrate into the endometrial cavity after UAE. The majority of these are expelled spontaneously without significant symptoms. Rarely, submucosal fibroids greater than 6 cm in size that become endocavitary may cause postprocedural complications requiring further intervention and medical treatment.

  15. Endovascular Coil Embolization of Segmental Arteries Prevents Paraplegia After Subsequent TAAA Repair – An Experimental Model

    Science.gov (United States)

    Geisbüsch, S; Stefanovic, A; Koruth, JS; Lin, HM; Morgello, S; Weisz, DJ; Griepp, RB; Di Luozzo, G

    2013-01-01

    Objective To test a strategy for minimizing ischemic spinal cord injury (SCI) following extensive thoracoabdominal aneurysm (TAAA) repair, we occluded a small number of segmental arteries (SAs) endovascularly one week before simulated aneurysm repair in an experimental model. Methods 30 juvenile Yorkshire pigs (25.2±1.7kg) were randomized into three groups. All SAs—intercostal and lumbar—were sacrificed by a combination of surgical ligation of the lumbar SAs and occlusion of intercostal SAs with thoracic endovascular stent grafting (TEVAR). 7–10 days before this simulated TAAA replacement, SAs in the lower thoracic/upper lumbar region were occluded using embolization coils: 1.5±0.5 SAs in Group 1 (T13/L1), and 4.5±0.5 in Group 2 (T11-L3). No SAs were coiled in the controls. Hind limb function was evaluated blindly from daily videotapes using a modified Tarlov score: 0=paraplegia; 9=full recovery. After sacrifice, each segment of spinal cord was graded histologically using the 9-point Kleinman score: 0=normal, 8=complete necrosis. Results Hind limb function remained normal after coil embolization. After simulated TAAA repair, paraplegia occurred in 6/10 control pigs, but only 2/10 pigs in Group 1: no pigs in Group 2 had SCI. Tarlov scores were significantly better in Group 2 (Control vs 1 p=0.06; Control vs 2 p= 0.0002; 1 vs 2 p=0.05). A dramatic reduction in histologic damage—most prominently in the coiled region—was seen when SAs were embolized before simulated TAAA repair. Conclusions Endovascular coiling of 2–4 SAs prevents paraplegia in an experimental model of extensive hybrid TAAA repair, and helps protect the spinal cord from ischemic histopathological injury. A clinical trial in a selected patient population at high risk for postoperative SCI may be appropriate. PMID:24220154

  16. Intractable Postpartum Bleeding: A Comparison of the Retrospective Analysis of Angiographic Findings and Transcatheter Arterial Embolization According to Delivery Pattern

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Eun Jung; Kim, Young Hwan; Kim, Si Hyung; Choi, Jin Soo; Park, Jun Cheol; Kwon, Sang Hun; Jo, Chi Heum; Cha, Soon Do [Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2008-12-15

    We evaluated the technical aspect and efficacy of transcatheter arterial embolization (TAE) in cases of intractable postpartum bleeding by comparing the angiographic findings women patients according to their delivery pattern. Between July of 2003 and March of 2008, 55 female patients were enrolled in this study. Of the 55 patients, 36 underwent a vaginal delivery (group 1), whereas 19 underwent a cesarean section delivery (group 2). We retrospectively evaluated the angiographic findings and the embolization technique between groups, using a Pearson Chi-Square test. Medical records and telephone interview findings were also reviewed to evaluate the efficacy of TAE and the outcome of fertility. Significantly greater positive angiographic findings were found in group 2 (63.2%) relative to group 1 (30.6%). For positive angiographic findings, except for AVM, the embolization was performed using coil or glue with gelfoam. For the negative angiographic findings or AVM, the gelfoam was the only embolic agent used. In all patients except for one, bleeding stopped after embolization. Major complications occurred in 2 patients only, and included uterine synechia and perforation. All patients except for one recovered after menstruation. In total, four patients became pregnant and one patient delivered a healthy infant. Positive angiographic findings requiring embolization with coil or glue, as well as gelfoam, were more commonly encountered in group 2 than in group 1. Based on the outcome of the study group, TAE is a safe and effective treatment for intractable postpartum bleeding and is also useful for preserving fertility.

  17. Uterine artery embolization for uterine arteriovenous malformation in five women desiring fertility: pregnancy outcomes.

    Science.gov (United States)

    Vilos, Angelos G; Vilos, George A; Hollett-Caines, Jackie; Rajakumar, Chandrew; Garvin, Greg; Kozak, Roman

    2015-07-01

    Uterine arteriovenous malformations (AVM) are rare and can be classified as either congenital or acquired. Acquired AVMs may result from trauma, uterine instrumentation, infection or gestational trophoblastic disease. The majority of acquired AVMs are encountered in women of reproductive age with a history of at least one pregnancy. Traditional therapies of AVMs include medical management of symptomatic bleeding, blood transfusions, uterine artery embolization (UAE) or hysterectomy. In this retrospective case series, we report our experience with AVM and UAE in five symptomatic women of reproductive age who wished to preserve fertility. Patients were 18-32 years old, and had 1-3 previous pregnancies prior to initial presentation. All patients were followed until their deliveries. All five patients delivered live births. Three of the five patients required two embolization procedures and one of these women required a subsequent hysterectomy. Two deliveries were at term and had normal weight babies and normal placenta. One woman had cerclage placed and developed chorioamnionitis at 34 weeks but had a normal placenta. Two pregnancies were induced AVM as previously thought and should be questioned as an initial therapy in symptomatic women of reproductive age desiring fertility preservation. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Uterine artery embolization with and without local methotrexate infusion for the treatment of cesarean scar pregnancy.

    Science.gov (United States)

    Qi, Feng; Zhou, Wei; Wang, Mei-Fen; Chai, Ze-Ying; Zheng, Ling-Zhi

    2015-08-01

    To compare the clinical value of uterine artery embolization (UAE) with local methotrexate (MTX) infusion to embolization without MTX in the treatment of cesarean scar pregnancies (CSPs). From January 2009 to December 2013, 50 patients with CSP treated with UAE receiving or not receiving local MTX infusion prior to curettage were analyzed retrospectively. Twenty-two patients were offered UAE with local MTX infusion prior to curettage (UAE + MTX group), whereas 28 patients received UAE alone prior to curettage (UAE group). Clinical data and the outcomes were analyzed, followed by a brief review of the published literature summarizing what is known about UAE with and without MTX for the treatment of CSP. UAE was successful in 42 of 50 cases (84%), with complications occurring in only five patients. There were no significant differences in the success rate, complication rate, recovery time, or hospitalization costs between the UAE + MTX group and the UAE group. However, blood loss in the UAE + MTX group was significantly higher than in the UAE group. UAE with or without local MTX infusion might be an effective treatment for CSP. Compared with UAE alone, UAE with local MTX infusion did not dramatically improve the therapeutic effect of UAE. A larger and more comprehensive random control study is warranted to better evaluate the therapeutic effects of UAE in the treatment of CSP. Copyright © 2015. Published by Elsevier B.V.

  19. Effectiveness of intra-arterial anesthesia for uterine fibroid embolization using dilute lidocaine

    Energy Technology Data Exchange (ETDEWEB)

    Zhan, Songhua; Li, Yi; Wang, Guoliang; Han, Hongjie; Yang, Zhenyan [Tongji Hospital of Tongji University, Department of Radiology, Shanghai (China)

    2005-08-01

    A modified protocol of uterine fibroid embolization (UFE) is proposed for alleviating the postinterventional pain. This randomized and double-blinded clinical trial is to evaluate the effectiveness of intra-arterial infusion of dilute lidocaine for postinterventional pain relief in UFE. Forty-six patients who underwent UFE were randomly grouped equally. In the test group, after the poly(vinyl alcohol) embolization was complete, a dilute lidocaine solution with 40 mg in 6.0 ml, 3.0 ml for each side or 4.0 and 2.0 ml for two sides, was given through the catheter. In the control group, the patients received 6.0 ml of saline solution as a placebo. A simple pain degree classification method for patient self-evaluation was developed. A questionnaire was completed by each patient to record the degree of pain during five periods; these were during the procedure, the first 12 h, the second 12 h, between 24 and 48 h, and between 48 and 72 h. The numbers of patients with the same degree of pain in the five time segments from the two groups were statistically compared. Compared with the control group, the patients in the test group experienced less pain within 48 h after the procedure (p<0.01). The results suggest that this improved UFE protocol is a simple approach to prevent the acute postinterventional pain of UFE. (orig.)

  20. Imaging before and after uterine artery embolization; Bildgebende Diagnostik vor und nach Uterusmyomembolisation

    Energy Technology Data Exchange (ETDEWEB)

    Kroencke, T.J. [Charite - Universitaetsmedizin Berlin, Radiologische Klinik, Campus Virchow-Klinikum, Berlin (Germany)

    2008-07-15

    Percutaneous catheter-based embolization treatment of symptomatic uterine fibroids has evolved into the most widely used alternative therapeutic approach to surgical treatment worldwide. Uterine artery embolization (UAE) induces infarction of leiomyomas, resulting in ischemic necrosis, hyaline degeneration, and size reduction with resolution of associated symptoms. Published experience suggests that UAE is an effective and reliable option for treating uterine fibroids with high patient satisfaction. Magnetic resonance imaging (MRI) is superior to ultrasonography for determining the site, size and number of fibroids, which is important for establishing the indication for UAE. Other potential advantages of MRI include the option of performing MR angiography (MRA) and obtaining contrast-enhanced images for monitoring the outcome of UAE and assessing possible complications after UAE. (orig.) [German] Die perkutane kathetergestuetzte Uterusmyomembolisation ist inzwischen weltweit die am meisten verbreitete Alternative zur operativen Behandlung des symptomatischen Uterus myomatosus. Der durch Embolisation der Aa. uterinae (Syn. Uterusarterienembolisation, UAE) bewirkte 'Myominfarkt' fuehrt zu ischaemischer Nekrose, hyalinem Umbau und Groessenreduktion der Myome unter Rueckbildung myomassoziierter Beschwerden. Die bisher publizierten Erfahrungen zeigen, dass es sich bei der Embolisation um eine effektive und sichere Methode mit hoher Patientinnenzufriedenheit handelt. Die Magnetresonanztomographie (MRT) ist dem Ultraschall in der fuer die Indikationsstellung wichtigen Beurteilung von Lage, Groesse und Zahl der Myomknoten ueberlegen. Weitere moegliche Vorteile ergeben sich durch den Einsatz der MR-Angiographie (MRA) sowie kontrastmittelunterstuetzter Aufnahmen zur Erfolgskontrolle und Abklaerung von Komplikationen nach Embolisation. (orig.)

  1. Transcatheter arterial embolization of ruptured hepatocellular carcinoma : effectiveness and long-term follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Eai Hong; Kim, Jae Kyu; Jeong, Yong Yeon; Cha, Sung Ho; Chung, Tae Woong; Kim, Yn Hyeon; Kim, Byoung Jin; Seo, Jeong Jin; Kang, Heoung Keun [Chonnam National Univ., Kwangju (Korea, Republic of). Medical School

    1998-01-01

    To evaluate the effectiveness of emergent transcatheter arterial embolization (TAE) in the treatment of bleeding from ruptured hepatocellular carcinoma(HCC) and long-term follow-up. Technical and clinical success was up to 100%. Mesoportography showed the presence of portal vein thrombosis in nine patients and its absence in 11. In 15 patients, three weeks of follow-up by CT showed lipiodol uptake by the mass and the disappearance of highly attenuated peritoneal fluid. Within one week of embolization, four of the 20 patients died of sepsis, shock, and hepatic failure, and within one month of this procedure, one died of renal failure. Three-month, six-month, and one-year survival rate was 11%, while in 11%, while in 11 patients not suffering from this condition, the rate was 70%: the difference between the two groups was statistically significant (p < 0.05). As the first choice of treatment for patients with hemoperitoneum from ruptured HCC, emergent TAE is an effective, life-saving therapeutic procedure: in these patients, portal vein thrombosis may be a factor influencing risk and prognosis. (author). 18 refs., 4 figs.

  2. Superselective transcather arterial embolization for hepatocellular carcinoma with a mixture of ethanol and lipiodol

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Han, Joon Koon; Choi, Byung Ihn; Han, Man Chung [Seoul National University, College of Medicine, Seoul (Korea, Republic of)

    1992-05-15

    To evaluate the effectiveness of superselective transcatheter arterial embolization (STAE) for hepatocellular carcinoma (HCC) with a mixture of ethanol and Lipiodol, STAE was done in 12 male patients with HCC. There were diagnosed clinically with angiographic findings and elevated alphafetprotein levels and three were recurrent tumors after surgery. Sono-guided aspiration biopsy proved the diagnosis of hepatocellular carcinoma in another six patients. The tumor was a small single nodule (2-5cm in diameter) in 11 patients. In one patient, two nodules were found. Superselective catheterization was done using 3F Tracker catheter (Target Therapeutics USA) coaxially through 6F catheter into the feeding hepatic artery, usually the third order branch. One to four cc of 75% ethanol mixed with Lipiodol was infused under fluoroscopy immediately after injection of 2% lidocaine. Immediate angiography and CT after 2 weeks were undertaken. Complete segmental or subsegmental devascularization including feeding arteries and tumor vascularities occurred in all patients. Follow-up angiography after 6 to 15 months revealed the tumor opacified by Lipiodol. The tumor decreased in 5 cases and recurrence was found in three patients. CT taken 2 weeks after STAE showed low density halo around the tumor in 5 cases. Subsequent segmentectomy in four patients revealed total or near total necrosis of the tumor and no evidence of damage in surrounding parenchyma. STAE for HCC with a mixture of ethanol and Lipiodol is an effective and safe measure for small HCC.

  3. Coronary artery embolism from infectious endocarditis treated with catheter thrombectomy using a GuideLiner catheter.

    Science.gov (United States)

    Oestreich, Brett A; Sommer, Per; Armstrong, Ehrin J

    2016-04-01

    A 27-year-old male with history of IV drug use and recurrent endocarditis necessitating bioprosthetic mitral and tricuspid valve replacements presented with 2 weeks of fevers and chest pain. ECG revealed inferior ST-elevation myocardial infarction and he was taken urgently to the cardiac catheterization laboratory. Coronary angiography revealed thrombotic occlusion of the distal right coronary artery (RCA) with no angiographic evidence of atherosclerotic disease. Aspiration thrombectomy was performed followed by rheolytic thrombectomy. Despite multiple attempts at thrombectomy, significant residual organized thrombus persisted in the distal RCA. Therefore, further thrombectomy was performed by placing a GuideLiner catheter (Vascular Solutions, Minneapolis, MN) deep within the right coronary artery near the bifurcation into the posterior descending and posterior left ventricular arteries. After repeat aspiration, there was significant improvement with thrombolysis in myocardial infarction 3 flow. Intravascular ultrasound of the RCA revealed a normal-appearing vessel without evidence of atherosclerotic disease and mild residual thrombus. The decision was made to not pursue stent placement, given the concern for a likely embolic source. Following the procedure, the patient's chest pain resolved and his ST-segments normalized. © 2015 Wiley Periodicals, Inc.

  4. Efficacy and Safety of Prostatic Arterial Embolization: Systematic Review with Meta-Analysis and Meta-Regression.

    Science.gov (United States)

    Shim, Sung Ryul; Kanhai, Karan J K; Ko, Young Myoung; Kim, Jae Heon

    2017-02-01

    This study attempted to overcome the limitations of previous systematic reviews to determine the overall treatment efficacy and safety of prostatic arterial embolization compared with standard therapy. Meta-analyses were done of randomized, controlled and single group trials. Meta-regression analysis of the moderator effect was performed with single group analysis. The outcomes measured were mean changes in I-PSS (International Prostate Symptom Score), quality of life, maximal urinary flow rate, prostate volume, post-void residual volume and prostate specific antigen. Adverse events were compared as proportional differences between the embolization group and groups receiving other therapies in comparative studies. A total of 16 studies met our selection criteria and were included in the meta-analysis. Three studies were comparative and included a total of 297 subjects, including 149 in the experimental groups and 148 in the control groups. The other 13 studies were noncomparative and included a total of 750 experimental subjects. Pooled overall standardized mean differences for embolization in I-PSS, maximal urinary flow rate and prostate volume were significantly impaired in the experimental vs control groups. Overall weighted mean differences for all outcomes except prostate specific antigen were significantly improved from baseline by embolization treatment in noncomparative studies. Sensitivity analysis of study duration showed that all outcome measurements did not differ before vs after 6 months. Although there is growing evidence of the efficacy and safety of prostatic arterial embolization for benign prostatic hyperplasia, this systematic review using meta-analysis and meta-regression showed that prostatic arterial embolization should still be considered an experimental treatment modality. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  5. Prostatic Arterial Embolization for Control of Hematuria in Patients with Advanced Prostate Cancer.

    Science.gov (United States)

    Chen, Jhih-Wei; Shin, Ji Hoon; Tsao, Teng-Fu; Ko, Heung-Gyu; Yoon, Hyun-Ki; Han, Ki-Chang; Thamtorawat, Somrach; Hong, Bumsik

    2017-02-01

    Nine patients with advanced prostate cancer (stage T4) underwent prostatic arterial embolization (PAE) for refractory prostatic hematuria. Angiograms showed prostatic neovascularity in all cases, and complete PAE was achieved in 8 cases (89% technical success rate). Gross hematuria ceased after PAE in 6 cases, translating to a 67% clinical success rate. There were no PAE-related complications. At 3-month follow-up, 2 cases showed recurrent hematuria, 4 patients had died from PAE-unrelated etiologies, and only 3 patients survived and were without gross hematuria. PAE could represent an alternative option for patients with advanced prostate cancer to control hematuria. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  6. Transcatheter Arterial Embolization Using Ethanol in a Dialysis Patient for Contracting Enlarged Polycystic Kidneys

    Energy Technology Data Exchange (ETDEWEB)

    Rim, Hark; Jung, Gyoo Sik; Jung, Yeon Soon [Kosin University College of Medicine, Gospel Hospital, Busan (Korea, Republic of)

    2010-10-15

    The mass effect of nephromegaly in patients with autosomal dominant polycystic kidney disease may cause pain and symptoms by compressing the alimentary tract, lungs, and heart. Conventional therapies exist to contract enlarged polycystic kidneys including surgical and interventional procedures. A surgical nephrectomy is often difficult to perform in dialysis patients due to the associated risks related to surgery. In contrast, renal transcatheter arterial embolization (TAE) with metallic coils, which is a less invasive interventional procedure, can also be utilized to contract enlarged kidneys in dialysis patients as an effective treatment. However, metallic coils present the possibility of recanalization and cost issues. Thus, we used ethanol instead of coils in renal TAE to resolve these issues. We report a dialysis patient with enlarged polycystic kidneys and poor oral intake due to abdominal distention that was successfully treated by TAE with absolute ethanol

  7. Prostatic Artery Embolization as an Alternative to Indwelling Bladder Catheterization to Manage Benign Prostatic Hyperplasia in Poor Surgical Candidates

    Energy Technology Data Exchange (ETDEWEB)

    Rampoldi, Antonio; Barbosa, Fabiane, E-mail: fabiane001@hotmail.com [Ospedale Niguarda Ca’ Granda, Department of Interventional Radiology (Italy); Secco, Silvia [Ospedale Niguarda Ca’ Granda, Department of Urology (Italy); Migliorisi, Carmelo [Ospedale Niguarda Ca’ Granda, Department of Interventional Radiology (Italy); Galfano, Antonio; Prestini, Giovanni [Ospedale Niguarda Ca’ Granda, Department of Urology (Italy); Harward, Sardis Honoria [Dartmouth-Hitchcock Medical Center, The Dartmouth Institute for Health Policy and Clinical Practice (United States); Trapani, Dario Di [Ospedale Niguarda Ca’ Granda, Department of Urology (Italy); Brambillasca, Pietro Maria; Ruggero, Vercelli; Solcia, Marco [Ospedale Niguarda Ca’ Granda, Department of Interventional Radiology (Italy); Carnevale, Francisco Cesar [University of Sao Paulo Medical School, Department of Interventional Radiology (Brazil); Bocciardi, Aldo Massimo [Ospedale Niguarda Ca’ Granda, Department of Urology (Italy)

    2017-04-15

    PurposeTo prospectively assess discontinuation of indwelling bladder catheterization (IBC) and relief of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) following prostate artery embolization (PAE) in poor surgical candidates.MethodsPatients ineligible for surgical intervention were offered PAE after at least 1 month of IBC for management of urinary retention secondary to BPH; exclusion criteria for PAE included eligibility for surgery, active bladder cancer or known prostate cancer. Embolization technical and clinical success were defined as bilateral prostate embolization and removal of IBC, respectively. Patients were followed for at least 6 months and evaluated for International Prostate Symptom Score, quality of life, prostate size and uroflowmetric parameters.ResultsA total of 43 patients were enrolled; bilateral embolization was performed in 33 (76.7%), unilateral embolization was performed in 8 (18.6%), and two patients could not be embolized due to tortuous and atherosclerotic pelvic vasculature (4.7%). Among the patients who were embolized, mean prostate size decreased from 75.6 ± 33.2 to 63.0 ± 23.2 g (sign rank p = 0.0001, mean reduction of 19.6 ± 17.3%), and IBC removal was achieved in 33 patients (80.5%). Clavien II complications were reported in nine patients (21.9%) and included urinary tract infection (three patients, 7.3%) and recurrent acute urinary retention (six patients, 14.6%). Nine patients (22.0%) experienced post-embolization syndrome.ConclusionsPAE is a safe and feasible for the relief of LUTS and IBC in highly comorbid patients without surgical treatment options.

  8. Mechanical Recanalization of Cerebral Artery Embolic Occlusion Using a Self-Expanding Stent: Experimental Analysis in Canine Model

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo; Kim, Snag Joon; Lee, Deok Hee; Suh, Dae Chul [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2011-07-15

    To evaluate the feasibility of a self-expanding stent for acute embolic occlusion, and recanalization mechanism by histologic examination. Five mongrel dogs were used as study subjects. Each vertebral artery was occluded, and a self-expanding stent was used for recanalization. We evaluated the technical success rate for the placement of the stent to the targeted vessel, the recanalization rate, and residual stenosis. We obtained two specimens of the stented vertebral arteries for histologic evaluation. One dog died of an unknown cause during the induction of anesthesia. In two dogs, only one side of the vertebral artery was used, whereas both vertebral arteries were used in the remaining dogs. A total of six vertebral arteries were successfully occluded. The technical success rate for stenting without complication was 66.7%. The immediate recanalization rate after stenting was 100%. The residual stenosis was 35.6 {+-} 18.6%. On microscopic examination, the stent concentrically displaced the clot and the clot was captured between the stent mesh and arterial wall. Self-expanding stents were effective in revascularizing the cerebrovascular embolic occlusion. The self-expanding stent seemed to achieve recanalization by pushing the clot to the arterial wall and capturing the clot between the stent mesh and arterial wall.

  9. Analysis of the Quality of Information Obtained About Uterine Artery Embolization From the Internet

    Energy Technology Data Exchange (ETDEWEB)

    Tavare, Aniket N. [British Medical Association House, British Medical Journal Group (United Kingdom); Alsafi, Ali, E-mail: ali.alsafi03@imperial.ac.uk; Hamady, Mohamad S. [St. Mary' s Hospital, Imaging Department (United Kingdom)

    2012-12-15

    Purpose: The Internet is widely used by patients to source health care-related information. We sought to analyse the quality of information available on the Internet about uterine artery embolization (UAE). Materials and Methods: We searched three major search engines for the phrase 'uterine artery embolization' and compiled the top 50 results from each engine. After excluding repeated sites, scientific articles, and links to documents, the remaining 50 sites were assessed using the LIDA instrument, which scores sites across the domains of accessibility, usability, and reliability. The Fleisch reading ease score (FRES) was calculated for each of the sites. Finally, we checked the country of origin and the presence of certification by the Health On the Net Foundation (HONcode) as well as their effect on LIDA and FRES scores.ResultsThe following mean scores were obtained: accessibility 48/60 (80%), usability 42/54 (77%), reliability 20/51 (39%), total LIDA 110/165 (67%), and FRES 42/100 (42%). Nine sites had HONcode certification, and this was associated with significantly greater (p < 0.05) reliability and total LIDA and FRES scores. When comparing sites between United Kingdom and United States, there was marked variation in the quality of results obtained when searching for information on UAE (p < 0.05). Conclusion: In general, sites were well designed and easy to use. However, many scored poorly on the reliability of their information either because they were produced in a non-evidence-based way or because they lacking currency. It is important that patients are guided to reputable, location-specific sources of information online, especially because prominent search engine rank does not guarantee reliability of information.

  10. Successful Coil Embolization of Pediatric Carotid Cavernous Fistula Due to Ruptured Posttraumatic Giant Internal Carotid Artery Aneurysm.

    Science.gov (United States)

    Wajima, Daisuke; Nakagawa, Ichiro; Park, Hun Soo; Yokoyama, Shohei; Wada, Takeshi; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2017-02-01

    The goal of the treatment of direct carotid cavernous fistula (CCF) is to occlude the arteriovenous shunt and to preserve the patency of the concerned internal carotid artery. However, for the ipsilateral posttraumatic fragile cerebrum, coil embolization plus parent artery occlusion for the high-flow direct CCF is better for the prevention of hyperperfusion syndrome and intracranial hemorrhage. We experienced such a case and managed it successfully. A 6-year-old boy had severe head trauma caused by being hit by a car. He was transferred to our department and diagnosed as having left acute subdural hematoma and acute brain swelling. Emergent evacuation of hematoma and external decompression were performed. He was treated for severe brain swelling in the intensive care unit for 2 months. Cranioplasty was performed 3 months after the injury. His right hemiparesis and aphasia persisted, so he was transferred to a rehabilitation hospital. However, 2 years after the head injury, he was referred to our department because of abducens nerve palsy. He was diagnosed as having a symptomatic posttraumatic direct CCF, which was caused by a ruptured left cavernous giant internal carotid artery aneurysm. The direct CCF was treated with coil embolization of the giant aneurysm and parent artery occlusion. Coil embolization of the aneurysm and parent artery occlusion for the posttraumatic direct CCF was a good option to manage the abducens nerve palsy and to prevent postoperative hyperperfusion. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Blunt renal trauma: comparison of contrast-enhanced CT and angiographic findings and the usefulness of transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kitase, M.; Mizutani, M.; Tomita, H.; Kono, T.; Sugie, C.; Shibamoto, Y. [Nagoya City University, Nagoya, (Japan). Graduate School of Medical Sciences. Dept. of Radiology

    2007-07-15

    Full text: Background: The purpose of this study was to evaluate the role of contrast-enhanced CT and the usefulness of super selective embolization therapy in the management of arterial damage in patients with severe blunt renal trauma. Patients and Methods: Nine cases of severe renal trauma were evaluated. In all cases, we compared contrast enhanced CT findings with angiographic findings, and performed transcatheter arterial embolization (TAE) in six of them with microcoils and gelatin sponge particles. Morphological changes in the kidney and site of infarction after TAE were evaluated on follow-up CT Chronological changes in blood biochemistry findings after injury, degree of anemia and renal function were investigated. Adverse effects or complications such as duration of hematuria, fever, abdominal pain, renovascular hypertension and abscess formation were also evaluated. Results: The CT finding of extravasation was a reliable sign of active bleeding and useful for determining the indication of TAE. In all cases, bleeding was effectively controlled with super selective embolization. There was minimal procedure-related loss of renal tissue. None of the patients developed abscess, hypertension or other complications. Conclusions: In blunt renal injury, contrast-enhanced CT was useful for diagnosing arterial hemorrhage. Arterial bleeding may produce massive hematoma and TAE was a useful treatment for such cases. By using selective TAE for a bleeding artery, it was possible to minimize renal parenchymal damage, with complications of TAE rarely seen. (author)

  12. Emergent embolization for control of massive hemorrhage from a splanchnic artery with a new coaxial catheter system

    Energy Technology Data Exchange (ETDEWEB)

    Okazaki, M.; Higashihara, H.; Koganemaru, F.; Ono, H.; Fujimitsu, R.; Yamasaki, S.; Toyoshima, H.; Sato, S.; Hoashi, T.; Kimura, T. (Fukuoka Univ. Hospital (Japan). Dept. of Diagnostic Radiology)

    1992-01-01

    Emergent superselective embolization with a 3.0 F (1 mm) coaxial catheter and a steerable guidewire was performed in 27 patients with massive hemorrhage from a small-caliber splanchnic artery. Eight patients had intraperitoneal hemorrhage, 3 had hemobilia, 9 had gastric hemorrhage, and 7 had intestinal hemorrhage. Out of 27 patients, 7 had hemorrhage from a splanchnic artery pseudoaneurysm. Complete cessation of bleeding was obtained in all patients initially, but in 3 patients gastric hemorrhage recurred later. Otherwise, there was no rebleeding nor any major complication such as marked infarction of tissue or misplacement of embolic materials. This coaxial catheter system was highly reliable for achieving superselective catheterization in small-caliber arteries, minimizing the volume of infarcted tissue and allowing maximal preservation of splanchnic organic function. We conclude that this system represents a major advance in interventional radiology. (orig.).

  13. [A case of urinary incontinence due to hypoplastic kidney with an ectopic ureteral opening: successful treatment with transcatheter arterial embolization].

    Science.gov (United States)

    Ohzeki, Takayuki; Mori, Yasunori; Hashimoto, Kiyoshi; Katoh, Yoshinari; Iguchi, Masanori; Sawai, Yuka

    2010-11-01

    We report a 21-year-old woman,who presented with a major complaint of urinary incontinence without dry time. On the basis of computed tomographic examination and vaginography,she was diagnosed as having a hypoplastic left kidney with a solitary ectopic ureteral opening on the left. Transcatheter arterial embolization of the renal artery using anhydrous ethanol was conducted for renal ablation. No postoperative complications were noted,and the symptoms of urinary incontinence were eliminated. Embolization of the renal artery for ablation of a hypoplastic kidney with symptoms can be achieved without laparotomy while causing little stress and few complications,with an outcome comparable to surgical nephrectomy. This procedure is expected to be adopted as a standard therapeutic modality in the future.

  14. Gelatin sponge particle embolization of spontaneously putured intrahepatic arterial aneurysms in a patient with polyarteritis nodosa: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Seol, Myung Jin; Noh, Kyung Hee; Kim, Young Jun; Jeon, Doo Sung [Dept. of Radiology, Presbyterian Medical Center, Jeonju (Korea, Republic of)

    2017-01-15

    Multiple intrahepatic arterial aneurysms and spontaneous aneurysmal rupture associated with polyarteritis nodosa leading to hemoperitoneum are extremely rare occurrences, but the conditions can be life-threatening if left untreated because of the risk of massive hemorrhage. We report a case of a high-risk surgical patient with polyarteritis nodosa complicated by spontaneous rupture of multiple intrahepatic arterial aneurysms. He was initially treated with emergency gelatin sponge particle embolization, followed by maintenance steroid treatment. Complete resolution of intrahepatic arterial aneurysms was observed at follow-up.

  15. [Analysis of clinical prognosis and the correlation between bile duct injury after transcatheter arterial chemoembolization and the level of hepatic arterial embolization in patients with hepatocellular carcinoma].

    Science.gov (United States)

    Xu, H Y; Yu, X P; Feng, R; Hu, H J; Xiao, W W

    2017-05-23

    Objective: To evaluate the correlation between bile duct injury after transcatheter arterial chemoembolization and the level of hepatic arterial embolization, and to analyze the clinical prognosis of hepatocellular carcinoma patients. Methods: From January18, 2012 to December18, 2014, 21 patients underwent TACE for HCC were retrospectively reviewed, including patients' clinical and pathological data. The clinical outcome and relevant factors for bile duct injury were analyzed. Results: A total of 21 patients were identified with bile duct injury at our single institution. All patients received 48 TACE treatments, including proper hepatic artery (14), left hepatic artery (3), the right hepatic artery (10), left and right hepatic artery (9) and tumor artery branches (12). Thirty-five bile duct injury occurred in 21 patients: 7 cases was close to the tumor, 2 distant to the tumor, 7 at right liver, 2 left liver, 11 both lobes of liver and 6 hepatic hilar. After medical conservative treatment and biliary tract inside and outside drainage, liver function of 10 cases were improved. In four patients with hepatic bile duct stricture and biloma, the effect of drainage was not obvious, which subsequently caused biliary complications such as infection, gallbladder and common bile duct stones. Three patients with liver cirrhosis at decompensation stage developed complications, and one of them died of hepatic encephalopathy. Four patients experienced tumor recurrence during the follow-up period. Conclusions: The location of bile duct injury after transcatheter arterial chemoembolization is quite consistent with the level of hepatic arterial embolization. There may be some blood vessels mainly involved in blood supply of biliary duct. Complete embolism of these vessels may lead to bile duct injuries. Biliary drainage is ineffective in patients with hilar bile duct stricture, and can lead to complications of biliary tract later on.

  16. Prostate Artery Embolization for Complete Urinary Outflow Obstruction Due to Benign Prostatic Hypertrophy.

    Science.gov (United States)

    Yu, Simon Chun Ho; Cho, Carmen Chi Min; Hung, Esther Hiu Yee; Chiu, Peter Ka Fung; Yee, Chi Hang; Ng, Chi Fai

    2017-01-01

    We aimed to evaluate the effectiveness of PAE in weaning of catheter and relieving obstructive urinary symptoms in patients with acute urinary retention (AUR) due to benign prostatic hypertrophy (BPH) and failed trial without catheter (TWOC). In this prospective study approved by the institutional review board, a signed informed consent was obtained. Eighteen consecutive patients with AUR due to BPH and failed TWOC were recruited. Nineteen consecutive patients with BPH but without AUR were recruited as a control. Patients with CTA evidence of arterial occlusion or significant stenosis along the prostate artery access path were excluded. PAE was performed using microspheres (100-300 μm diameter). Outcome assessment included successful weaning of catheter in 2 weeks, procedure-related complications, change of symptomatology and urodynamic findings at 1 month as compared to baseline, percent non-perfused prostate volume, and prostate volume reduction on MRI at 2 weeks. Two patients in the study group and four in the control group were excluded due to arterial pathology. Embolization of bilateral prostate arteries was achieved in all patients in both the groups (100%). There was no complication. The catheter was successfully weaned in 87.5% (14/16) of patients within 14 days in the treatment group. There was no significant difference in patient demographics, prostate characteristics, and all outcome assessment parameters between both the groups. PAE was probably safe and effective in weaning of catheter and relieving obstructive urinary symptoms in patients due to BPH, with treatment outcomes comparable to those without AUR.

  17. Prostate Artery Embolization for Complete Urinary Outflow Obstruction Due to Benign Prostatic Hypertrophy

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Simon Chun Ho, E-mail: simonyu@cuhk.edu.hk; Cho, Carmen Chi Min; Hung, Esther Hiu Yee [The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology (Hong Kong); Chiu, Peter Ka Fung; Yee, Chi Hang; Ng, Chi Fai [The Chinese University of Hong Kong, Department of Surgery, Prince of Wales Hospital (Hong Kong)

    2017-01-15

    BackgroundWe aimed to evaluate the effectiveness of PAE in weaning of catheter and relieving obstructive urinary symptoms in patients with acute urinary retention (AUR) due to benign prostatic hypertrophy (BPH) and failed trial without catheter (TWOC).Materials and MethodsIn this prospective study approved by the institutional review board, a signed informed consent was obtained. Eighteen consecutive patients with AUR due to BPH and failed TWOC were recruited. Nineteen consecutive patients with BPH but without AUR were recruited as a control. Patients with CTA evidence of arterial occlusion or significant stenosis along the prostate artery access path were excluded. PAE was performed using microspheres (100–300 μm diameter). Outcome assessment included successful weaning of catheter in 2 weeks, procedure-related complications, change of symptomatology and urodynamic findings at 1 month as compared to baseline, percent non-perfused prostate volume, and prostate volume reduction on MRI at 2 weeks.ResultsTwo patients in the study group and four in the control group were excluded due to arterial pathology. Embolization of bilateral prostate arteries was achieved in all patients in both the groups (100%). There was no complication. The catheter was successfully weaned in 87.5% (14/16) of patients within 14 days in the treatment group. There was no significant difference in patient demographics, prostate characteristics, and all outcome assessment parameters between both the groups.ConclusionsPAE was probably safe and effective in weaning of catheter and relieving obstructive urinary symptoms in patients due to BPH, with treatment outcomes comparable to those without AUR.

  18. Short-term outcomes following elective transcatheter arterial embolization for splenic artery aneurysms: data from a nationwide administrative database.

    Science.gov (United States)

    Naganuma, Michio; Matsui, Hiroki; Koizumi, Jun; Fushimi, Kiyohide; Yasunaga, Hideo

    2015-09-01

    Splenic artery aneurysm (SAA) rupture is life-threatening. Although elective transcatheter arterial embolization (TAE) suggested low in-hospital death in previous studies, there has been no large multi-center study of elective TAE for SAA. To examine the short-term outcomes of TAE for splenic artery aneurysm (SAA) and analyze the factors associated with the outcomes, including liver cirrhosis, using a nationwide administrative inpatient database. We identified patients who received elective TAE with a principal diagnosis of SAA. We assessed the patient background characteristics, comprising age, sex, and specific co-morbidities, including liver cirrhosis. The outcomes included the rate of TAE-related complications (acute pancreatitis, splenic infarction, splenic abscess, or intraperitoneal hematoma), length of stay, and in-hospital mortality. Among 18.3 million inpatients in the database between July 2010 and March 2013, we identified 534 patients who received elective TAE for SAA at 229 participating hospitals. Fifty-four (10.1%) patients had liver cirrhosis. No in-hospital deaths were observed. Thirty-two (6.0%) patients had at least one TAE-related complication. A multivariate linear regression analysis revealed that liver cirrhosis was significantly associated with longer length of stay (9.5 days; 95% confidence interval [CI], 7.0-12.0 days; P < 0.001). A logistic regression analysis showed that liver cirrhosis was not significantly associated with TAE-related complications (odds ratio, 0.99; 95% CI, 0.29-3.39; P = 0.980). The results revealed no in-hospital mortality and a low complication rate associated with elective TAE for SAA including liver cirrhosis patients.

  19. Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 2, Insights into the Technical Rationale

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Fei, E-mail: feisun@ccmijesususon.com; Crisóstomo, Verónica, E-mail: crisosto@ccmijesususon.com; Báez-Díaz, Claudia, E-mail: cbaez@ccmijesususon.com; Sánchez, Francisco M., E-mail: msanchez@ccmijesususon.com [Jesús Usón Minimally Invasive Surgery Centre (Spain)

    2016-02-15

    Rationale of prostatic artery embolization (PAE) in the treatment of symptomatic benign prostatic hyperplasia is conventionally believed to include two parts: shrinkage of the enlarged prostate gland as a result of PAE-induced ischemic infarction and potential effects to relax the increased prostatic smooth muscle tone by reducing the number and density of α{sub 1}-adrenergic receptor in the prostate stroma. This review describes new insights into the likely mechanisms behind PAE, such as ischemia-induced apoptosis, apoptosis enhanced by blockage of androgens circulation to the embolized prostate, secondary denervation following PAE, and potential effect of nitric oxide pathway immediately after embolization. Studies on therapeutic mechanisms in PAE may shed light on potentially new treatment strategies and development of novel techniques.

  20. Bariatric Arterial Embolization with Non-spherical Polyvinyl Alcohol Particles for Ghrelin Suppression in a Swine Model.

    Science.gov (United States)

    Kim, Jae Min; Kim, Man-Deuk; Han, Kichang; Muqmiroh, Lailatul; Kim, Seung Up; Kim, Gyoung Min; Kwon, Joonho; Park, Sung Il; Won, Jong Yun; Lee, Do Yun

    2017-05-01

    To evaluate the effect of bariatric arterial embolization (BAE) with non-spherical polyvinyl alcohol (PVA) particles on systemic ghrelin levels, weight change, and gastric ulceration risk in a swine model. From March 2014 to February 2015, ten healthy swine were used in the study (mean weight 31.5 kg; range 24.0-41.5 kg). The animals were randomly assigned to two groups: the embolized group (n = 5) in which BAE was performed and the control group (n = 5). In the embolized group, BAE was performed by selectively infusing 150-250 or 50-150 μm PVA into the gastric arteries that supplied the fundus of the stomach. In the control group, a sham procedure was performed with saline infusion. Plasma ghrelin levels were prospectively obtained at baseline and every 2 weeks thereafter. Endoscopy was performed 3 weeks after BAE to see whether any gastric ulcer occurred. To determine the durability of the occluded arteries, repeated celiac trunk angiography was performed 8 weeks after BAE. Then, all the swine were killed and necropsies were performed. The mean post-procedure ghrelin value decreased by 370.0 pg/mL in the embolized group at week 3 (mean 536.0 ± 334.3 pg/mL) and week 5 (mean 515.0 ± 150.0 pg/mL, p ghrelin levels were not significantly decreased between the embolized and control groups. There was a significant body weight change as follows: 35.1 ± 9.5 to 46.6 ± 15.7 kg and 31.8 ± 5.8 to 41.2 ± 6.6 kg at baseline and endpoint in the control and embolized groups, respectively (p ghrelin levels in embolized animals, but levels are not significantly different compared to controls. Stomach ulcerations were identified in 60% of the embolized animals.

  1. Large mobile thrombus in non-atherosclerotic thoracic aorta as the source of peripheral arterial embolism

    Directory of Open Access Journals (Sweden)

    Brkovic Zoran

    2005-11-01

    Full Text Available Abstract The presence of thrombi in the atherosclerotic and/or aneurysmatic aorta with peripheral arterial embolism is a common scenario. Thrombus formation in a morphologically normal aorta, however, is a rare event. A 50 years old woman was admitted to the mergency department for pain, coldness, and anesthesia in the the left foot. She had a 25 years history of cigarette smoking, a history of postmenopausal hormone replacement therapy (HRT, hypercholesterolemia and hyperfibrinogenemia. An extensive serologic survey for hypercoagulability, including antiphospholipid antibodies, and vasculitis disorders was negative. Transesophageal echocardiography revealed a large, pedunculated and hypermobile thrombus attached to the aortic wall 5 cm distal of the left subclavian artery. The patient was admitted to the surgery department, where a 15 cm long fresh, parietal thrombus could be removed from the aorta showing no macroscopic wall lesions or any other morphologic abnormalities. This case report demonstrates the possibility of evolving a large, pedunculated thrombus in a morphologically intact aorta in a postmenopausal woman with thrombogenic conditions such as hyperfibrinogenemia, hypercholesterolemia, smoking and HRT. For these patients, profiling the individual risk and weighing the benefits against the potential risks is warranted before prescribing HRT.

  2. EMBOLIZATION AND CHEMOEMBOLIZATION PROSTATIC ARTERIES OF BENIGN PROSTATIC HYPERPLASIA AND PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    N. B. Tabynbaev

    2017-01-01

    Full Text Available The article gives the results of the use of embolization of prostatic arteries in benign prostatic hyperplasia in 3 patients, two of whom have been with suprapubic drainage of the bladder. The patient was 120 ml without suprapubic drainage of the bladder residual urine. The age of patients was 68 to 70 years. According TRUS, the average prostate volume was 86.0 ± 12.6 cm3 . 4 patients» superselective prostatic artery chemoembolization was performed in prostate cancer. Chemicals for carrying out this procedure served adriamycin at a dose of 50 mg. Two of the four patients with prostate cancer was hormone-resistant form. Three patients had PCa T3b N0M0 stage T2bN0M0 histologically verified number Gleason 7, 7, 8, 9. All four had difficulty urinating, the amount of residual urine was 54 to 98 ml. As a source of transportation used chemotherapy microspheres (gepasfery size of 300–500 microns. Treatment outcomes assessed at one month. The efficiency of the methods for the treatment of benign prostatic hyperplasia and prostate cancer in the form of return of spontaneous urination, decrease in residual urine, reducing the prostate-specific antigen. 

  3. Antibody response to a T-cell-independent antigen is preserved after splenic artery embolization for trauma.

    Science.gov (United States)

    Olthof, D C; Lammers, A J J; van Leeuwen, E M M; Hoekstra, J B L; ten Berge, I J M; Goslings, J C

    2014-11-01

    Splenic artery embolization (SAE) is increasingly being used as a nonoperative management strategy for patients with blunt splenic injury following trauma. The aim of this study was to assess the splenic function of patients who were embolized. A clinical study was performed, with splenic function assessed by examining the antibody response to polysaccharide antigens (pneumococcal 23-valent polysaccharide vaccine), B-cell subsets, and the presence of Howell-Jolly bodies (HJB). The data were compared to those obtained from splenectomized patients and healthy controls (HC) who had been included in a previously conducted study. A total of 30 patients were studied: 5 who had proximal SAE, 7 who had distal SAE, 8 who had a splenectomy, and 10 HC. The median vaccine-specific antibody response of the SAE patients (fold increase, 3.97) did not differ significantly from that of the HC (5.29; P = 0.90); however, the median response of the splenectomized patients (2.30) did differ (P = 0.003). In 2 of the proximally embolized patients and none of the distally embolized patients, the ratio of the IgG antibody level postvaccination compared to that prevaccination was <2. There were no significant differences in the absolute numbers of lymphocytes or B-cell subsets between the SAE patients and the HC. HJB were not observed in the SAE patients. The splenic immune function of embolized patients was preserved, and therefore routine vaccination appears not to be indicated. Although the median antibody responses did not differ between the patients who underwent proximal SAE and those who underwent distal SAE, 2 of the 5 proximally embolized patients had insufficient responses to vaccination, whereas none of the distally embolized patients exhibited an insufficient response. Further research should be done to confirm this finding. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  4. Treatment of unresectable primary and metastatic liver cancer with yttrium-90 microspheres (TheraSphere): assessment of hepatic arterial embolization.

    Science.gov (United States)

    Sato, Kent; Lewandowski, Robert J; Bui, James T; Omary, Reed; Hunter, Russell D; Kulik, Laura; Mulcahy, Mary; Liu, David; Chrisman, Howard; Resnick, Scott; Nemcek, Albert A; Vogelzang, Robert; Salem, Riad

    2006-01-01

    In Canada and Europe, yttrium-90 microspheres (TheraSphere); MDS Nordion, Ottawa, Canada) are a primary treatment option for primary and secondary hepatic malignancies. We present data from 30 patients with hepatocellular carcinoma (HCC) and metastatic liver disease treated with TheraSphere from a single academic institution to evaluate the angiographically evident embolization that follows treatment. Seven interventional radiologists from one treatment center compared pretreatment and posttreatment angiograms. The reviewers were blinded to the timing of the studies. The incidence of postembolization syndrome (PES) was determined as well as objective tumor response rates by the World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), and European Association for the Study of the Liver (EASL) criteria. There were 420 independent angiographic observations that were assessed using the chi-squared statistic. The pretreatment and posttreatment angiograms could not be correctly identified on average more than 43% of the time (p = 0.0004). The postprocedure arterial patency rate was 100%. The objective tumor response rates for all patients were 24%, 31%, and 72% for WHO, RECIST, and EASL criteria, respectively. All of the patients tolerated the procedure without complications and were treated on an outpatient basis, and four patients had evidence of PES. This treatment method does not result in macroscopic embolization of the hepatic arteries, thereby maintaining hepatic tissue perfusion. These data support the principle that the favorable response rates reported with TheraSphere are likely due to radiation and microscopic embolization rather than flow-related macroscopic embolization and ischemia.

  5. High-resolution computed tomography evaluation of the bronchial lumen to vertebral body diameter and pulmonary artery to vertebral body diameter ratios in anesthetized ventilated normal cats.

    Science.gov (United States)

    Lee-Fowler, Tekla M; Cole, Robert C; Dillon, A Ray; Tillson, D Michael; Garbarino, Rachel; Barney, Sharron

    2017-10-01

    Objectives Bronchial lumen to pulmonary artery diameter (BA) ratio has been utilized to investigate pulmonary pathology on high-resolution CT images. Diseases affecting both the bronchi and pulmonary arteries render the BA ratio less useful. The purpose of the study was to establish bronchial lumen diameter to vertebral body diameter (BV) and pulmonary artery diameter to vertebral body diameter (AV) ratios in normal cats. Methods Using high-resolution CT images, 16 sets of measurements (sixth thoracic vertebral body [mid-body], each lobar bronchi and companion pulmonary artery diameter) were acquired from young adult female cats and 41 sets from pubertal female cats. Results Young adult and pubertal cat BV ratios were not statistically different from each other in any lung lobe. Significant differences between individual lung lobe BV ratios were noted on combined age group analysis. Caudal lung lobe AV ratios were significantly different between young adult and pubertal cats. All other lung lobe AV ratios were not significantly different. Caudal lung lobe AV ratios were significantly different from all other lung lobes but not from each other in both the young adult and pubertal cats. Conclusions and relevance BV ratio reference intervals determined for individual lung lobes could be applied to both young adult and pubertal cats. Separate AV ratios for individual lung lobes would be required for young adult and pubertal cats. These ratios should allow more accurate evaluation of cats with concurrent bronchial and pulmonary arterial disease.

  6. Robotic-Assisted Versus Manual Prostatic Arterial Embolization for Benign Prostatic Hyperplasia: A Comparative Analysis.

    Science.gov (United States)

    Bagla, Sandeep; Smirniotopoulos, John; Orlando, Julie C; Piechowiak, Rachel

    2017-03-01

    Prostatic artery embolization (PAE) is a safe and efficacious procedure for benign prostatic hyperplasia (BPH), though is technically challenging. We present our experience of technical and clinical outcomes of robotic and manual PAE in patients with BPH. IRB-approved retrospective study of 40 consecutive patients 49-81 years old with moderate or severe grade BPH from May 2014 to July 2015: 20 robotic-assisted PAE (group 1), 20 manual PAE (group 2). Robotic-assisted PAE was performed using the Magellan Robotic System. American Urological Association (AUA-SI) score, cost, technical and clinical success, radiation dose, fluoroscopy, and procedure time were reviewed. Statistical analysis was performed within and between each group using paired t test and one-way analysis of variance respectively, at 1 and 3 months. No significant baseline differences in age and AUA-SI between groups. Technical success was 100% (group 1) and 95% (group 2). One unsuccessful subject from group 2 returned for a successful embolization using robotic assistance. Fluoroscopy and procedural times were similar between groups, with a non-significant lower patient radiation dose in group 1 (30,632.8 mGy/cm2 vs 35,890.9, p = 0.269). Disposable cost was significantly different between groups with the robotic-assisted PAE incurring a higher cost (group 1 $4530.2; group 2 $1588.5, p Robotic-assisted PAE offers technical success comparable to manual PAE, with similar clinical improvement with an increased cost.

  7. Robotic-Assisted Versus Manual Prostatic Arterial Embolization for Benign Prostatic Hyperplasia: A Comparative Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Bagla, Sandeep, E-mail: sandeep.bagla@gmail.com [Vascular Institute of Virginia, LLC (United States); Smirniotopoulos, John [New York Presbyterian Hospital/Weill Cornell Medical Center (United States); Orlando, Julie C.; Piechowiak, Rachel [Vascular Institute of Virginia, LLC (United States)

    2017-03-15

    PurposeProstatic artery embolization (PAE) is a safe and efficacious procedure for benign prostatic hyperplasia (BPH), though is technically challenging. We present our experience of technical and clinical outcomes of robotic and manual PAE in patients with BPH.Materials and MethodsIRB-approved retrospective study of 40 consecutive patients 49–81 years old with moderate or severe grade BPH from May 2014 to July 2015: 20 robotic-assisted PAE (group 1), 20 manual PAE (group 2). Robotic-assisted PAE was performed using the Magellan Robotic System. American Urological Association (AUA-SI) score, cost, technical and clinical success, radiation dose, fluoroscopy, and procedure time were reviewed. Statistical analysis was performed within and between each group using paired t test and one-way analysis of variance respectively, at 1 and 3 months.ResultsNo significant baseline differences in age and AUA-SI between groups. Technical success was 100% (group 1) and 95% (group 2). One unsuccessful subject from group 2 returned for a successful embolization using robotic assistance. Fluoroscopy and procedural times were similar between groups, with a non-significant lower patient radiation dose in group 1 (30,632.8 mGy/cm{sup 2} vs 35,890.9, p = 0.269). Disposable cost was significantly different between groups with the robotic-assisted PAE incurring a higher cost (group 1 $4530.2; group 2 $1588.5, p < 0.0001). Clinical improvement was significant in both arms at 3 months: group 1 mean change in AUA-SI of 8.3 (p = 0.006), group 2: 9.6 (p < 0.0001). No minor or major complications occurred.ConclusionsRobotic-assisted PAE offers technical success comparable to manual PAE, with similar clinical improvement with an increased cost.

  8. Risk Factors related to hemorrhage necessitating renal artery embolization after percutaneous nephrostomy

    Energy Technology Data Exchange (ETDEWEB)

    Byon, Jung Hee; Han, Young Min; Jin, Gong Yong; Song, Ji Soo [Chonbuk National University Hospital and Medical School, Jeonju (Korea, Republic of)

    2015-12-15

    To investigate risk factors related to severe bleeding necessitating renal artery embolization (RAE) after percutaneous nephrostomy (PCN). 36 patients who underwent RAE from January 2005 to June 2014 were retrospectively reviewed. Among them, 10 patients underwent embolization because of severe bleeding after PCN (bleeding group). From 1762 patients who underwent PCN in the same period, we selected 21 patients who underwent PCN without bleeding after the procedure (non-bleeding group). We investigated possible related risk factors, such as the presence of underlying diseases, activated partial thromboplastin time (aPTT), prothrombin time (PT), platelet count, puncture site, procedure time, size of the kidney, distance from skin to renal cortex, maximum caliber of the indwelling catheter, parenchymal thickness, and grade of hydronephrosis. We used Fisher's exact test and independent t test for data analyses. We classified hydronephrosis as either 'mild hydronephrosis,' or 'moderate or severe hydronephrosis.' The frequency of mild hydronephrosis was 80.0% (8/10) in the bleeding group and 33.3% (7/21) in the non-bleeding group (p = 0.023). There were no significant differences between the two groups in the incidence of underlying diseases. Similarly, other risk factors (PT, aPTT, platelet count, procedure time, distance from skin to renal cortex, maximum caliber of the indwelling catheter, kidney size, and parenhcymal thickness) also did not differ significantly between the two groups. Mild hydronephrosis is a risk factor for severe bleeding necessitating RAE after PCN. Therefore, when performing PCN, careful attention should be paid to patients with mild hydronephrosis.

  9. Study of the Impact of Uterine Artery Embolization (UAE) on Endometrial Microvessel Density (MVD) and Angiogenesis

    Energy Technology Data Exchange (ETDEWEB)

    Tan Guosheng; Xiang Xianhong; Guo Wenbo; Zhang Bing; Chen Wei; Yang Jianyong, E-mail: kerisgz@126.com [The First Affiliated Hospital of Sun Yat-sen University, Department of Interventional Radiology (China)

    2013-08-01

    PurposeTo investigate the influence of uterine artery embolization (UAE) on endometrial microvessel density (MVD) and angiogenesis.MethodsSixty female guinea pigs were divided into two groups, the control group (n = 15) and the UAE treatment group (n = 45). In the UAE group, tris-acryl gelatin microspheres were used to generate embolization. Animals were further divided into three subgroups, A1, A2, and A3 (n = 15 for each subgroup), with uterine specimens collected at 7-15, 16-30, and 31-45 days after UAE, respectively. Immunostaining for factor VIII and CD105 was performed to identify total endometrial MVD (MVD{sub FVIII}) and CD105-positive angiogenesis (MVD{sub CD105}) at the indicated time points after UAE.ResultsQuantitative analysis revealed that MVD{sub FVIII} significantly decreased in the A1 (11.40 {+-} 2.76, p < 0.05) and A2 (15.37 {+-} 3.06, p < 0.05) groups compared to the control group (19.40 {+-} 2.50), and was restored to normal in the A3 group (18.77 {+-} 2.69). UAE caused a temporal up-regulation of MVD{sub CD105}-positive angiogenesis in the A1 group (9.33 {+-} 2.37, p < 0.05) and the A2 group (11.63 {+-} 1.56, p < 0.05) compared to the control group (7.12 {+-} 1.67), and the MVD{sub CD105} value returned to normal in the A3 group (8.07 {+-} 1.97).ConclusionUAE caused a temporal decrease in endometrial MVD that reversed over time as a result of the increase of CD105-positive angiogenesis. Although the UAE-induced reduction of endometrial MVD was reversible, its long-term effect on endometrial receptivity still needs further study.

  10. Endovascular coil embolization of segmental arteries prevents paraplegia after subsequent thoracoabdominal aneurysm repair: an experimental model.

    Science.gov (United States)

    Geisbüsch, Sarah; Stefanovic, Angelina; Koruth, Jacob S; Lin, Hung-Mo; Morgello, Susan; Weisz, Donald J; Griepp, Randall B; Di Luozzo, Gabriele

    2014-01-01

    To test a strategy for minimizing ischemic spinal cord injury after extensive thoracoabdominal aneurysm (TAAA) repair, we occluded a small number of segmental arteries (SAs) endovascularly 1 week before simulated aneurysm repair in an experimental model. Thirty juvenile Yorkshire pigs (25.2 ± 1.7 kg) were randomized into 3 groups. All SAs, both intercostal and lumbar, were killed by a combination of surgical ligation of the lumbar SAs and occlusion of intercostal SAs with thoracic endovascular stent grafting. Seven to 10 days before this simulated TAAA replacement, SAs in the lower thoracic/upper lumbar region were occluded using embolization coils: 1.5 ± 0.5 SAs in group 1 (T13/L1), and 4.5 ± 0.5 SAs in group 2 (T11-L3). No SAs were coiled in the controls. Hind limb function was evaluated blindly from daily videotapes using a modified Tarlov score (0 = paraplegia, 9 = full recovery). After death, each segment of spinal cord was graded histologically using the 9-point Kleinman score (0 = normal, 8 = complete necrosis). Hind limb function remained normal after coil embolization. After simulated TAAA repair, paraplegia occurred in 6 of 10 control pigs, but in only 2 of 10 pigs in group 1; no pigs in group 2 had a spinal cord injury. Tarlov scores were significantly better in group 2 (control vs group 1, P = .06; control vs group 2, P = .0002; group 1 vs group 2, P = .05). A dramatic reduction in histologic damage, most prominently in the coiled region, was seen when SAs were embolized before simulated TAAA repair. Endovascular coiling of 2 to 4 SAs prevented paraplegia in an experimental model of extensive hybrid TAAA repair, and helped protect the spinal cord from ischemic histopathologic injury. A clinical trial in a selected patient population at high risk for postoperative spinal cord injury may be appropriate. Copyright © 2014 The American Association for Thoracic Surgery. All rights reserved.

  11. Combined application of distal and proximal embolic protection devices in endovascular stenting for severe carotid artery stenosis

    Directory of Open Access Journals (Sweden)

    Zhi-hua DU

    2011-09-01

    Full Text Available Objective To analyze and summarize methods and experiences of combined application of distal and proximal embolic protection devices(EPD in endovascular stenting for severe carotid artery stenosis.Methods Five patients with severe stenosis of the common carotid artery or with extracranial segment of the internal carotid artery diagnosed through digital subtraction angiography(DSA from March to July 2010 were involved in the present study.All patients received carotid angioplasty and stenting(CAS,with a combination of distal and proximal EPD via the percutaneous femoral artery approach.Results The operation failed in one patient,whereas technical success with no intraoperative complication was achieved in four patients.The symptoms disappeared or improved in the four cases that achieved technical success.The follow-up duration was one to three months,and no cerebral ischemia was found.Conclusion CAS with the combined application of distal and proximal EPD in some special cases of carotid artery stenosis may surmount the shortage of single EPD,reduce the risk of intraoperative embolization,decrease the time of intraoperative endovascular inflow occlusion,and reduce high-risk operations.CAS may be used as an individualized treatment strategy for patients with carotid artery stenosis.

  12. Clinical Analysis of Pulmonary Lipiodol Embolism in Patients with Hepatic Carcinoma after Transcatheter Arterial Chemoembolization

    Directory of Open Access Journals (Sweden)

    Wen-jin JIANG

    2015-03-01

    Full Text Available Objective:To explore the clinical manifestations, therapeutic methods and preventive measures of pulmonary lipiodol embolism (PLE induced by transcatheter arterial chemoembolization (TACE so as to improve the cognition and management of PLE. Methods:A total of 2 613 patients with hepatic cancer without history of pulmonary disease who were treated with TACE in our hospital from Sept., 2004 to Mar., 2013 were selected. The clinical manifestations, therapeutic methods and preventing measures of the 9 patients who were accompanied with PLE were observed to analyze the pre-operative hepatic computed tomography (CT and chest X-ray, intra-operative contrast examination, dosage of lipiodol and chemotherapeutic drugs, clinical manifestation and therapeutic progression as well as the postoperative follow-up.Results: Nine patients accompanied by PLE had different-severity cough, hemoptysis and progressive dyspnea, and chest X-ray and/or CT showed flaky high-density radiography. After treated with oxygen inhalation, bronchus expansion and inflammation alleviation, 8 patients were improved but 1 died. Of the 8 patients, 2 were given ventilator to assist breath, and the clinical symptoms of 8 patients disappeared within 3-15 d. The re-examined chest X-ray showed normal after 20-60 d follow-up observation. Additionally, 6 patients were with nidus diameter ≥10 cm, 6 with hepatic artery-vein fistula and 7 with lipiodol dosage ≥20 mL.Conclusion: PLE often occurs in patients with giant hepatic carcinoma accompanied by hepatic artery-vein fistula, whose lipiodol dosage is ≥20 mL. Accurate and correct management during operation can effectively reduce the development of PLE.

  13. Ghrelin Suppression and Fat Loss after Left Gastric Artery Embolization in Canine Model

    Energy Technology Data Exchange (ETDEWEB)

    Bawudun, Dilmurat [Xinjiang Medical University, Department of Interventional Radiology, First Affiliated Hospital (China); Xing Yan; Liu Wenya, E-mail: wenyaliu2002@hotmail.com; Huang Yujie [Xinjiang Medical University, Imaging Center, First Affiliated Hospital (China); Ren Weixin [Xinjiang Medical University, Department of Interventional Radiology, First Affiliated Hospital (China); Ma Mei [Xinjiang Medical University, Animal Research Center, First Affiliated Hospital (China); Xu Xiaodong [Xinjiang Medical University, Department of Interventional Radiology, First Affiliated Hospital (China); Teng Gaojun [Southeast University, Department of Radiology, Zhong-da Hospital (China)

    2012-12-15

    Purpose: To evaluate the effects of left gastric artery embolization (LGAE) on plasma ghrelin levels, abdominal fat, and body weight in beagles. Methods: The institutional animal care and use committee approved this study. Fifteen healthy adult beagles (12 male and three female animals) were randomly divided into three experimental groups: LGAE was proceeded with mixed emulsion of bleomycin A{sub 5} hydrochloride and lipiodol (group A), and polyvinyl alcohol particles (group B). Transcatheter saline injections in the left gastric artery were performed as a control. Weight and fasting plasma ghrelin levels were obtained at baseline and at weekly intervals for 8 weeks after the procedure in all animals. All animals were scanned and measured by multidetector computed tomography at baseline and at week 8 for evaluation of abdominal fat. Results: In LGAE-treated animals, plasma ghrelin and body weight significantly decreased compared to control animals (group A: P = 0.007 and P = 0.000; group B: P = 0.004 and P = 0.000, respectively). Subcutaneous fat size was also significantly reduced (P = 0.011 and P = 0.027 for groups A and B, respectively). The decreasing percentage in ghrelin levels at week 6 (peak of recovery) of LGAE-treated animals were negatively correlated with the size of area supplied by left gastric artery (r = -0.693, P = 0.026). Conclusion: LGAE could suppress the plasma concentration of ghrelin, which results in subcutaneous fat size reduction and weight loss. Compensatory ghrelin production might occur in the remnant gastric fundus after LGAE.

  14. ECG-gated pulmonary artery CTA for evaluation of right ventricular function in patients with acute pulmonary embolism.

    Science.gov (United States)

    Liang, Hong-Wei; Zhao, De-Li; Liu, Xin-Ding; Chen, Peng; Zhou, Hai-Ting; Zhao, Cheng-Lei; Wang, Guo-Kun; Xu, Mei-Ling; Zhang, Jin-Ling

    2017-02-01

    To evaluate right ventricular function in patients with acute pulmonary embolism (APE) using electrocardiogram-gated CTA and to discuss the clinical value of pulmonary artery CTA PATIENTS AND METHODS: Based on death risk evaluation, 86 APE patients were divided into high-risk group (n=46) and non-high-risk group (n=40). The CT pulmonary embolism (PE) index and parameters of right ventricular function were analyzed from the CTPA images and compared between the two groups. Potential correlation between the two was also discussed. CT PE index (median 24.69%) of the high-risk group was obviously higher than that of the non-high-risk group (median 8.58%) (Pright ventricular function were significantly different between the two groups (Pright ventricular function. ECG-gated pulmonary artery CTA is suitable for assessing the severity of APE and right ventricular function. © 2016, Wiley Periodicals, Inc.

  15. Bariatric Left Gastric Artery Embolization for the Treatment of Obesity: A Review of Gut Hormone Involvement in Energy Homeostasis.

    Science.gov (United States)

    Anton, Kevin; Rahman, Tariq; Bhanushali, Ashok; Patel, Aalpen A

    2016-01-01

    The global population is becoming more overweight and obese, leading to increases in associated morbidity and mortality rates. Advances in catheter-directed embolotherapy offer the potential for the interventional radiologist to make a contribution to weight loss. Left gastric artery embolization reduces the supply of blood to the gastric fundus and decreases serum levels of ghrelin. Early evidence suggests that this alteration in gut hormone balance leads to changes in energy homeostasis and weight reduction. The pathophysiologic findings and current evidence associated with the use of left gastric artery embolization are reviewed. The prevalence of obesity continues to increase at an alarming rate, and, thus far, advances in medical management have been relatively ineffective in slowing this trend. Lifestyle modifications such as diet and exercise are effective initially, but most patients regain the weight in the long term. Bariatric surgery is the most effective strategy for achieving long-term weight loss; however, as with all surgical procedures, it has potential complications.

  16. A New Flow Control Technique Using Diluted Epinephrine in the N-butyl-2-cyanoacrylate Embolization of Visceral Artery Pseudoaneurysms Secondary to Chronic Pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Morishita, Hiroyuki, E-mail: hmorif@koto.kpu-m.ac.jp [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan); Yamagami, Takuji [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science (Japan); Takeuchi, Yoshito [National Cancer Center, Division of Diagnostic Radiology (Japan); Matsumoto, Tomohiro; Asai, Shunsuke; Masui, Koji [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan); Sato, Hideki [Japan Red Cross Kyoto Daiichi Hospital, Department of Gastroenterology (Japan); Taniguchi, Fumihiro [Japan Red Cross Kyoto Daiichi Hospital, Department of Surgery (Japan); Sato, Osamu [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan); Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science (Japan)

    2012-08-15

    Although n-butyl-2-cyanoacrylate (NBCA) has been used as an effective liquid embolization material, its indication for pseudoaneurysms has seemingly been limited because of the technical difficulties of using NBCA, such as reflux to the parent artery and causing significant infarction. Thus, considerable skill in using NBCA or a device to control blood flow during its polymerization is required to achieve embolization without severe complications. We report our new technique for controlling blood flow using diluted epinephrine in transcatheter arterial NBCA embolization of five pseudoaneurysms in four cases secondary to hemosuccus pancreaticus.

  17. Segmental embolization of the gastroduodenal artery in a case of a perforated pseudoaneurysm and gastrointestinal bleeding; Segmentembolisation der Arteria gastroduodenalis bei perforiertem Pseudoaneurysma und gastrointestinaler Massivblutung

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, R. [Inst. fuer Diagnostische Radiologie der Friedrich-Alexander-Univ. Nuernberg-Erlangen (Germany); Inst. fuer Diagnostische und Interventionelle Radiologie der Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany); Cavallaro, A.; Bautz, W. [Inst. fuer Diagnostische Radiologie der Friedrich-Alexander-Univ. Nuernberg-Erlangen (Germany)

    2004-07-01

    We present the history of a woman suffering from an extensive gastrointestinal bleeding due to liver cirrhosis and chronic pancreatitis. Selective angiogram of the celiac artery revealed a pseudoaneurysm of the gastroduodenal artery caused by inflammatory wall penetration. The life-threatening hemorrhage was completely stopped by embolization with three stainless steel coils after microcatheter engagement of the gastroduodenal artery. The particularity of this case is the restricted embolization of the aneurysm vessel segment, so the collateral circulation of the gastroduodenal and pancreaticoduodenal artery could be preserved. (orig.)

  18. Uterine artery embolization for uterine arteriovenous malformation is associated with placental abnormalities in the subsequent pregnancy: two cases report

    OpenAIRE

    Soeda, Shu; Kyozuka, Hyo; Suzuki, Satoshi; Yasuda, Shun; Nomura, Yasuhisa; Fujimori, Keiya

    2014-01-01

    Uterine arteriovenous malformation (AVM) is generally associated with uterine trauma such as dilatation and curettage, therapeutic abortion, uterine surgery and uterine malignant tumors^{1)}. Uterine artery embolization (UAE) is performed on patients with uterine AVM who have desire for future pregnancy^{2)}. Some successful pregnancies were reported after UAE for uterine AVM^{5,6)}, however complication during pregnancy has not been described clearly. We herein for the first time report two ...

  19. Transarterial embolization treatment for aberrant systemic arterial supply to the normal lung: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bo Ra; Jo, Jeong Hyun; Park, Byeong Ho [Dept. of Radiology, Dong A University Hospital, Dong A University College of Medicine, Busan (Korea, Republic of)

    2017-06-15

    A 24-year-old man presented with dyspnea on exertion and intermittent blood-tinged sputum. He was diagnosed with aberrant systemic arterial supply to the normal lung (ASANL) based on the results of imaging studies. The patient was successfully treated with transarterial embolization using coils and a vascular plug and his symptoms disappeared during the follow-up. Herein, we reported the imaging findings of ASANL, differential diagnoses, and its treatment options. In addition, we reviewed the relevant literature.

  20. Bariatric Arterial Embolization with Non-spherical Polyvinyl Alcohol Particles for Ghrelin Suppression in a Swine Model

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Min; Kim, Man-Deuk, E-mail: mdkim@yuhs.ac; Han, Kichang; Muqmiroh, Lailatul [Yonsei University College of Medicine, Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Korea, Republic of); Kim, Seung Up [Yonsei University College of Medicine, Department of Internal Medicine, Severance Hospital (Korea, Republic of); Kim, Gyoung Min; Kwon, Joonho; Park, Sung Il; Won, Jong Yun; Lee, Do Yun [Yonsei University College of Medicine, Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Korea, Republic of)

    2017-05-15

    PurposeTo evaluate the effect of bariatric arterial embolization (BAE) with non-spherical polyvinyl alcohol (PVA) particles on systemic ghrelin levels, weight change, and gastric ulceration risk in a swine model.Materials and MethodsFrom March 2014 to February 2015, ten healthy swine were used in the study (mean weight 31.5 kg; range 24.0–41.5 kg). The animals were randomly assigned to two groups: the embolized group (n = 5) in which BAE was performed and the control group (n = 5). In the embolized group, BAE was performed by selectively infusing 150–250 or 50–150 μm PVA into the gastric arteries that supplied the fundus of the stomach. In the control group, a sham procedure was performed with saline infusion. Plasma ghrelin levels were prospectively obtained at baseline and every 2 weeks thereafter. Endoscopy was performed 3 weeks after BAE to see whether any gastric ulcer occurred. To determine the durability of the occluded arteries, repeated celiac trunk angiography was performed 8 weeks after BAE. Then, all the swine were killed and necropsies were performed.ResultsThe mean post-procedure ghrelin value decreased by 370.0 pg/mL in the embolized group at week 3 (mean 536.0 ± 334.3 pg/mL) and week 5 (mean 515.0 ± 150.0 pg/mL, p < 0.05) relative to baseline (880.0 ± 559.5 pg/mL), respectively, but ghrelin levels were not significantly decreased between the embolized and control groups. There was a significant body weight change as follows: 35.1 ± 9.5 to 46.6 ± 15.7 kg and 31.8 ± 5.8 to 41.2 ± 6.6 kg at baseline and endpoint in the control and embolized groups, respectively (p < 0.05). However, the difference between groups was not significant at endpoint. In the embolized group, ulcerations were identified in three animals (60%) and the recanalization of the embolized arteries was noted on follow-up angiography in three animals (60%), respectively.ConclusionBAE with PVA particles can transiently suppress ghrelin

  1. Transcranial Direct Middle Meningeal Artery Puncture for the Onyx Embolization of Dural Arteriovenous Fistula Involving the Superior Sagittal Sinus

    Science.gov (United States)

    Oh, Jae-Sang; Shim, Jai-Joon; Bae, Hack-Gun

    2015-01-01

    A 66-year-old woman presented with intermittent paraparesis and generalized tonic-clonic seizure. Cerebral angiography demonstrated dural arteriovenous fistula (AVF) involving superior sagittal sinus (SSS), which was associated with SSS occlusion on the posterior one third. The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux. Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough. Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later. Microcatheter could be located far distally to the fistula through 5 F sheath placed into the MMA and complete obliteration of dural AVF was achieved using 3.9 cc of Onyx. PMID:25674345

  2. Perioperative Hemodynamic Monitoring of Common Hepatic Artery for Endovascular Embolization of a Pancreaticoduodenal Arcade Aneurysm with Celiac Stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Shibata, Eisuke, E-mail: eisuke.shibata1130@gmail.com; Takao, Hidemasa; Amemiya, Shiori; Ohtomo, Kuni [The University of Tokyo, Department of Radiology, Graduate School of Medicine (Japan)

    2017-03-15

    This report describes perioperative hemodynamic monitoring of the common hepatic artery (CHA) during endovascular treatment of a pancreaticoduodenal arcade aneurysm, in a patient with celiac artery stenosis caused by the median arcuate ligament. Pressure monitoring was performed as a safety measure against critical complications such as liver ischemia. As the aneurysm was located in the anterior pancreaticoduodenal artery (APDA) and the posterior pancreaticoduodenal artery (PPDA) was small in caliber, the patient was considered to be at a high risk of liver ischemia. No significant change in pressure was observed in the CHA on balloon occlusion test in the APDA. Immediately after embolization, the PPDA enlarged and the pressure in the CHA was well maintained. Pressure monitoring appears to improve patient safety during endovascular treatment of visceral aneurysms.

  3. Arterial blood gas analysis and alveolar-arterial oxygen gradient in diagnosis and prognosis of elderly patients with suspected pulmonary embolism.

    Science.gov (United States)

    Masotti, L; Ceccarelli, E; Cappelli, R; Barabesi, L; Forconi, S

    2000-12-01

    Arterial blood gas analysis (BGA) remains a first-step diagnostic approach in patients with suspected pulmonary embolism (PE). The aim of this study was to evaluate BGA parameters in elderly patients with suspected pulmonary embolism for diagnosis and 14-day prognosis. We performed a retrospective cohort observational study of 6 years (1994-1999) in a 60-bed acute geriatric ward of University Hospital in Siena, Italy. Room air arterial oxygen partial pressure (pO2), arterial carbon dioxide partial pressure (pCO2), pH, arterial oxyhemoglobin saturation (SO2), and alveolar-arterial oxygen gradient [D(A-a)O2] were performed on hospital admission of 75 patients with confirmed PE (CPE) and were compared with data from 43 patients with unconfirmed PE (UCPE). The same parameters of 54 CPE surviving patients were compared with 21 CPE nonsurviving patients. Significantly lower PO2 and SO2, and higher DA-aO2 were found in CPE patients. Respiratory alkalosis was found in one third of the patients in both groups (no significant difference). In the CPE group, there was a significantly lower SO2 in nonsurviving patients, without significant differences for the other parameters. Metabolic acidosis was significantly more frequent in nonsurviving patients. More severe hypoxemia, oxyhemoglobin hyposaturation, and higher D(A-a)O2 are associated with the diagnosis of PE in elderly patients. Respiratory alkalosis is less frequent than in younger patients, and metabolic disorders are negative prognostic indicators.

  4. Catheter-directed gastric artery chemical embolization suppresses systemic ghrelin levels in porcine model.

    Science.gov (United States)

    Arepally, Aravind; Barnett, Brad P; Patel, Tarak H; Patel, Tarek T; Howland, Valerie; Boston, Ray C; Kraitchman, Dara L; Malayeri, Ashkan A

    2008-10-01

    To prospectively test, in a porcine model, the hypothesis that catheter-directed gastric artery chemical embolization (GACE) can result in suppression of systemic ghrelin levels and affect weight gain. This study, which had Animal Care and Use Committee approval, was performed in healthy, growing swine (weight range, 40-45 kg; n = 10). GACE was performed in five swine with the infusion of sodium morrhuate (125 mug) selectively into the gastric arteries that supply the fundus. Five control animals underwent a sham procedure with 5 mL of saline. Weight and fasting plasma ghrelin levels were obtained in animals at baseline and in weeks 1-4. Statistical testing for substantial differences in ghrelin blood levels over time and between treated and untreated animals was performed by using a cross-sectional time-series linear model with feasibility generalized least squares. The pattern of the change in ghrelin levels over time was significantly different between control and treated animals (P ghrelin levels were significantly reduced at week 1 (mean, 664.1 pg/mL +/- 103.1 [standard error of the mean], P ghrelin values in swine treated with GACE decreased from baseline to -34%, -38.6%, -42.5%, and -12.9% during weeks 1-4, respectively. In control swine, percentage change in serum ghrelin was -1.7%, -9.7%, +2.6%, and +18.2% during weeks 1-4, respectively. At the end of 4 weeks, control swine continued to gain weight, with a 15.1% increase from their original weight, while the weight in swine treated with GACE plateaued at an increase of 7.8% from the original weight. Catheter-directed GACE can suppress the appetite hormone ghrelin and affect weight gain. (c) RSNA, 2008.

  5. Presumed Arterial Gas Embolism After Breath-Hold Diving in Shallow Water.

    Science.gov (United States)

    Harmsen, Stefani; Schramm, Dirk; Karenfort, Michael; Christaras, Andreas; Euler, Michael; Mayatepek, Ertan; Tibussek, Daniel

    2015-09-01

    Dive-related injuries are relatively common, but almost exclusively occur in recreational or scuba diving. We report 2 children with acute central nervous system complications after breath-hold diving. A 12-year-old boy presented with unilateral leg weakness and paresthesia after diving beneath the water surface for a distance of ∼25 m. After ascent, he suddenly felt extreme thoracic pain that resolved spontaneously. Neurologic examination revealed right leg weakness and sensory deficits with a sensory level at T5. Spinal MRI revealed a nonenhancing T2-hyperintense lesion in the central cord at the level of T1/T2 suggesting a spinal cord edema. A few weeks later, a 13-year-old girl was admitted with acute dizziness, personality changes, confusion, and headache. Thirty minutes before, she had practiced diving beneath the water surface for a distance of ∼25 m. After stepping out, she felt sudden severe thoracic pain and lost consciousness. Shortly later she reported headache and vertigo, and numbness of the complete left side of her body. Neurologic examination revealed reduced sensibility to all modalities, a positive Romberg test, and vertigo. Cerebral MRI revealed no pathologic findings. Both children experienced a strikingly similar clinical course. The chronology of events strongly suggests that both patients were suffering from arterial gas embolism. This condition has been reported for the first time to occur in children after breath-hold diving beneath the water surface without glossopharyngeal insufflation. Copyright © 2015 by the American Academy of Pediatrics.

  6. Efficacy of prophylactic uterine artery embolization before obstetrical procedures with high risk for massive bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Heung Kyu; Shin, Ji Hoon; Ko, Gi Young; Gwon, Dong Il; Kim, Jin Hyung; Han, Ki Chang; Lee, Shin Wha [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2017-04-15

    To evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE) before obstetrical procedures with high risk for massive bleeding. A retrospective review of 29 female patients who underwent prophylactic UAE from June 2009 to February 2014 was performed. Indications for prophylactic UAE were as follows: dilatation and curettage (D and C) associated with ectopic pregnancy (cesarean scar pregnancy, n = 9; cervical pregnancy, n = 6), termination of pregnancy with abnormal placentation (placenta previa, n = 8), D and C for retained placenta with vascularity (n = 5), and D and C for suspected gestational trophoblastic disease (n = 1). Their medical records were reviewed to evaluate the safety and efficacy of UAE. All women received successful bilateral prophylactic UAE followed by D and C with preservation of the uterus. In all patients, UAE followed by obstetrical procedure prevented significant vaginal bleeding on gynecologic examination. There was no major complication related to UAE. Vaginal spotting continued for 3 months in three cases. Although oligomenorrhea continued for six months in one patient, normal menstruation resumed in all patients afterwards. During follow-up, four had subsequent successful natural pregnancies. Spontaneous abortion occurred in one of them during the first trimester. Prophylactic UAE before an obstetrical procedure in patients with high risk of bleeding or symptomatic bleeding may be a safe and effective way to manage or prevent serious bleeding, especially for women who wish to preserve their fertility.

  7. Incorporating uterine artery embolization in the treatment of cesarean scar pregnancy following diagnostic ultrasonography.

    Science.gov (United States)

    Li, Yang; Wang, Weiwen; Yang, Ting; Wei, Xing; Yang, Xiaofeng

    2016-08-01

    To evaluate combining uterine artery embolization (UAE) with other treatments for cesarean scar pregnancy (CSP). A retrospective study included patients attending the First affiliated Hospital of Xi'an Jiaotong University, China, between March 1, 2009 and March 31, 2014, who were diagnosed with CSP. Patients were classified by ultrasonography as having endogenous CSP (CSP type I [CSP-I]) or exogenous CSP (CSP type II [CSP-II]). Patient outcomes were compared between patients who underwent treatment that included or excluded UAE. Patient records were reviewed and patients were interviewed by telephone to report on recovery following treatment. In total, 52 patients met the inclusion criteria. In patients with CSP-I, the blood loss, length of hospital stay, and time before restoration of normal β human chorionic gonadotropin levels were significantly higher in patients who were treated with methotrexate combined with dilatation and curettage compared with those treated with UAE combined with dilatation and curettage (Ptreatment of CSP-I and CSP-II was safe; CSP should be properly classified to select the appropriate treatment. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  8. Efficacy of Preoperative Transcatheter Arterial Embolization for Nasopharyngeal Angiofibroma: A Comparative Study

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Guosheng; Ma, Zhenjiang [The First Affiliated Hospital of Sun Yat-sen University, Department of Interventional Radiology (China); Long, Weiqing [The First Affiliated Hospital of Sun Yat-sen University, Department of Clinical Laboratory (China); Liu, Liangshuai [The First Affiliated Hospital of Sun Yat-sen University, Department of Interventional Radiology (China); Zhang, Bing [The First Affiliated Hospital of Sun Yat-sen University, Department of Nuclear Medicine (China); Chen, Wei; Yang, Jianyong; Li, Heping, E-mail: jxgdhp@163.com [The First Affiliated Hospital of Sun Yat-sen University, Department of Interventional Radiology (China)

    2017-06-15

    ObjectiveThis study aimed to retrospectively evaluate the efficacy and safety of preoperative transcatheter arterial embolization (pTAE) for treating nasopharyngeal angiofibroma (NPAF).MethodsSeventy-four NPAF patients were hospitalized for elective surgical treatment with pTAE (pTAE group, n = 32) or surgical treatment alone (non-pTAE group, n = 42) between January 1990 and December 2013. The following outcome measures were retrospectively analyzed and compared: intraoperative bleeding volume, surgery time (ST), duration of postoperative hospital stay (PHS), and disease recurrence.ResultsAmong Radkowski stage I patients, those in pTAE group had a slightly higher but not significant bleeding volume than patients in non-pTAE group (344 ± 407 vs. 248 ± 219 mL, P = 0.899); among stage II/III patients, however, patients in pTAE group showed a significantly lower bleeding volume than patients in non-pTAE group (stage II, 829 ± 519 vs. 1339 ± 767 mL, P = 0.035; stage III, 1267 ± 592 vs. 2125  ± 479 mL, P = 0.024). The two groups presented comparable OTs, PHSs, and rates of frontal recurrence (all P>0.05).ConclusionspTAE significantly reduces intraoperative bleeding in NPAF patients with Radkowski stage II/III disease, but offers no additional benefits regarding ST, PHS, or recurrence.

  9. A Systematic Review of Prostatic Artery Embolization in the Treatment of Symptomatic Benign Prostatic Hyperplasia

    Energy Technology Data Exchange (ETDEWEB)

    Kuang, Michelle; Vu, Anthony [McMaster University, Michael G. DeGroote School of Medicine (Canada); Athreya, Sriharsha, E-mail: sathreya@stjoes.ca [St. Joseph’s Healthcare (Canada)

    2017-05-15

    PurposeTo summarize current evidence on outcomes and complications of prostatic artery embolization as a treatment for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia.Methods and MaterialsA database search of MEDLINE, Embase, Web of Science, and Cochrane Library was performed for published literature up to August 2015 concerning PAE in the treatment of BPH. Inclusion and exclusion criteria were applied by two independent reviewers, and disagreements were resolved by consensus. Peer-reviewed studies concerning PAE with BPH with a sample size >10 and at least one measured parameter were included.ResultsThe search yielded 193 articles, of which ten studies representing 788 patients, with a mean age of 66.97 years, were included. Patients had LUTS ranging from moderate to severe. At 6 months following procedure, PV, PVR, Qmax, IPSS, and QoL were significantly improved (P < 0.05), while for PSA there was no significant change. At 12 and 24 months, PV, PSA, PVR, Qmax, IPSS, and QoL were significantly improved (P < 0.05). IIEF was unchanged at 6 and 12 months but was significantly reduced at 24 months.ConclusionThis suggests that PAE is effective in treating LUTS in the short and intermediate term.

  10. Diffusion-weighted MR imaging of uterine leiomyomas following uterine artery embolization

    Energy Technology Data Exchange (ETDEWEB)

    Sutter, Olivier; Shotar, Eimad; Guerrache, Youcef; Place, Vinciane; Oprea, Raluca; Le Dref, Olivier; Boudiaf, Mourad [Hopital Lariboisiere, AP-HP, Department of Body and Interventional Imaging, Paris (France); Soyer, Philippe; Dohan, Anthony [Hopital Lariboisiere, AP-HP, Department of Body and Interventional Imaging, Paris (France); Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France); UMR INSERM 965, Hopital Lariboisiere, Paris (France); Dautry, Raphael; Sirol, Marc [Hopital Lariboisiere, AP-HP, Department of Body and Interventional Imaging, Paris (France); Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France); Ricbourg, Aude [Hopital Lariboisiere-AP-HP, Department of Obstetrics and Gynecology, Paris (France)

    2016-10-15

    To test whether variations in apparent diffusion coefficient (ADC) values of uterine leiomyomas after uterine artery embolization (UAE) may correlate with outcome and assess the effects of UAE on leiomyomas and normal myometrium with magnetic resonance imaging (MRI). Data of 49 women who underwent pelvic MRI before and after UAE were retrospectively reviewed. Uterine and leiomyoma volumes, ADC values of leiomyomas, and normal myometrium were calculated before and after UAE. By comparison with baseline ADC values, a significant drop in leiomyoma ADC was found at 6-month post-UAE (1.096 x 10{sup -3} mm{sup 2}/s vs. 0.712 x 10{sup -3} mm{sup 2}/s, respectively; p < 0.0001), but not at 48-h post-UAE. Leiomyoma devascularization was complete in 40/49 women (82 %) at 48 h and in 37/49 women (76 %) at 6 months. Volume reduction and leiomyoma ADC values at 6 months correlated with the degree of devascularization. There was a significant drop in myometrium ADC after UAE. Perfusion defect of the myometrium was observed at 48 h in 14/49 women (28.5 %) in association with higher degrees of leiomyoma devascularization. Six months after UAE, drop in leiomyoma ADC values and volume reduction correlate with the degree of leiomyoma devascularization. UAE affects the myometrium as evidenced by a drop in ADC values and initial myometrial perfusion defect. (orig.)

  11. [Multidetector-row CT evaluation of acute bowel ischemia induced by embolization of superior mesenteric artery in experimental porcine models].

    Science.gov (United States)

    Qiang, Jin-wei; Li, Ruo-kun; Feng, Xiao-yuan; Liao, Zhi-he; He, Cheng; Feng, Qin; Zhang, Biao; Ye, Xuan-guang

    2010-02-01

    To evaluate the application of multi-detector row CT (MDCT) and CT angiography (CTA) for detecting early signs of acute bowel ischemia (ABI) in experimental porcine models. Twelve pigs were assigned to four groups with 3 in each group. The digital subtraction angiography of superior mesenteric artery (SMA) and the embolization of branches of SMA with gelatin sponge and blood clot were performed by percutaneous transfemoral artery puncture and catheterization. MDCT pre- and post-contrast scanning in the arterial, venous and delay phase and CTA with three-dimensional reconstruction were carried out at pre-operation, 3 h, 6 h, 9 h, and 12 h after occlusion. The normal mesenteric vascular anatomy, arterial occlusion, mesentery and bowel changes, and dynamic change were evaluated. ABI changes were identified pathologically in all the 12 experimental pigs, and the severity of ischemia increased over time after embolization. CTA showed all 57 embolized branches of SMA and 29 of 34 unoccluded arterial branches with 5 false-positive vessel occlusions. The sensitivity and specificity of CTA were 100% and 85.3%, respectively. Thin-slab maximum intensity projection (TSMIP) revealed the disappearance of distal comb-like vessel branches and brush-like vasa recta, which were clearly delineated in the normal bowel segments. Using this criterion, TSMIP correctly defined 23 of 24 ischemic bowel segments and all the 12 normal bowel segments with a sensitivity of 95.8% and a specificity of 100%. MDCT and CTA reliably define normal and occluded mesenteric vessels in the pig. It can easily detect ischemic bowel segment by identified early changes of ischemia. The early direct ischemic signs are occluded vessels, the disappearance of distal comb-like branches or brush-like vasa recta, and poor bowel enhancement. The early indirect sign is bowel dilatation with fluid collection.

  12. Interest of uterine artery embolization with gelatin sponge particles prior to myomectomy for large and/or multiple fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Butori, Noemie [Department of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Marechal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex (France); Tixier, Herve; Filipuzzi, Laurence; Mutamba, William [Department of Gynecology and Obstetrics, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Marechal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex (France); Guiu, Boris; Cercueil, Jean-Pierre [Department of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Marechal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex (France); Douvier, Serge; Sagot, Paul [Department of Gynecology and Obstetrics, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Marechal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex (France); Krause, Denis [Department of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Marechal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex (France); Loffroy, Romaric, E-mail: romaric.loffroy@chu-dijon.fr [Department of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Marechal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex (France)

    2011-07-15

    Purpose: To evaluate the efficacy of pre-myomectomy uterine artery embolization with gelatin sponge particles to reduce operative blood loss and facilitate removal of fibroids. Materials and methods: This retrospective study included 33 women (mean age, 36 years; range, 24-45 years), of whom at least 18 wished to preserve fertility. They presented with at least one large myoma (mean diameter, 90 mm; range, 50-150 mm) and had undergone preoperative uterine artery embolization with resorbable gelatin sponge by unilateral femoral approach between December 2001 and November 2008. Clinical, radiological and surgical data were available for all patients. Mean haemoglobin levels before and after surgery were compared with Student's t-test. Results: No complication or technical failure of embolization occurred. The myomectomies were performed during laparotomy (25 cases) or laparoscopy (8 cases). Dissection of fibroids was easier (mean, 3 per patient; range, 1-11), with a mean operating time of 108 {+-} 50 min (range, 30-260 min). Bloodless surgery was the rule with a mean estimated peroperative blood loss of 147 {+-} 249 mL (range, 0-800 mL). Mean pre-(12.9 {+-} 1.3 g/dL) and post-therapeutic (11.4 {+-} 1.2 g/dL) haemoglobin levels were not statistically different (p > 0.05). There was no need for blood transfusion. None of the patients required hysterectomy. The mean duration of hospital stay was 7.5 {+-} 1.3 days (range, 3-12 days). Conclusion: Preoperative uterine artery embolization is effective in reducing intraoperative blood loss and improves the chances of performing conservative surgery. It should be considered a useful adjunct to myomectomy in women at high hemorrhagic risk or who refuse blood transfusion.

  13. Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience

    Energy Technology Data Exchange (ETDEWEB)

    Raupach, J., E-mail: janraupach@seznam.cz; Lojik, M., E-mail: miroslav.lojik@fnhk.cz; Chovanec, V., E-mail: chovanec.v@seznam.cz; Renc, O., E-mail: ondrejrenc@seznam.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Strýček, M., E-mail: m.strycek@gmail.com [Faculty of Medicine at Charles University (Czech Republic); Dvořák, P., E-mail: petr.dvorak@fnhk.cz; Hoffmann, P., E-mail: hoffmpet@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Guňka, I., E-mail: gunka@email.cz; Ferko, A., E-mail: a.ferko@seznam.cz [Faculty of Medicine at Charles University and University Hospital, Department of Surgery (Czech Republic); Ryška, P., E-mail: ryska@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Omran, N., E-mail: nidal81@gmail.com [Faculty of Medicine at Charles University and University Hospital, Department of Cardiac Surgery (Czech Republic); Krajina, A., E-mail: krajina@fnhk.cz; Čabelková, P., E-mail: pavla.cabelkova@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Čermáková, E., E-mail: cermakovae@lfhk.cuni.cz [Faculty of Medicine at Charles University, Computer Technology Center (Czech Republic); Malý, R., E-mail: malyr@volny.cz [Faculty of Medicine at Charles University and University Hospital, Department of Medicine (Czech Republic)

    2016-02-15

    PurposeRetrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA).Materials and methodsFrom 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised.ResultsWe achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %.ConclusionPrimary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.

  14. Is CT angiography of the pulmonary arteries indicated in patients with high clinical probability of pulmonary embolism?

    Science.gov (United States)

    Martínez Montesinos, L; Plasencia Martínez, J M; García Santos, J M

    2017-06-30

    When a diagnostic test confirms clinical suspicion, the indicated treatment can be administered. A problem arises when the diagnostic test does not confirm the initially suspected diagnosis; when the suspicion is grounded in clinically validated predictive rules and is high, the problem is even worse. This situation arises in up to 40% of patients with high suspicion for acute pulmonary embolism, raising the question of whether CT angiography of the pulmonary arteries should be done systematically. This paper reviews the literature about this issue and lays out the best evidence about the relevant recommendations for patients with high clinical suspicion of acute pulmonary embolism and negative findings on CT angiography. It also explains the probabilistic concepts derived from Bayes' theorem that can be useful for ascertaining the most appropriate approach in these patients. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Transretroperitoneal CT-guided Embolization of Growing Internal Iliac Artery Aneurysm after Repair of Abdominal Aortic Aneurysm: A Transretroperitoneal Approach with Intramuscular Lidocaine Injection Technique

    Energy Technology Data Exchange (ETDEWEB)

    Park, Joon Young, E-mail: pjy1331@hanmail.net; Kim, Shin Jung, E-mail: witdd2@hanmail.net; Kim, Hyoung Ook, E-mail: chaos821209@hanmail.net [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Kim, Yong Tae, E-mail: mono-111@hanmail.net [Chonnam National University Hwasun Hospital, Department of Radiology (Korea, Republic of); Lim, Nam Yeol, E-mail: apleseed@hanmail.net; Kim, Jae Kyu, E-mail: kjkrad@jnu.ac.kr [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Chung, Sang Young, E-mail: sycpvts@jnu.ac.kr; Choi, Soo Jin Na, E-mail: choisjn@jnu.ac.kr; Lee, Ho Kyun, E-mail: mhaha@hanmail.net [Chonnam National University Hospital, Department of Surgery (Korea, Republic of)

    2015-02-15

    This study was designed to evaluate the efficacy and safety of CT-guided embolization of internal iliac artery aneurysm (IIAA) after repair of abdominal aortic aneurysm by transretroperitoneal approach using the lidocaine injection technique to iliacus muscle, making window for safe needle path for three patients for whom CT-guided embolization of IIAA was performed by transretroperitoneal approach with intramuscular lidocaine injection technique. Transretroperitoneal access to the IIAA was successful in all three patients. In all three patients, the IIAA was first embolized using microcoils. The aneurysmal sac was then embolized with glue and coils without complication. With a mean follow-up of 7 months, the volume of the IIAAs remained stable without residual endoleaks. Transretroperitoneal CT-guided embolization of IIAA using intramuscular lidocaine injection technique is effective, safe, and results in good outcome.

  16. Safety and Efficacy of Occlusion of Large Extra-Prostatic Anastomoses During Prostatic Artery Embolization for Symptomatic BPH

    Energy Technology Data Exchange (ETDEWEB)

    Amouyal, Gregory, E-mail: gregamouyal@hotmail.com; Chague, Pierre, E-mail: pierre.chague@gmail.com; Pellerin, Olivier, E-mail: olivier.pellerin@aphp.fr [Université Paris Descartes - Sorbonne - Paris – Cité, Faculté de Médecine (France); Pereira, Helena, E-mail: helena.pereira@aphp.fr [Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit (France); Giudice, Costantino Del, E-mail: costantino.delgiudice@aphp.fr [Université Paris Descartes - Sorbonne - Paris – Cité, Faculté de Médecine (France); Dean, Carole, E-mail: carole.dean@aphp.fr [Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Interventional Radiology Department (France); Thiounn, Nicolas, E-mail: nicolas.thiounn@aphp.fr; Sapoval, Marc, E-mail: marc.sapoval2@aphp.fr [Université Paris Descartes - Sorbonne - Paris – Cité, Faculté de Médecine (France)

    2016-09-15

    IntroductionDuring PAE, preembolization angiography of the prostatic artery can show large extra-prostatic shunts, at high risk, if embolized, of rectal or penile necrosis. We report our experience with 11 consecutive patients who underwent protective embolization of large extra-prostatic shunts before successful PAE.Materials and MethodsWe treated 11 consecutive male patients (mean age 67 years), part of a series of 55 consecutive male patients referred for PAE to treat LUTS due to BPH, between December 2013 and January 2015. The procedure involved the exclusion of an extra-prostatic shunt originating from the PA, prior to complete bilateral PAE. We compared the safety and efficacy of the 11 shunt exclusions followed by embolization of the PA to the other 44 basic PAE. Clinical success was defined as a decrease of 25 % or eight points of IPSS, QoL <3 or a one-point decrease, and a Qmax improvement of 25 % or 2.5 mL/s.ResultsWe had a 100 % rate of occlusion of the anastomosis. Bilateral embolization of the PA was performed in all patients with no additional time of procedure (p = 0.18), but a significant increase of dose area product (p = 0.03). Distal (PErFecTED) embolization was possible in 64 %. There was no worsening of erectile dysfunction, no rectal or penile necrosis, no immediate or late other clinical complications. Clinical success was 91 % (mean follow-up: 3.5 months), compared to 78 % for the entire PAE group.ConclusionPAE using the protection technique in case of large extra-prostatic shunts is as safe and effective as basic procedures and does not induce any additional time of procedure.

  17. Successful Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery for Recurrent Uterine Fibroid Previously Treated with Uterine Artery Embolization

    Directory of Open Access Journals (Sweden)

    Sang-Wook Yoon

    2010-01-01

    Full Text Available A 45-year-old premenopausal woman was referred to our clinic due to recurring symptoms of uterine fibroids, nine years after a uterine artery embolization (UAE. At the time of screening, the patient presented with bilateral impairment and narrowing of the uterine arteries, which increased the risk of arterial perforation during repeated UAE procedures. The patient was subsequently referred for magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS treatment. Following the treatment, the patient experienced a significant improvement in symptoms (symptom severity score was reduced from 47 to 12 by 1 year post-treatment. MR images at 3 months showed a 49% decrease in fibroid volume. There were no adverse events during the treatment or the follow-up period. This case suggests that MRgFUS can be an effective treatment option for patients with recurrent fibroids following previous UAE treatment.

  18. Uterine Artery Embolization for Retained Products of Conception with Marked Vascularity: A Safe and Efficient First-Line Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Bazeries, Paul, E-mail: paul.bazeries@chu-angers.fr; Paisant-Thouveny, Francine; Yahya, Sultan; Bouvier, Antoine; Nedelcu, Cosmina [Centre Hospitalier Universitaire d’Angers, Département d’Imagerie Diagnostique et interventionnelle (France); Boussion, Francoise; Sentilhes, Loic [Centre Hospitalier Universitaire d’Angers, Département de Gynécologie et Obstétrique (France); Willoteaux, Serge; Aubé, Christophe [Centre Hospitalier Universitaire d’Angers, Département d’Imagerie Diagnostique et interventionnelle (France)

    2017-04-15

    ObjectiveTo report our clinical practice regarding a case series of retained products of conception (RPOC) with marked vascularity (MV) managed with selective uterine artery embolization (UAE) as first-line treatment.MethodsThis was a monocentric, retrospective study of 31 consecutive cases of RPOC with MV diagnosed by Doppler ultrasound in the context of postpartum/postabortal bleeding. The primary outcome was the absence of rebleeding following embolization.ResultsRPOC with MV occurred after abortion in 27 out of 31 patients (87%). The time elapsed between delivery/abortion and UAE ranged from 1 to 210 days (mean 55.7 ± 45 days). Primary clinical success was achieved in 23 women (74.2%) following a single embolization. In total, 27 out of 31 women (87%) had been exclusively managed by UAE with conservative success. Although procedural success was achieved in this number, six women had a further procedure to evacuate RPOC despite procedural success. Large uterine arteriovenous (AV) shunts associated with RPOC were observed in five cases (16.1%), among which two were successfully treated after a single UAE and one after two UAEs, while hysterectomy was performed in the last two cases despite two and three UAE procedures respectively. RPOC was histologically proven in ten cases (32.2%) including four out of five cases of uterine AV shunt.ConclusionRPOC with MV can present with large uterine AV shunt, particularly in case of late management. Uterine artery embolization is an effective and safe first-line treatment, and should be evaluated for this indication in larger prospective trials.

  19. Prophylactic Embolization of the Cystic Artery Prior to Radioembolization of Liver Malignancies—An Evaluation of Necessity

    Energy Technology Data Exchange (ETDEWEB)

    Powerski, Maciej, E-mail: maciej.powerski@med.ovgu.de; Busse, Anke, E-mail: anke.busse@med.ovgu.de; Seidensticker, Max, E-mail: max.seidensticker@med.ovgu.de; Fischbach, Frank, E-mail: frank.fischbach@med.ovgu.de; Seidensticker, Ricarda, E-mail: ricarda.seidensticker@med.ovgu.de; Strach, Katharina, E-mail: katharina.strach@med.ovgu.de; Dudeck, Oliver, E-mail: oliver.dudeck@med.ovgu.de; Ricke, Jens, E-mail: jens.ricke@med.ovgu.de; Pech, Maciej, E-mail: maciej.pech@med.ovgu.de [Otto-von-Guericke University, Department of Radiology and Nuclear Medicine (Germany)

    2015-06-15

    PurposePrior to radioembolization (RE) of hepatic tumors, many centers prophylactically occlude the cystic artery (CA) during evaluation angiography (EVA) to prevent radiation-induced cholecystitis. There is no conclusive evidence for the protective effect of CA embolization and it bears the risk of inducing ischemic cholecystitis. The aim of this study is to evaluate the justification for CA embolization by comparing clinical and morphologic imaging parameters between patients undergoing coil occlusion of the cystic artery (COCA) and those with uncoiled CA (UCCA).Materials and MethodsRetrospective comparison of 37 patients with UCCA versus 68 patients with COCA in terms of clinical findings (CRP, leukocyte count, body temperature, upper abdominal pain) and morphologic imaging parameters associated with cholecystitis (gallbladder (GB) wall thickness, free fluid in GB bed, bremsstrahlung SPECT) after EVA, after RE, and at 6-week follow-up.ResultsAt none of the 3 time points (EVA, RE, 6-week follow-up) was there any significant difference in CRP, leukocyte count, body temperature, or upper abdominal pain between the UCCA and COCA group. There was also no significant difference between the two groups with regard to GB wall thickness, fluid in the GB bed, and bremsstrahlung in SPECT. One patient of the UCCA group and two patients of the COCA developed cholecystitis requiring treatment.ConclusionComparison of clinical and imaging findings between patients with and without CA embolization prior to RE identified no predictors of radiogenic or ischemic cholecystitis after RE. Our study provides no evidence for a benefit of prophylactic CA embolization before RE.

  20. Uterine Artery Embolization for Retained Products of Conception with Marked Vascularity: A Safe and Efficient First-Line Treatment.

    Science.gov (United States)

    Bazeries, Paul; Paisant-Thouveny, Francine; Yahya, Sultan; Bouvier, Antoine; Nedelcu, Cosmina; Boussion, Francoise; Sentilhes, Loic; Willoteaux, Serge; Aubé, Christophe

    2017-04-01

    To report our clinical practice regarding a case series of retained products of conception (RPOC) with marked vascularity (MV) managed with selective uterine artery embolization (UAE) as first-line treatment. This was a monocentric, retrospective study of 31 consecutive cases of RPOC with MV diagnosed by Doppler ultrasound in the context of postpartum/postabortal bleeding. The primary outcome was the absence of rebleeding following embolization. RPOC with MV occurred after abortion in 27 out of 31 patients (87%). The time elapsed between delivery/abortion and UAE ranged from 1 to 210 days (mean 55.7 ± 45 days). Primary clinical success was achieved in 23 women (74.2%) following a single embolization. In total, 27 out of 31 women (87%) had been exclusively managed by UAE with conservative success. Although procedural success was achieved in this number, six women had a further procedure to evacuate RPOC despite procedural success. Large uterine arteriovenous (AV) shunts associated with RPOC were observed in five cases (16.1%), among which two were successfully treated after a single UAE and one after two UAEs, while hysterectomy was performed in the last two cases despite two and three UAE procedures respectively. RPOC was histologically proven in ten cases (32.2%) including four out of five cases of uterine AV shunt. RPOC with MV can present with large uterine AV shunt, particularly in case of late management. Uterine artery embolization is an effective and safe first-line treatment, and should be evaluated for this indication in larger prospective trials.

  1. High-resolution computed tomography bronchial lumen to pulmonary artery diameter ratio in anesthetized ventilated cats with normal lungs.

    Science.gov (United States)

    Reid, Lauren E; Dillon, A Ray; Hathcock, John T; Brown, Lawrence A; Tillson, Michael; Wooldridge, Anne A

    2012-01-01

    High-resolution computed tomography (CT) is the preferred noninvasive tool for diagnosing bronchiectasis in people. A criterion for evaluating dilation of the bronchus is the bronchial lumen to pulmonary artery diameter (bronchoarterial ratio [BA ratio]). A ratio of > 1.0 in humans or > 2.0 in dogs has been suggested as a threshold for identifying bronchiectasis. The purpose of this study was to establish the BA ratio in normal cats. Fourteen specific pathogen-free cats were selected for analysis of thoracic CT images. The BA ratios of the lobar bronchi of the left cranial (cranial and caudal parts), right cranial, right middle, left caudal, and right caudal lung lobes were measured. The mean of the mean BA ratio of all lung lobes was 0.71 +/- 0.05. Individual BA ratios ranged from 0.5 to 1.11. Comparing individual lobes for each cat, there was no significant difference (P = 0.145) in mean BA ratio between lung lobes. A mean BA ratio for these normal cats was 0.71 +/- 0.1, which suggests an upper cut-off normal value > 0.91 (mean +/- 2 standard deviations) between normal and abnormal cats.

  2. Hybrid treatment of bullet embolism at the abdominal aortic bifurcation, complicated with thoracoabdominal aorta pseudoaneurysm and common iliac artery occlusion: case report

    Directory of Open Access Journals (Sweden)

    Patrick Bastos Metzger

    2014-03-01

    Full Text Available Embolization due to a firearm projectile entering the bloodstream is a rare event that is unlikely to be suspected during initial treatment of trauma patients. We describe and discuss a case of bullet embolism of the abdominal aortic bifurcation, complicated by a pseudoaneurysm of the thoracoabdominal aorta and occlusion of the right common iliac artery, but successfully treated using a combination of endovascular methods and conventional surgery.

  3. Unilateral Versus Bilateral Prostatic Arterial Embolization for Lower Urinary Tract Symptoms in Patients with Prostate Enlargement

    Energy Technology Data Exchange (ETDEWEB)

    Bilhim, Tiago, E-mail: tiagobilhim@hotmail.com [Universidade Nova de Lisboa (UNL), Departamento Universitario de Anatomia, Faculdade de Ciencias Medicas (FCM) (Portugal); Pisco, Joao; Rio Tinto, Hugo; Fernandes, Lucia [Interventional Radiology, Saint Louis Hospital (Portugal); Campos Pinheiro, Luis [Universidade Nova de Lisboa (UNL), Departamento Universitario de Urologia, Faculdade de Ciencias Medicas (FCM) (Portugal); Duarte, Marisa; Pereira, Jose A. [Interventional Radiology, Saint Louis Hospital (Portugal); Oliveira, Antonio G. [Universidade Nova de Lisboa (UNL), Biostatistics Department, Faculdade de Ciencias Medicas (FCM) (Portugal); O' Neill, Joao [Universidade Nova de Lisboa (UNL), Departamento Universitario de Anatomia, Faculdade de Ciencias Medicas (FCM) (Portugal)

    2013-04-15

    This study was designed to compare baseline data and clinical outcome between patients with prostate enlargement/benign prostatic hyperplasia (PE/BPH) who underwent unilateral and bilateral prostatic arterial embolization (PAE) for the relief of lower urinary tract symptoms (LUTS). This single-center, ambispective cohort study compared 122 consecutive patients (mean age 66.7 years) with unilateral versus bilateral PAE from March 2009 to December 2011. Selective PAE was performed with 100- and 200-{mu}m nonspherical polyvinyl alcohol (PVA) particles by a unilateral femoral approach. Bilateral PAE was performed in 103 (84.4 %) patients (group A). The remaining 19 (15.6 %) patients underwent unilateral PAE (group B). Mean follow-up time was 6.7 months in group A and 7.3 months in group B. Mean prostate volume, PSA, International prostate symptom score/quality of life (IPSS/QoL) and post-void residual volume (PVR) reduction, and peak flow rate (Qmax) improvement were 19.4 mL, 1.68 ng/mL, 11.8/2.0 points, 32.9 mL, and 3.9 mL/s in group A and 11.5 mL, 1.98 ng/mL, 8.9/1.4 points, 53.8 mL, and 4.58 mL/s in group B. Poor clinical outcome was observed in 24.3 % of patients from group A and 47.4 % from group B (p = 0.04). PAE is a safe and effective technique that can induce 48 % improvement in the IPSS score and a prostate volume reduction of 19 %, with good clinical outcome in up to 75 % of treated patients. Bilateral PAE seems to lead to better clinical results; however, up to 50 % of patients after unilateral PAE may have a good clinical outcome.

  4. Long-Term Follow-up of Uterine Artery Embolization for Symptomatic Adenomyosis

    Energy Technology Data Exchange (ETDEWEB)

    Smeets, A. J., E-mail: radiol@eztilburg.nl; Nijenhuis, R. J. [St. Elisabeth Ziekenhuis, Department of Radiology (Netherlands); Boekkooi, P. F.; Vervest, H. A. M. [St. Elisabeth Ziekenhuis, Department of Obstetrics and Gynecology (Netherlands); Rooij, W. J. van; Lohle, P. N. M. [St. Elisabeth Ziekenhuis, Department of Radiology (Netherlands)

    2012-08-15

    Introduction: Long-term results of uterine artery embolization (UAE) for adenomyosis are largely unknown. We assess long-term outcome of UAE in 40 women with adenomyosis. Materials and methods: Between March 1999 and October 2006, 40 consecutive women with adenomyosis (22 in combination with fibroids) were treated with UAE. Changes in junction zone thickness were assessed with magnetic resonance imaging (MRI) at baseline and again at 3 months. After a mean clinical follow-up of 65 months (median 58 [range 38-129]), women filled out the uterine fibroid symptom and quality of life (UFS-QoL) questionnaire, which had additional questions on the long-term evolution of baseline symptoms and adverse events. Results: During follow-up, 7 of 40 women (18%) underwent hysterectomy. Among these 7 women, the junction zones were significantly thicker, both at baseline (mean 23 vs. 16 mm, P = 0.028) and at 3-month follow-up (mean 15 vs. 9 mm, P = 0.034). Of 33 women with preserved uterus, 29 were asymptomatic. Four patients had symptom severity scores of 50 to 85 and overall QoL scores of 60 to 66, indicating substantial clinical symptoms. There was no relation between clinical outcome and the initial presence of fibroids in addition to adenomyosis. Conclusion: In women with therapy-resistant adenomyosis, UAE resulted in long-term preservation of the uterus in the majority. Most patients with preserved uterus were asymptomatic. The only predictor for hysterectomy during follow-up was initial thickness of the junction zone. The presence or absence of fibroids in addition to adenomyosis had no relation with the need for hysterectomy or clinical outcome.

  5. Uterine Artery Embolization for Symptomatic Fibroids with High Signal Intensity on T2-Weighted MR Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Suyon; Kim, Man Deuk; Lee, Myung Su; Lee, Mu Sook; Park, Sung Il; Won, Jong Yun; Lee, Do Yun; Lee, Kwang Hun [Dept. of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Severance Hospital, Seoul (Korea, Republic of)

    2012-09-15

    To evaluate the effectiveness of uterine artery embolization (UAE) for treating symptomatic fibroids with high signal intensity (SI) on magnetic resonance (MR) T2-weighted imaging (T2WI). A total of 537 cases, consisting of 14 patients with high SI fibroids on T2WI (T2 high group), were retrospectively included and compared with 28 randomly selected patients with low SI fibroids on T2WI (control group). High SI of a predominant fibroid on T2WI was defined as having the same or higher SI than the myometrium. Patient ages ranged from 28 to 52 years (mean, 38.1 years). All patients underwent MRI before and after UAE. Predominant fibroid and uterine volumes were calculated with MR images. Symptom status in terms of menorrhagia and dysmenorrhea was scored on a scale of 0-10, with 0 being no symptoms and 10 being the baseline, or initial symptoms. Of the patients in the T2 high group, 13 out of 14 (92.9%) patients demonstrated complete necrosis of the predominant fibroids. The mean volume reduction rates of the predominant fibroids in the T2 high group was 61.7% at three months after UAE, which was significantly higher than the volume reduction rates of 42.1% noted in the control group (p < 0.05). Changes in symptom scores for menorrhagia and dysmenorrhea after UAE (baseline score minus follow-up score) were 4.9 and 7.5 in T2 high group and they were 5.0 and 7.7 in control group, suggesting a significant resolution of symptoms (p < 0.01) in both groups but no significant difference between the two groups. UAE is effective for uttering fibroids showing high SI on T2WI. The mean volume reduction rate of the predominant fibroids three months after UAE was greater in the T2 high group than in the control group.

  6. Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors.

    Science.gov (United States)

    Torre, Antoine; Fauconnier, Arnaud; Kahn, Vanessa; Limot, Olivier; Bussierres, Laurence; Pelage, Jean Pierre

    2017-07-01

    To evaluate the fertility of women eligible for surgical multiple myomectomy, but who carefully elected a fertility-sparing uterine artery embolization (UAE). Non-comparative open-label trial, on women ≤40 years, presenting with multiple symptomatic fibroids (at least 3, ≥3 cm), immediate pregnancy wish, and no associated infertility factor. Women had a bilateral limited UAE using tris-acryl gelatin microspheres ≥500 μm. Fertility, ovarian reserve, uterus and fibroid sizes, and quality of life questionnaires (UFS-QoL) were prospectively followed. Fifteen patients, aged 34.8 years (95%CI 32.2-37.5, median 36.0, q1-q3 29.4-39.5) were included from November 2008 to May 2012. During the year following UAE, 9 women actively attempting to conceive experienced 5 live-births (intention-to-treat fertility rate 33.3%, 95%CI 11.8%-61.6%). Markers of ovarian reserve remained stable. The symptoms score was reduced by 66% (95%CI 48%-85%) and the quality of life score was improved by 112% (95%CI 21%-204%). Uterine volume was reduced by 38% (95%CI 24%-52%). Women were followed for 43.1 months (95%CI 32.4-53.9), 10 live-births occurred in 8 patients, and 5 patients required secondary surgeries for fibroids. Women without associated infertility factors demonstrated an encouraging capacity to deliver after UAE. Further randomized controlled trials comparing UAE and myomectomy are warranted. • Women without infertility factors showed an encouraging delivery rate after UAE. • For women choosing UAE over abdominal myomectomy, childbearing may not be impaired. • Data are insufficient to definitively recommend UAE as comparable to myomectomy. • Further randomized trials comparing fertility after UAE or myomectomy are warranted.

  7. Renal embolic protection devices improve blood flow after stenting for atherosclerotic renal artery stenosis.

    Science.gov (United States)

    Paul, Timir K; Lee, John H; White, Christopher J

    2012-11-15

    We sought to measure angiographic renal frame counts (RFC), as a quantitative angiographic assessment of renal blood flow, to evaluate microvascular compromise due to atheroembolism associated with RAS. Atheroembolism associated with renal artery stenting (RAS) has been implicated as a cause for worsening renal function following successful intervention. Use of a distal embolic protection device (EPD) during RAS has been shown to be safe with debris capture in a high percentage of cases. However, objective benefit for renal function with EPD has been difficult to demonstrate. A control group of 30 consecutive patients (33 kidneys) who underwent RAS without EPD were compared with 33 consecutive patients (33 kidneys) who underwent RAS with EPD using RFC measurement. The prestent and poststent mean RFC for the control group was 30.4 ± 12.1 vs. 23.7 ± 9.9 (P = 0.002) and for the EPD group it was 42.6 ± 12.6 vs. 28.3 ± 9.2 (P EPD group had a greater improvement in renal blood flow, manifested by a greater reduction of the RFC (Δ RFC) 14.2 ± 15.2 vs. 6.7 ± 11.7 (P = 0.03) compared with the control group. The use of an EPD was associated with a much larger improvement in renal blood flow (lower RFC) following RAS. This suggests that EPD's may be effective in preventing renal atheroembolic injury and that a controlled trial measuring the impact of EPD's on renal blood flow following RAS should be performed. Copyright © 2012 Wiley Periodicals, Inc.

  8. Intra-vesical Prostatic Protrusion (IPP) Can Be Reduced by Prostatic Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Yen-Ting, E-mail: ymerically@gmail.com; Amouyal, Grégory, E-mail: gregamouyal@hotmail.com [Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Vascular and Oncological Interventional Radiology (France); Thiounn, Nicolas, E-mail: nicolas.thiounn@egp.aphp.fr [Assistance Publique Hopitaux de Paris, Hôpital Européen Georges-Pompidou, Urology (France); Pellerin, Olivier, E-mail: olivier.pellerin@aphp.fr [Université Paris Descartes, Sorbonne Paris-Cité (France); Pereira, Héléna, E-mail: helena.pereira@aphp.fr; Giudice, Costantino Del, E-mail: costantino.del-giudice@egp.aphp.fr; Déan, Carole, E-mail: carole.dean@aphp.fr [Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Vascular and Oncological Interventional Radiology (France); Sapoval, Marc, E-mail: marc.sapoval2@aphp.fr [Université Paris Descartes, Sorbonne Paris-Cité (France)

    2016-05-15

    BackgroundProstate artery embolization (PAE) is a new approach to improve lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia. PAE results in global reduction of prostate volume (PV). There are no data available on the efficacy of PAE in reducing intra-vesical prostatic protrusion (IPP), an anatomic feature that is clinically related with bladder outlet obstruction and LUTS.ObjectiveTo assess the results of PAE in patients with significant IPP due to median lobe hyperplasia and to compare the IPSS decrease and IPP change.Material and MethodsProspective analysis of 18 consecutive patients with significant IPP (>5 mm) related to median lobe hyperplasia undergoing PAE using 30–500-μm-calibrated trisacryl microspheres. We measured IPP on sagittal T2-weighted images before and 3 months after PAE. IPSS and clinical results were also evaluated at 3 months.ResultsPAE resulted in significant IPP reduction (1.57 cm ± 0.55 before PAE and 1.30 cm ± 0.46 after PAE, p = 0.0005) (Fig. 1) with no complication. IPSS, quality of life (QoL), total prostate-specific antigen (PSA) level, and PV showed significant reduction after PAE, and maximum urinary flow rate (Q{sub max}) showed significant increase after PAE. No significant change of International Index of Erectile Function (IIEF) for clinical evaluation after PAE. A significant correlation was found between the IPP change and the IPSS change (r = 0.636, p = 0.0045).ConclusionPatients had significant IPP reduction as well as significant symptomatic improvement after PAE, and these improvements were positively correlated.

  9. Short- and long-term results of transcatheter embolization for massive arterial hemorrhage from gastroduodenal ulcers not controlled by endoscopic hemostasis

    Science.gov (United States)

    Loffroy, Romaric; Guiu, Boris; Mezzetta, Lise; Minello, Anne; Michiels, Christophe; Jouve, Jean-Louis; Cheynel, Nicolas; Rat, Patrick; Cercueil, Jean-Pierre; Krausé, Denis

    2009-01-01

    BACKGROUND AND AIM: Severe bleeding from gastrointestinal ulcers is a life-threatening event that is difficult to manage when endoscopic treatment fails. Transcatheter embolization has been suggested as an alternative treatment in this situation. The present study reports on the efficacy and long-term outcomes of transcatheter embolization after failed endoscopic treatments were assessed in high-operative-risk patients. METHODS: A retrospective review of 60 consecutive emergency embolization procedures in hemodynamically unstable patients (41 men, 19 women; mean [±SD] age 69.4±15 years) was conducted. Patients were referred for selective angiography between 1999 and 2008 after failed endoscopic treatment of massive bleeding from gastrointestinal ulcers. Mean follow-up was 22 months. RESULTS: Embolization was feasible and successful in 57 patients. Sandwich coiling of the gastroduodenal artery was used in 34 patients, and superselective occlusion of the terminal feeding artery (with glue, coils or gelatin particles) was used in 23 patients. Early rebleeding occurred in 16 patients and was managed with endoscopy (n=8), reembolization (n=3) or surgery (n=5). No major embolization-related complications occurred. Sixteen patients died within 30 days after embolization (including three who died from rebleeding) and 11 died thereafter. No late bleeding recurrences were reported. CONCLUSIONS: Selective angiographic embolization is safe and effective for controlling life-threatening bleeding from gastroduodenal ulcers. The procedure usually obviates the need for emergency surgery in these high-risk patients. Survival depends chiefly on underlying conditions. PMID:19214287

  10. Uterine artery embolization for uterine arteriovenous malformation is associated with placental abnormalities in the subsequent pregnancy: two cases report.

    Science.gov (United States)

    Soeda, Shu; Kyozuka, Hyo; Suzuki, Satoshi; Yasuda, Shun; Nomura, Yasuhisa; Fujimori, Keiya

    2014-01-01

    Uterine arteriovenous malformation (AVM) is generally associated with uterine trauma such as dilatation and curettage, therapeutic abortion, uterine surgery and uterine malignant tumors(1)). Uterine artery embolization (UAE) is performed on patients with uterine AVM who have desire for future pregnancy(2)). Some successful pregnancies were reported after UAE for uterine AVM(5,6)), however complication during pregnancy has not been described clearly. We herein for the first time report two cases of successful pregnancy and spontaneous delivery after UAE for uterine AVM who had placenta accreta and placental abruption respectively. Although successful pregnancy is possible after UAE for AVM, placenta abnormalities have to be considered during pregnancy and after delivery.

  11. Spontaneous rupture of a giant hepatic hemangioma. Sequential treatment with preoperative transcatheter arterial embolization and conservative hepatectomy.

    Science.gov (United States)

    Lupinacci, R M; Szejnfeld, D; Farah, J F M

    2011-01-01

    Hemangioma is the most common benign tumor of the liver and it is often asymptomatic. Spontaneous rupture of liver hemangiomas is a rare but potentially lethal complication. Emergent hepatic resection has been the treatment of choice but carries high operative morbidity and mortality. Recently, preoperative transcatheter arterial embolization (TAE) has been used successfully for the management of bleeding ruptured liver tumors and non-operative treatment of symptomatic giant liver hemangiomas. We report a case of spontaneous rupture of a giant hepatic hemangioma that presented with thoracic and abdominal pain and shock due to hemoperitoneum. Once proper diagnosis was made the patient was successfully managed by TAE, followed by conservative hepatic resection.

  12. Intervention of raltitrexed combined with epirubicin in hepatic arterial infusion and embolization in treatment of primary liver cancer

    Directory of Open Access Journals (Sweden)

    WANG Baoxin

    2015-05-01

    Full Text Available ObjectiveTo evaluate the therapeutic effect of intervention of raltitrexed combined with epirubicin in hepatic arterial infusion and embolization in the treatment of advanced primary liver cancer. MethodsA total of 80 patients with advanced primary liver cancer who were admitted to the Central Hospital of China National Petroleum Corporation from January 2011 to May 2013 and not suitable for surgical treatment were selected and randomly divided into study group (n=40 and control group (n=40. The study group was treated with intervention of raltitrexed combined with epirubicin in hepatic arterial infusion and embolization, while the control group was treated with intervention of fluorouracil (5-FU combined with epirubicin in hepatic arterial infusion and embolization. The treatment was given once every four weeks for a total of three to six circles. The response rate (RR, disease control rate (DCR, median time to progression, survival rate, and the decreases in alpha fetoprotein (AFP, carcinoembryonic antigen (CEA, transaminase, and bilirubin of the two groups were observed. Comparison of categorical data between the two groups was made by chi-square test, and comparison of continuous data was made by t test. ResultsThe RRs of the study group and control group were 52.5% and 22.5%, respectively, and the difference was significant (χ2=7.680, P=0.006; the DCRs of the study group and control group were 87.5% and 60.0%, respectively, and the difference was significant (χ2=7.813, P=0.005; the median time to progression of the study group and control group was 12.2 and 8.0 months, respectively, and the difference was significant (t=5.118, P=0.00; the 1- and 2-year survival rates of the study group were 85.0% and 60.0%, respectively, with the control group being 65.0% and 37.5%, and the difference was significant (χ2=4.267, P=0.039; χ2=4.053, P=0.044. One month after chemoembolization, the number of patients whose AFP, transaminase, and bilirubin

  13. Transcatheter Arterial Embolization for Shock Caused by Intratumoral Hemorrhaging in Neurofibromatosis Type 1: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Hiroto Saijo

    2014-02-01

    Full Text Available Neurofibromatosis type 1 (NF-1 is an autosomal dominant disorder characterized by café-au-lait spots and neurofibroma. Vascular NF-1 lesions are rare, but bleeding from such lesions can sometimes cause lethal complications because surgical hemostasis is difficult to achieve due to the fragile nature of the surrounding blood vessels and soft tissue. In recent years, some reports have suggested that transcatheter arterial embolization (TAE is an effective treatment for vascular NF-1 lesions. We report the cases of 2 NF-1 patients who developed intratumoral hemorrhaging and were successfully treated with TAE.

  14. Four-dimensional Transcatheter Intra-arterial Perfusion MR Imaging Before and After Uterine Artery Embolization in the Rabbit VX2 Tumor Model

    Science.gov (United States)

    Chung, Johnathan C.; Wang, Dingxin; Lewandowski, Robert J.; Tang, Richard; Chrisman, Howard B.; Vogelzang, Robert L.; Woloschak, Gayle E.; Larson, Andrew C.; Omary, Reed A.; Ryu, Robert K.

    2010-01-01

    Purpose To test the hypothesis that four-dimensional (4D) transcatheter intra-arterial perfusion (TRIP) MR imaging can measure uterine fibroid perfusion changes immediately before and after uterine artery embolization (UAE) in the rabbit VX2 tumor model. Materials and Methods Eight VX2 uterine tumors were grown in 6 rabbits. After positioning a catheter within the uterine artery, we performed 4D TRIP-MRI measurements with 3 mL injections of 2.5% gadopentetate dimeglumine. We used a dynamic 3D spoiled-GRE sequence with in vivo B1-field correction for improved accuracy during perfusion quantification. We performed UAE using 1 mL of gelatin microspheres (2×106 particles; diameter 40-120 μm). Two regions-of-interest were drawn within each tumor upon perfusion maps. Functional embolic endpoints were reported as the mean percent reduction in fibroid tumor perfusion. Measurements before and after UAE were compared using paired t-tests (α = 0.05). Results VX2 uterine tumor perfusion decreased significantly from 27.1 at baseline to 7.09 after UAE (mL/min/100 mL tissue, p < 0.0001). Overall perfusion reduction was 76.3% (95% CI: 66.3%-86.3%). Conclusion 4D TRIP MRI can objectively quantify uterine fibroid perfusion reductions during UAE in VX2 rabbits. This technique could be used clinically to potentially determine an optimal embolic endpoint with the long-term goals of improving UAE success rates and minimizing procedure-related ischemic pain. PMID:20432349

  15. Role of CT and Endovascular Embolization in Managing Pseudoaneurysms of the Internal Maxillary Artery

    Directory of Open Access Journals (Sweden)

    Chao-Bao Luo

    2006-07-01

    Conclusion: CT is a useful tool for guiding catheter angiography to localize the majority of IMPAs. Endovascular embolization can succeed in managing IMPAs, and should be performed as soon as the IMPA is depicted.

  16. Computed tomography angiography with pulmonary artery thrombus burden and right-to-left ventricular diameter ratio after pulmonary embolism.

    Science.gov (United States)

    Ouriel, Kenneth; Ouriel, Richard L; Lim, Yeun J; Piazza, Gregory; Goldhaber, Samuel Z

    2017-02-01

    Purpose Computed tomography angiography is used for quantifying the significance of pulmonary embolism, but its reliability has not been well defined. Methods The study cohort comprised 10 patients randomly selected from a 150-patient prospective trial of ultrasound-facilitated fibrinolysis for acute pulmonary embolism. Four reviewers independently evaluated the right-to-left ventricular diameter ratios using the standard multiplanar reformatted technique and a simplified (axial) method, and thrombus burden with the standard modified Miller score and a new, refined Miller scoring system. Results The intraclass correlation coefficient for intra-observer variability was .949 and .970 for the multiplanar reformatted and axial methods for estimating right-to-left ventricular ratios, respectively. Inter-observer agreement was high and similar for the two methods, with intraclass correlation coefficient of .969 and .976. The modified Miller score had good intra-observer agreement (intraclass correlation coefficient .820) and was similar to the refined Miller method (intraclass correlation coefficient .883) for estimating thrombus burden. Inter-observer agreement was also comparable between the techniques, with intraclass correlation coefficient of .829 and .914 for the modified Miller and refined Miller methods. Conclusions The reliability of computed tomography angiography for pulmonary embolism was excellent for the axial and multiplanar reformatted methods for quantifying the right-to-left ventricular ratio and for the modified Miller and refined Miller scores for quantifying of pulmonary artery thrombus burden.

  17. Embolization of renal arteries before transplantation in patients with polycystic kidney disease: a single institution long-term experience

    Energy Technology Data Exchange (ETDEWEB)

    Petitpierre, F.; Cornelis, F.; Lasserre, A.S.; Tricaud, E.; Le Bras, Y.; Grenier, N. [Pellegrin Hospital, Department of Radiology, Bordeaux (France); Couzi, L.; Merville, P. [Pellegrin Hospital, Department of Nephrology, Bordeaux (France); Combe, C.; Ferriere, J.M. [Pellegrin Hospital, Department of Urology, Bordeaux (France)

    2015-11-15

    We aimed to retrospectively assess the long-term safety and efficacy of embolization of renal arteries (ERA) in patients with polycystic kidney disease (PKD) before renal transplantation. Between January 2008 and November 2013, 82 ERA procedures were performed on 76 kidneys in 73 patients (mean age 53 years, range: 34-72). All patients had terminal-stage PKD and were under dialysis and on the renal transplant waiting list with a temporary contraindication due to excessive renal volume. ERA was considered successful in 89.5 % (68/76) of embolized kidneys, meaning that the temporary contraindication for transplantation could be withdrawn for 65 patients (on average 5.6 months, range: 2.8-24.3, after ERA). Mean volume reduction was 40 (range: 2-69) at 3 months and 59 % (35-86) thereafter (both p < 0.001). Post-embolization syndrome occurred after 15 of 82 procedures (18.3 %). The severe complication rate was 4.9 %. Forty-three (67.7 %) transplantations were successfully conducted after ERA, with a mean follow-up of 26.2 months (range: 1.8-59.5), and the estimated 5-year graft survival rate was 95.3 % [95 % CI: 82.7-98.8]. ERA is a safe and effective alternative to nephrectomy before renal transplantation in patients with PKD. (orig.)

  18. Hybrid approach to the management of infective endocarditis complicated by coronary artery embolism: a case report.

    Science.gov (United States)

    Fiedler, Amy G; Schutt, Robert C; Greenhouse, David; Stone, James; Sundt, Thoralf M; Sakhuja, Rahul

    2017-06-01

    Septic coronary embolization in a patient with endocarditis is a rare and can be a devastating complication. The management of this clinical problem in the current era may be best served with a multi-modality approach. We present an interesting case of a patient with septic coronary embolization managed with the combined use of aspiration thrombectomy followed by surgical management of the infected valve.

  19. Gravidez e parto após embolização arterial para tratamento de leiomioma uterino Pregnancy and delivery after arterial embolization for fibroid treatment

    Directory of Open Access Journals (Sweden)

    Cláudio Emilio Bonduki

    2006-10-01

    Full Text Available OBJETIVO: Analisar a evolução da gestação e partos após tratamento de leiomioma uterino por embolização das artérias uterinas. MÉTODOS: Foram incluídas na avaliação inicial 112 pacientes submetidas a embolização de artérias uterinas para tratamento de mioma uterino. Destas, somente nove desejavam o tratamento conservador para manter a capacidade reprodutiva. Este procedimento foi indicado para estas nove pacientes, pois elas não eram susceptíveis ao tratamento conservador cirúrgico. Submeteram-se a embolização das artérias uterinas com partículas de álcool polivinílico ou embosferas com diâmetro de 500 a 700 µm e evoluíram sem intercorrências. RESULTADOS: Durante o acompanhamento dessas nove pacientes houve boa resposta clínica, com redução significativa no volume do útero e dos miomas. Dessas nove, quatro engravidaram, sendo que duas tiveram abortamento precoce e duas evoluíram normalmente até o final da gestação com parto a termo, sendo um deles gemelar. CONCLUSÃO: A embolização de artérias uterinas é uma opção para o tratamento de miomas uterinos e apresenta bons resultados clínicos e anatômicos, permitindo manter a capacidade reprodutiva.PURPOSE: To analyze gestation evolution and deliveries after myoma treatment by embolization of the uterine arteries. METHODS: In the initial evaluation, 112 patients submitted to embolization of uterine arteries were included for treatment of myoma. From those, only nine wanted to be submitted to conservative treatment in order to keep their reproductive capacity. This procedure was indicated to the nine patients, since they were not susceptible to a conservative surgical treatment. They were submitted to embolization of the uterine arteries with particles of polyvinyl alcohol or embospheres with diameters ranging from 500 to 700 µm, and they have evolved without intercurrence. RESULTS: During the follow-up of these patients, there was a good clinical response

  20. Clinical and multidetector CT follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D rotational angiography

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Jung Min; Park, Kwang Bo; Kim, Keon Ha; Jeon, Pyoung; Shin, Sung Wook; Park, Hong Suk; Do, Young Soo (Dept. of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)), email: kbparksmc@skku.edu; Kim, Dong-Ik; Kim, Young-Wook (Div. of Vascular Surgery, Dept. of Surgery, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of))

    2011-10-15

    Background: There are very few reports regarding the use of 3D rotational angiography (3D RA) in embolization of renal artery aneurysms (RAAs). No valuable data have been reported on the follow-up result of coil embolization for RAAs on computed tomography (CT). Purpose: To evaluate the clinical and multidetector computed tomography (MDCT) follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D RA. Material and Methods: Six patients diagnosed with RAAs were included. Five patients underwent detachable coil embolization. Five patients underwent 3D RA and the parameters used for planning endovascular treatment obtained by 2D CT, reformatted 3D CT angiography (3D CTA), 2D digital subtraction angiography (2D DSA) and 3D RA were compared. The post embolization MDCT follow-up findings were analyzed retrospectively. Results: The technical success rate for detachable coil embolization was 40%. The 3D CTA showed the dome-to-neck ratio (DNR) and tangential view of the renal artery aneurysm in five patients (83.3%) and the 2D CT showed it in four (66.7%). An optimal working angle assessment could not be obtained on the 2D CT and 3D CTA. The 3D RA showed the DNR, tangential view, and optimal working angle in all patients. Renal infarction occurred in three patients and Postprocedural hypertension developed in two patients during the follow-up period. Conclusion: The 3D RA was useful in preoperative determination of adequate working angle for detachable coil embolization of RAAs. Late complications of detachable coil embolization for RAAs were renal infarction and hypertension

  1. Emergency gastroduodenal artery embolization by sandwich technique for angiographically obvious and oblivious, endotherapy failed bleeding duodenal ulcers

    Energy Technology Data Exchange (ETDEWEB)

    Anil, G., E-mail: ivyanil10@gmail.com [Department of Diagnostic Imaging, National University Hospital (Singapore); Department of Radiology, Changi General Hospital (Singapore); Tan, A.G.S.; Cheong, H.-W.; Ng, K.-S.; Teoh, W.-C. [Department of Radiology, Changi General Hospital (Singapore)

    2012-05-15

    Aim: To determine the feasibility, safety, and efficacy of adopting a standardized protocol for emergency transarterial embolization (TAE) of the gastroduodenal artery (GDA) with a uniform sandwich technique in endotherapy-failed bleeding duodenal ulcers (DU). Materials and methods: Between December 2009 and December 2010, 15 patients with endotherapy-failed bleeding DU were underwent embolization. Irrespective of active extravasation, the segment of the GDA supplying the bleeding DU as indicated by endoscopically placed clips was embolized by a uniform sandwich technique with gelfoam between metallic coils. The clinical profile of the patients, re-bleeding, mortality rates, and response time of the intervention radiology team were recorded. The angioembolizations were reviewed for their technical success, clinical success, and complications. Mean duration of follow-up was 266.5 days. Results: Active contrast-medium extravasation was seen in three patients (20%). Early re-bleeding was noted in two patients (13.33%). No patient required surgery. There was 100% technical success, while primary and secondary clinical success rates for TAE were 86.6 and 93.3%, respectively. Focal pancreatitis was the single major procedure-related complication. There was no direct bleeding-DU-related death. The response time of the IR service averaged 150 min (range 60-360 min) with mean value of 170 min. Conclusion: Emergency embolization of the GDA using the sandwich technique is a safe and highly effective therapeutic option for bleeding DUs refractory to endotherapy. A prompt response from the IR service can be ensured with an institutional protocol in place for such common medical emergencies.

  2. A Case of Ruptured Aneurysm of the Proper Esophageal Artery with Symptomatic Mediastinal Hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Jiajia; Sato, Yusuke, E-mail: yusuke@doc.med.akita-u.ac.jp [Akita University Graduate School of Medicine, Department of Thoracic Surgery (Japan); Takahashi, Satoshi [Akita University Graduate School of Medicine, Department of Radiology (Japan); Motoyama, Satoru; Yoshino, Kei; Sasaki, Tomohiko; Imai, Kazuhiro; Saito, Hajime; Minamiya, Yoshihiro [Akita University Graduate School of Medicine, Department of Thoracic Surgery (Japan)

    2016-08-15

    Mediastinal aneurysms are rare but potentially life-threatening. Among these, bronchial artery aneurysms are most frequently reported, whereas up to now aneurysms of the proper esophageal artery had never been reported. A 69-year-old woman was referred to our hospital for treatment of a massive mediastinal hematoma. Enhanced computed tomography and selective proper esophageal arteriography revealed a 5-mm aneurysm in the proper esophageal artery that arises from the thoracic aorta at the Th8 level and has an anastomotic branch with the bronchial artery peripherally. Transcatheter arterial embolization was successfully performed using a mixture of N-butyl cyanoacrylate and lipiodol (1:3 ratio, 0.3 ml). Post-embolization angiography showed no filling into the aneurysm. The patient recovered with no complications and was discharged on the 25th post-procedure day.

  3. Efficacy of occlusion of hepatic artery and risk of carbon dioxide gas embolism during laparoscopic hepatectomy in a pig model.

    Science.gov (United States)

    Makabe, Kenji; Nitta, Hiroyuki; Takahara, Takeshi; Hasegawa, Yasushi; Kanno, Shoji; Nishizuka, Satoshi; Sasaki, Akira; Wakabayashi, Go

    2014-08-01

    The important point in safely performing laparoscopic hepatectomy (LH) is to control bleeding. The aims of this study were: (i) to assess the bleeding reduction effect by occlusion of the hepatic artery in LH; and (ii) to evaluate the risk of carbon dioxide (CO2 ) gas embolism (GE) in the case of high pneumoperitoneum (PP). Nine piglets underwent laparoscopic left medial lobe and left lateral lobe resection, receiving either occlusion of the hepatic artery (hepatic artery clamping group: HACG, n = 9) or no occlusion (hepatic artery declamping group: HADCG, n = 9) using a PP of 15 mmHg. In addition, we observed changes in hemodynamics induced by PP. The state of GE was observed using transesophageal echocardiography (TEE) during LH (n = 8). GE was graded as grade 0 (none), grade 1 (minor), and grade 2 (major). The HACG had significantly less bleeding compared to the HADCG (P < 0.01). During LH, four animals showed grade 1 (37.5%) and one animal showed grade 2 (12.5%) GE at 15 mmHg. At 20 mmHg, all animals showed grade 2 (100%) GE. The occlusion of the hepatic artery in LH reduces blood loss. The control of bleeding from the hepatic vein is feasible with a high PP, but there is a possibility of GE. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  4. [Interventional emergency embolization for severe pelvic ring fractures with arterial bleeding. Integration into the early clinical treatment algorithm].

    Science.gov (United States)

    Westhoff, J; Laurer, H; Wutzler, S; Wyen, H; Mack, M; Maier, B; Marzi, I

    2008-10-01

    Presentation of our own experiences and results of an early clinical algorithm for treatment integrating emergency embolization (TAE) in cases of unstable pelvic ring fractures with arterial bleeding. Consecutive patient series from April 2002 to December 2006 at a level 1 trauma center. The data of the online shock room documentation (Traumawatch) of patients with a pelvic fracture and arterial bleeding detected on multislice computed tomography (MSCT) were examined for the following parameters: demographic data, injury mechanism, fracture classification according to Tile/AO and severity of the pelvic injury assessed with the Abbreviated Injury Score (AIS), accompanying injuries with elevation of the cumulative injury severity according to the Injury Severity Score (ISS), physiological admission parameters (circulatory parameters and initial Hb value) as well as transfusion requirement during treatment in the shock room, time until embolization, duration of embolization, and source of bleeding. Of a total of 162 patients, arterial bleeding was detected in 21 patients by contrast medium extravasation on MSCT, 12 of whom were men and 9 women with an average age of 45 (14-80) years. The mechanism of injury was high energy trauma in all cases. In 33% it involved type B pelvic fractures and in 67% type C fractures with an average AIS pelvis of 4.4 points (3-5) and a total severity of injury with the ISS of 37 points (21-66). Upon admission 47.6% presented hemodynamic instability with an average Hb value of 7.8 g/dl (3.2-12.4) and an average transfusion requirement of 6 red blood cell units (4-13). The time until the TAE was started was on average 62 min (25-115) with a duration period of the TAE of 25 min (15-67). Branches of the internal iliac artery were identified as the sole source of bleeding. The success rate of TAE amounted to over 90%. Interventional TAE represents an effective as well as a fast procedure for hemostasis of arterial bleeding detected on MSCT in

  5. Prostate Zonal Volumetry as a Predictor of Clinical Outcomes for Prostate Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Assis, André Moreira de, E-mail: andre.assis@criep.com.br, E-mail: andre.maa@gmail.com; Maciel, Macello Sampaio, E-mail: macielmjs@gmail.com; Moreira, Airton Mota, E-mail: airton.mota@criep.com.br; Paula Rodrigues, Vanessa Cristina de, E-mail: vanessapaular@yahoo.com.br [University of Sao Paulo Medical School, Vascular and Interventional Radiology Unit, Radiology Institute (Brazil); Antunes, Alberto Azoubel, E-mail: antunesuro@uol.com.br; Srougi, Miguel, E-mail: srougi@uol.com.br [University of Sao Paulo Medical School, Urology Department (Brazil); Cerri, Giovanni Guido, E-mail: giovanni-cerri@uol.com.br [University of Sao Paulo Medical School, Radiology Institute (Brazil); Carnevale, Francisco Cesar, E-mail: francisco.carnevale@criep.com.br [University of Sao Paulo Medical School, Vascular and Interventional Radiology Unit, Radiology Institute (Brazil)

    2017-02-15

    PurposeTo determine prostate baseline zonal volumetry and correlate these findings with clinical outcomes for patients who underwent prostate artery embolization (PAE) for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).Materials and MethodsThis is a retrospective study that included patients treated by PAE from 2010 to 2014. Baseline and 6-month follow-up evaluations included prostate MRI with whole prostate (WP) and central gland (CG) volume measurements—as well as prostate zonal volumetry index (ZVi) calculation, defined as the CG/WP volumes relation—the International Prostate Symptom Score (IPSS), and the Quality of life (QoL) index. Baseline WP, CG, and ZVi were statistical compared to IPSS and QoL values at 6 months.ResultsA total of 93 consecutive patients were included, with mean age of 63.4 years (range, 51–86). Clinical failure, defined as IPSS > 7 or QoL > 2, was seen in four cases (4.3%). Mean reductions in prostate volumes after PAE were of 30.6% and 31.2% for WP and CG, respectively (p < 0.0001). Clinical parameters had mean decrease from 21 to 3.3 points for IPSS, and from 4.7 to 1.2 points for QoL (p < 0.0001). Baseline WP, CG, and ZVi correlated to the degree of clinical improvement (p < 0.05 for all). The baseline ZVi cut-off calculated for better clinical outcomes was > 0.45, with 85% sensitivity and 75% specificity.ConclusionsBaseline CG and WP volumes as well as ZVi presented strong correlation with clinical outcomes in patients undergoing PAE, and its assessment should be considered in pre-treatment evaluation whenever possible. Both patients and medical team should be aware of the possibility of less favorable outcomes when ZVi < 0.45.

  6. [Clinical effect of terminal branches portal vein embolization combined with transcatheter arterial chemoembolization on liver neoplasms].

    Science.gov (United States)

    Peng, S Y; Huang, C Y; Wang, X A; Wang, Y F; Zhang, Y Y; Li, J T; Xu, B; Liang, X; Wang, J W; Hong, D F; Cai, X J

    2017-09-01

    Objective: To analyze the efficacy of branches portal vein embolization (TBPVE) combined with transcatheter arterial chemoembolization (TACE) on liver neoplasms. Methods: From August 2016 to May 2017, there were 13 patients including 11 males and 2 females with primary hepatocellular carcinoma who underwent TBPVE+ TACE , among whom there were 11 cases with a history of HBV infection.Average age of the 13 patients was (60.8±6.2)years. The live function of all patients were Child-Pugh A classification.The CT or MRI images of each patient was reconstructed and the standard liver volume(SLV) before TBPVE+ TACE was (1 181.2±49.3)ml, estimated future liver remnant(FLR) was (326.1±72.1)ml and FLR/SLV was (27.6±6.0)%.The puncture site for TBPVE was determined by the three-dimensional reconstruction of portal vein.CT scan or MRI, AFP and liver function test were repeated after one and two weeks after TBPVE+ TACE.FLR and FLR/SLV were calculated respectively.Hepatectomy would be performed if the patients agreed.The postoperative complications were analyzed. Results: On the 7thday after TBPVE+ TACE, the FLR/SLV was(42.6±8.0)% and the FLR increasement was(56.0±24.6)%.The level of AFP decreased from(87.9±81.8)μg/L to (29.7±20.9)μg/L.On the 14thday after TBPVE+ TACE, the FLR/SLV was(45.8±6.2)% and the FLR increasement was(71.8±29.0)%.Four patients underwent surgery which including 2 right hepatectomies and 2 right trisegmentectomies in 2 weeks after TBPVE+ TACE.Nine patients were performed with targeting intratumoral lactic acidosis TACE (TILA-TACE). No severe complication occurred in all patients. Conclusions: TBPVE could induce a rapid growth of the liver remnant but still with the concern of inducing the growth of neoplasms at the same time.To combine TACE in TBPVE therapy not also can the growth of neoplasms be prevented but also inducing its shrinking.This method might be a new mode for the treatment of hepatocellular carcinoma.

  7. Proximal splenic artery embolization for blunt splenic injury: clinical, immunologic, and ultrasound-Doppler follow-up.

    Science.gov (United States)

    Bessoud, Bertrand; Duchosal, Michel A; Siegrist, Claire-Anne; Schlegel, Susanna; Doenz, Francesco; Calmes, Jean-Marie; Qanadli, Salah D; Schnyder, Pierre; Denys, Alban

    2007-06-01

    To evaluate the clinical, US (ultrasound)-Doppler and hematologic findings after proximal splenic artery embolization (PSAE) for blunt injury. From August 1998 to February 2003, 37 patients (28 men and 9 women; 20-89 years old, mean 40 years) underwent PSAE for blunt injuries. One patient required secondary splenectomy after PSAE. Early complications were investigated during the hospital stay. Delayed follow-up included review of the outpatient records, telephone interview, consultation, US-Doppler splenic study, Howell-Jolly body search, and serum antibody titer determinations (pneumococcus and Haemophilus influenzae B). No early postprocedural complications were depicted. Ten patients were lost on follow-up. Two patients had a telephone interview that revealed no complication. Twenty-four patients were examined 6 to 63 (mean 26) months after the embolization. No late complication was reported. Splenic measurements were in the normal range: length (53-110 mm; mean, 73), width (49-110 mm; 76), thickness (26-56 mm; 38), volume (61-508 mL; 226), standard ellipsoid formula volume (32-265 mL; 118), corrected volume (29-238 mL; 106), and splenic volumetric index (2.3-18.8; 8.4). The spleen was homogeneous in 23 patients (96%). Intrasplenic vascularization was present and splenic vein was patent in all patients. Howell-Jolly bodies were found in two patients. All patients (24 of 24) evaluated for exposure-driven immunity against Haemophilus Influenza b had sufficient immunity. Seventeen of the 18 patients (94%) evaluated for exposure-driven immunity against pneumococcus had sufficient immunity. Five of the six patients (83%) evaluated for pneumococcus vaccine response had a sufficient response. Proximal splenic artery embolization in blunt splenic injuries is a well-tolerated technique without major long-term impact on the splenic anatomy and immune function.

  8. Selective embolization of the internal iliac arteries for the treatment of intractable hemorrhage in children with malignancies

    Directory of Open Access Journals (Sweden)

    Sul Hee Bae

    2011-04-01

    Full Text Available Purpose : Acute internal hemorrhage is an occasionally life-threatening complication in pediatric cancer patients. Many therapeutic approaches have been used to control bleeding with various degrees of success. In this study, we evaluated the efficacy of selective internal iliac artery embolization for controlling acute intractable bleeding in children with malignancies. Methods : We retrospectively evaluated the cases of 6 children with various malignancies (acute lymphoblastic leukemia, acute myelogenous leukemia, chronic myelogenous leukemia, T-cell prolymphocytic leukemia, Langerhans cell histiocytosis, and rhabdomyosarcoma, who had undergone selective arterial embolization (SAE of the internal iliac artery at the Chonnam National University Hwasun Hospital between January 2004 and December 2009. SAE was performed by an interventional radiologist using Gelfoam&#9415; and/or Tornado&#9415; coils. Results : The patients were 5 boys and 1 girl with median age of 6.9 years (range, 0.7&#8211;14.8 years at the time of SAE. SAE was performed once in 4 patients and twice in 2, and the procedure was unilateral in 2 and bilateral in 4. The causes of hemorrhage were as follows: hemorrhagic cystitis (HC in 3 patients, procedure-related internal iliac artery injuries in 2 patients, and tumor rupture in 1 patient. Initial attempt at conservative management was unsuccessful. Of the 6 patients, 5 (83.3% showed improvement after SAE without complications. Conclusion : SAE may be a safe and effective procedure for controlling acute intractable hemorrhage in pediatric malignancy patients. This procedure may obviate the need for surgery, which carries an attendant risk of morbidity and mortality in cancer patients with critical conditions.

  9. First Case of 2 Synchronous Gluteal Arteries Aneurysms Treated by Endovascular Plug Embolization: Case Report and Literature Review.

    Science.gov (United States)

    Esposito, Andrea; Menna, Danilo; Salcuni, Matteo; Di Leo, Ferdinando; Benedetto, Pietro; Trani, Antonio; Cappiello, Antonino Pierluigi

    2017-09-28

    Gluteal artery aneurysms (GAAs) are rare, accounting for less than 1% of all arterial aneurysms. Most of them are post-traumatic in nature and involve the superior gluteal artery (SGA), while injuries of the inferior gluteal artery (IGA) have been reported less frequently. We report an unusual case of a patient with double saccular GAA of unknown etiology, involving both the SGA and IGA, successfully treated by endovascular embolization. A 80-year-old man referred to our hospital complaining of the progressive onset of left buttock pain and swelling exacerbated by sitting position in the last 4 months. His past medical history was positive for hypertension, prostatic adenocarcinoma treated by brachytherapy, and endocarditis diagnosed about 30 years before and treated by cardiac surgical valve replacement; no history of trauma was reported. After ultrasonography was carried out, an enhanced computed tomography (CT) scan confirmed the presence of 2 large GAAs involving both the SGA and IGA, with maximum transverse diameter of 38 and 84 mm, respectively. The patient was referred for endovascular treatment after informed consent was provided. After sequential selective catheterization of SGA and IGA, 3 Amplatzer Plugs II (St. Jude Medical, Zaventem, Belgium) were deployed inside the aneurysms. Postoperative course was uneventful as buttock pain completely disappeared on the second postoperative day. The patient was discharged to home on the third postoperative day. One-month CT scan confirmed the complete thrombosis of the aneurysms without any endoleak. GAAs represent a rare pathology, and for that reason, the correct timing and choice of treatment are not clearly defined. Endovascular techniques are the first step in the approach to GAAs. In case of complex anatomy, GAAs embolization by the use of vascular plugs can be successfully performed. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Ectopic pregnancy after successful treatment with percutaneous transcatheter uterine arterial embolization for congenital uterine arteriovenous malformation: a case report.

    Science.gov (United States)

    Nasu, Kaei; Nishida, Masakazu; Yoshimatsu, Jun; Narahara, Hisashi

    2008-08-01

    Uterine arteriovenous malformation (AVM) is a rare disease. Percutaneous transcatheter uterine arterial embolization (UAE) has been performed in patients who wish to preserve their ability to conceive. UAE is considered to be a safe and effective procedure, but its long-term effect on fertility has not been fully elucidated. We present a case of ectopic tubal pregnancy after conservative treatment with UAE for uterine AVM. A 30-year-old Japanese woman was admitted for the treatment of unruptured right tubal pregnancy at 6 weeks of gestation. She had conceived spontaneously and delivered a healthy baby at term, 3 years previously. Subsequently, she was successfully treated with UAE for a large congenital uterine AVM. Transvaginal color Doppler ultrasonography revealed no evidence of residual AVM vessels. After the diagnosis of ectopic pregnancy, the patient underwent right tubectomy. At laparotomy, there were no adhesions or structural anomalies in the pelvic cavity that might affect tubal function. The patient's postoperative course was uneventful, and she is now healthy without conception 24 months after surgery. Prior uterine arterial embolization may have affected the tubal function in the present case, allowing tubal pregnancy to occur.

  11. [A Case of Unresectable Advanced Gastric Cancer Treated with Radiotherapy and Trans-Arterial Embolization, Resulting in Effective Hemostasis].

    Science.gov (United States)

    Okumura, Yuichiro; Kawada, Junji; Fujitani, Kazumasa; Nakatsuka, Rie; Motoori, Masaaki; Fukuda, Syoichi; Shimamoto, Shigetoshi; Nishikawa, Kazuhiro; Nomura, Masatoshi; Miyazaki, Susumu; Danno, Katsuki; Kubota, Masaru; Matsuda, Chu; Iwase, Kazuhiro; Tanaka, Yasuhiro

    2015-11-01

    We report the case of a 70-year-old man with unresectable advanced gastric cancer because of invasion to the pancreas and multiple liver metastases. He could have continued with fourth-line chemotherapy by controlling intermittent bleeding from the cancer by means of 2 rounds of radiotherapy and trans-arterial embolization. The serum hemoglobin level declined to 4.5 g/dL during second-line chemotherapy. As the venous bleeding from the cancer was difficult to control by endoscopic hemostasis, radiotherapy with 40 Gy/20 fractions was applied to the cancer. We were able to restart chemotherapy after the hemostasis, but 6 months later, the serum hemoglobin level declined to 6.1 g/dL. Additional radiotherapy of 20 Gy/10 fractions was delivered to the tumor, and successful hemostasis was achieved; the serum hemoglobin level reached 7.5 g/dL. However, a contrast-enhanced CT, which was performed 3 weeks later, demonstrated extravasation from the cancer into the gastric cavity. We conducted trans-arterial embolization, and the patient no longer required transfusion. We planned to restart chemotherapy soon, but after 1 month, he died of pneumonia.

  12. Partial anomalous left pulmonary artery with associated bronchial anomalies in a patient with repaired Tetralogy of Fallot.

    Science.gov (United States)

    Mathias, Helen C; Manghat, Nathan E

    2012-01-01

    We present a 28 year old man with repaired Tetralogy of Fallot who underwent CT imaging prior to pulmonary valve replacement. CT demonstrated a partial anomalous LPA with associated bronchial anomalies and normal variant pulmonary venous drainage. The case demonstrates the utility of multislice CT in delineating 3-dimensional vascular and bronchial anatomy in these complex anomalies. Copyright © 2012 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  13. Angiographic suppression of the artery of Adamkiewicz by venous hypertension resolving after embolization in a case of spinal epidural arteriovenous fistula

    Science.gov (United States)

    Eckart Sorte, Danielle; Pardo, Carlos A; Gailloud, Philippe

    2014-01-01

    A case of complete angiographic suppression of the artery of Adamkiewicz and anterior spinal artery in a patient with a spinal epidural arteriovenous fistula (AVF) is reported. Slow flow AVFs typically present with progressive myelopathy secondary to spinal venous hypertension (SVH). The lack of a normal venous phase during angiography and its restoration after treatment is commonly observed with these lesions, yet a similar phenomenon seems exceptional at the arterial level. Right T11 intercostal artery angiograms obtained before and after treatment of a left L4 epidural AVF documented the initial suppression of the artery of Adamkiewicz and anterior spinal artery, and their normal appearance immediately after correction of the SVH by embolization. This report confirms that SVH can angiographically suppress prominent and functionally important spinal arteries, re-emphasizing the potential role played by secondary arterial changes in SVH induced myelopathy. This hemodynamic phenomenon also represents a potential pitfall during diagnostic and therapeutic endovascular procedures. PMID:25028420

  14. Penile angiography and superselective embolization therapy in arterial priapism; Penisangiographie und superselektive Embolisationstherapie bei high-flow Priapismus

    Energy Technology Data Exchange (ETDEWEB)

    Dinkel, H.P.; Triller, J. [Inst. fuer Diagnostische Radiologie, Inselspital, Univ. Bern (Switzerland); Hochreiter, W. [Urologische Klinik, Inselspital, Univ. Bern (Switzerland)

    2003-08-01

    Purpose: To report feasibility, benefit and complications of penile angiography and superselective penile embolization in arterial priapism. Materials and Methods: Four consecutive patients (aged 28, 29, 40 and 49 years), who underwent penile angiography for arterial priapism (high-flow priapism) within a four-year period, were identified by a keyword search of our radiology information system. One patient had sustained a direct penile trauma (severe blow to the erected penis) and three patients suffered from recurrent spontaneous priapism. All patients had previously undergone corporeal aspiration and noradrenaline injection to achieve detumescence. Two patients had one or several unsuccessful spongiocavernous shunt procedures. Results: In three of the four patients, superselective pudendal and penile angiography demonstrated pathologic arteriocavernous shunting. In two of the three patients, superselective embolization using a coaxial micro-catheter was attempted. In one of the two patients, the cavernous artery became spastic before embolization material was actually injected, inducing immediate and lasting detumescence. In the other patient, unilateral Gelfoam embolization led to immediate detumescence but the priapism recurred 12 hours after the procedure. A subsequent contralateral Gelfoam embolization was successful. Erectile function was preserved in all cases. No procedure-related complications occurred. Conclusion: Our experience supports the prevailing opinion found in the current literature that superselective coaxial embolization constitutes the treatment of choice in patients with high-flow priapism. Prognosis is good with high probability of preserving the erectile function. (orig.) [German] Ziel: Untersuchung der Interventionsmoeglichkeiten bei arteriellem (high-flow) Priapismus durch endovaskulaere superselektive Embolisation der Penisarterien. Methode: Alle innerhalb eines Vierjahreszeitraums (1/99-5/2002) wegen Priapismus zur Angiographie

  15. Recurrence of Lower Urinary Tract Symptoms Following Prostate Artery Embolization for Benign Hyperplasia: Single Center Experience Comparing Two Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Carnevale, Francisco Cesar, E-mail: francisco.carnevale@criep.com.br; Moreira, Airton Mota [University of Sao Paulo, Department of Radiology (Brazil); Harward, Sardis Honoria [The Dartmouth Institute for Health Policy and Clinical Practice (United States); Bhatia, Shivank [University of Miami Medical Center, Department of Interventional Radiology (United States); Assis, Andre Moreira de [University of Sao Paulo, Department of Radiology (Brazil); Srougi, Miguel [University of Sao Paulo, Department of Urology (Brazil); Cerri, Giovanni Guido [University of Sao Paulo, Department of Radiology (Brazil); Antunes, Alberto Azoubel [University of Sao Paulo, Department of Urology (Brazil)

    2017-03-15

    PurposeTo compare recurrence of lower urinary tract symptoms (LUTS) recurrence at 12 months following original prostate artery embolization (oPAE) or “proximal embolization first, then embolize distal” (PErFecTED) PAE for benign prostatic hyperplasia (BPH).Materials and Methods105 consecutive patients older than 45 years, with prostate size greater than 30 cm{sup 3}, International Prostate Symptom Score (IPSS) ≥ 8, quality of life (QoL) index ≥ 3, and refractory status or intolerance of medical management were prospectively enrolled between June 2008 and August 2013. The study was IRB-approved, and all patients provided informed consent. Patients underwent oPAE or PErFecTED PAE and were followed for at least 12 months. Technical success was defined as bilateral embolization and clinical success (non-recurrence) was defined as removal of the Foley catheter in patients with urinary retention, IPSS < 8 and QoL index < 3 at 12 months of follow-up. Nonparametric statistics were used to compare the study groups due to the size of the study population and distributions of clinical data.Results97 patients had 12-month data and were categorized as oPAE without recurrence (n = 46), oPAE with recurrence (n  = 13), PErFecTED without recurrence (n  = 36), or PErFecTED with recurrence (n  = 2). Recurrence was significantly more common in oPAE patients (χ{sup 2}, p = 0.026). Unilateral embolization was significantly associated with recurrence among patients who underwent oPAE (χ{sup 2}, p = 0.032).ConclusionsBoth oPAE and PErFecTED PAE are safe and effective methods for treatment of LUTS, but PErFecTED PAE is associated with a significantly lower rate of symptom recurrence.

  16. Successful coil embolization of a ruptured basilar artery aneurysm in a child with leukemia: a case report.

    Science.gov (United States)

    Hayashi, Shihori; Maehara, Taketoshi; Mukawa, Maki; Aoyagi, Masaru; Yoshino, Yoshikazu; Nemoto, Shigeru; Ono, Toshiaki; Ohno, Kikuo

    2014-01-01

    Ruptured intracranial aneurysms are rare in the pediatric population compared to adults. This has incited considerable discussion on how to treat children with this condition. Here, we report a child with a ruptured saccular basilar artery aneurysm that was successfully treated with coil embolization. A 12-year-old boy with acute lymphoblastic leukemia and accompanying abdominal candidiasis after chemotherapy suddenly complained of a severe headache and suffered consciousness disturbance moments later. Computed tomography scans and cerebral angiography demonstrated acute hydrocephalus and subarachnoid hemorrhage caused by saccular basilar artery aneurysm rupture. External ventricular drainage was performed immediately. Because the patient was in severe condition and did not show remarkable signs of central nervous system infection in cerebrospinal fluid studies, we applied endovascular treatment for the ruptured saccular basilar artery aneurysm, which was successfully occluded with coils. The patient recovered without new neurological deficits after ventriculoperitoneal shunting. Recent reports indicate that both endovascular and microsurgical techniques can be used to effectively treat ruptured cerebral aneurysms in pediatric patients. A minimally invasive endovascular treatment was effective in the present case, but long-term follow-up will be necessary to confirm the efficiency of endovascular treatment for children with ruptured saccular basilar artery aneurysms.

  17. A dynamic concept of middle cerebral artery occlusion and cerebral infarction in the acute state based on interpreting severe hyperemia as a sign of embolic migration

    DEFF Research Database (Denmark)

    Olsen, T S; Lassen, N A

    1984-01-01

    The present study investigates the pathogenesis of focal cerebral hyperemia, its effect on brain tissue and discusses its pathophysiological and therapeutic importance in the light of interpreting severe hyperemia as a sign of arterial reopening probably due to embolic migration. Cerebral angiogr...

  18. Local treatment in unresectable hepatic metastases of carcinoid tumors: Experiences with hepatic artery embolization and radiofrequency ablation

    Directory of Open Access Journals (Sweden)

    van Coevorden Frits

    2005-11-01

    Full Text Available Abstract Background Hepatic metastases of carcinoid tumors cause incapacitating symptoms, but are usually diffuse and therefore unresectable. In this article we evaluate our experiences with local treatment techniques in the management of carcinoid patients with hepatic metastases and failing systemic treatment. Methods Fifteen consecutive carcinoid patients (11 men and 4 women; median age 60 years; range 45–71 years were treated with either hepatic artery embolization (HAE with Ivalon particles or radiofrequency ablation (RFA (percutaneously or intra-operatively. Follow-up evaluation was performed by CT scan and 24-hours urinary 5-HIAA excretions. Results A total of 18 HAE's was performed in 13 patients, while 10 lesions in 3 patients were treated with RFA. Median follow-up was 12.5 months (2 – 25 months. Median duration of symptoms was 22 months (8 – 193 months. Median overall decrease of 5-HIAA excretion 2 months after HAE was 32% with tumor regression on CT-scan in 4 patients (30% and improvement of symptoms with a median duration of 15 months in 3 of them (23%. Embolization led to fatal hepatic failure in one patient. The 3 patients treated with RFA showed a decrease of urinary 5-HIAA values of 34, 81 and 93% respectively, with tumor regression in all of them. Improvement of symptoms was reported in 2 patients up to 25 months. Conclusion Liver embolization performed late in the clinical course had limited effect on symptoms and biochemical and radiological parameters. First experiences with RFA are favorable and might encourage to apply RFA more widely in metastatic carcinoid.

  19. Efficacy and surgical procedures of preoperative splenic artery embolization for laparoscopic splenectomy of a massive splenomegaly: A case report

    Directory of Open Access Journals (Sweden)

    Toshikatsu Nitta

    2015-01-01

    Full Text Available Here, we describe the case of a 58-year-old woman diagnosed with massive splenomegaly with a malignant lymphoma that had a maximum diameter of 24 cm. Splenectomy was indicated because of thrombocytopenia and abdominal distention. Therefore, a balloon catheter was inserted preoperatively through the splenic artery for embolization and continuous infusion to reduce the spleen volume. It enabled easy handling of the spleen and minimized bleeding. The volume of the spleen was estimated at 1896 g through the skin incision, as measured by volumetric computed tomography; thus, laparoscopy seemed difficult. However, the surgery was successfully performed only with laparoscopic surgery, and the volume of the resected spleen was 1020 g. This preoperative preparation is an effective alternative to laparoscopic removal of a huge splenomegaly.

  20. Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 1, Pathological Background and Clinical Implications

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Fei, E-mail: feisun@ccmijesususon.com; Crisóstomo, Verónica, E-mail: crisosto@ccmijesususon.com; Báez-Díaz, Claudia, E-mail: cbaez@ccmijesususon.com; Sánchez, Francisco M., E-mail: msanchez@ccmijesususon.com [Jesús Usón Minimally Invasive Surgery Centre (Spain)

    2016-01-15

    Pathological features of benign prostatic hyperplasia (BPH) dictate various responses to prostatic artery embolization (PAE). Typically, BPH originates in the transition zone and periurethral region, where should be considered the primary target area in PAE procedures. Given that histological heterogeneity of components in hyperplasia nodules, epithelial or stromal, identifying the more responsive nodules to PAE will have clinical implications. Since some lower urinary tract symptoms (LUTS) in patients with BPH are usually related to bladder outlet obstruction-induced changes in bladder function rather than to outflow obstruction directly, proper selection of candidate patients prior to PAE is of great clinical importance. BPH is a typical chronic progressive condition, suggesting PAE could aim not only to relieve LUTS but also to delay or prevent the clinical progression. Awareness of the pathological background of BPH is essential for interventional radiologists to improve clinical outcomes and develop new treatment strategies in clinical practice of PAE.

  1. Non-dysbaric arterial gas embolism associated with chronic necrotizing pneumonia, bullae and coughing: a case report.

    Science.gov (United States)

    Ceponis, Peter J; Fox, William; Tailor, Tina D; Hurwitz, Lynne M; Amrhein, Timothy J; Moon, Richard Je

    2017-01-01

    Arterial gas embolism (AGE) can be clinically devastating, and is most often associated with exposure to changes in ambient pressure, medical procedure or congenital malformation. Here we report a case of AGE in a 78-year-old male without these traditional risk factors. Rather, the patient's history included chronic obstructive pulmonary disease, necrotizing pneumonia, bullous disease and coughing. He was safely treated with hyperbaric oxygen (HBO₂) therapy for AGE, with initial clinical improvement, but ultimately died from his underlying condition. Pathophysiology is discussed. This case illustrates the possibility that AGE can occur due to rupture of lung tissue in the absence of traditional risk factors. HBO₂ therapy should be considered in the management of such patients. Copyright© Undersea and Hyperbaric Medical Society.

  2. Superior Hypogastric Nerve Block to Reduce Pain After Uterine Artery Embolization: Advanced Technique and Comparison to Epidural Anesthesia

    Energy Technology Data Exchange (ETDEWEB)

    Binkert, Christoph A., E-mail: christoph.binkert@ksw.ch [Kantonsspital Winterthur, Institute of Radiology and Nuclear Medicine (Switzerland); Hirzel, Florian C. [Kantonsspital Winterthur, Department of Gynecology (Switzerland); Gutzeit, Andreas; Zollikofer, Christoph L. [Kantonsspital Winterthur, Institute of Radiology and Nuclear Medicine (Switzerland); Hess, Thomas [Kantonsspital Winterthur, Department of Gynecology (Switzerland)

    2015-10-15

    PurposeTo evaluate a modified superior hypogastric nerve block (SHNB) to reduce pain after uterine artery embolization (UAE) compared to epidural anesthesia.Materials and methodsIn this retrospective study, the amount of opiate drugs needed after UAE was compared between SHNB and epidural anesthesia. Eighty one consecutive women (mean age: 43.67 years) were in the SHNB group and 27 consecutive women (mean age: 43.48 years) treated earlier at the same institution in the epidural anesthesia group. UAE was performed from a unilateral femoral artery approach using a 4F catheter. 500–700 or 700–900 μm trisacryl gelatine microspheres were used as embolic agents. The SHNB was performed by advancing a 21G from the abdominal wall below the umbilicus to the anterior portion of the 5th vertebral body. For optimal guidance a cranio-caudal tilt of 5°–15° was used. On a lateral view the correct contrast distribution in front of the vertebral body is confirmed. Then 20 ml local anesthesia (ropivacain 0.75 %) is injected. In case of an asymmetric right–left distribution the needle was repositioned.ResultsAll SHNB were successful without severe complications. The mean time for the SHNB was 4 min 38 s (2 min 38 s–9 min 27 s). The needle was repositioned in average 0.87 times. The opiate dose for the SHNB group was 19.33 ± 22.17 mg which was significantly lower. The average time to receive an opiate drug after SHNB was 4 h 41 min.ConclusionThe SHNB is a safe and minimally time-consuming way to reduce pain after UAE especially within the first 4 h.

  3. Predicting the results of uterine artery embolization: correlation between initial intramural fibroid volume and percentage volume decrease

    Science.gov (United States)

    Woźniak, Sławomir; Szkodziak, Piotr; Woźniakowska, Ewa; Paszkowski, Maciej; Wrona, Wojciech; Milart, Paweł; Paszkowski, Tomasz; Popajewski, Michał

    2014-01-01

    Introduction and objective Uterine artery embolization (UAE) is a minimally invasive treatment option for symptomatic fibroids. Long-term follow-up studies have shown that at five-year follow-up after UAE, up to 30% of patients required a hysterectomy. Therefore, it seems of utmost importance to identify patients, who are unlikely to benefit from UAE. It has been postulated that the percentage volume reduction of fibroids may predict long-term UAE outcome. The results of available studies are equivocal, therefore it seemed of interest to investigate the correlation between the preinterventional intramural fibroid volume and imaging outcome of UAE in premenopausal patients. Material and methods Uterine artery embolization was performed in 65 premenopausal patients with symptomatic, intramural fibroids. Dominant fibroid volume was assessed using an integrated VOCAL (Virtual Organ Computer-aided AnaLysis) imaging program at baseline and 3 months after UAE. The percentage reduction of fibroid volume was calculated. The association between preinterventional fibroid volumes and percentage volume reductions was determined with the Spearman rank correlation test. Results Before UAE, the median dominant fibroid volume was 101 cm3 (range 23.6-610). At three-month follow-up the median dominant leiomyoma volume decreased to 50.4 cm3 (range 6.9-193.9). Median percentage reduction of fibroid volume three months after UAE was calculated at 50.1% (range 2.7-93.5). The Spearman correlation test between the preinterventional dominant fibroid volume and percentage volume reduction showed a statistically significant, positive correlation (R = 0.33; p = 0.006). Conclusions The percentage volume reduction of intramural leiomyomas after UAE seems to be more pronounced in the case of larger tumors. PMID:26327862

  4. The Technique and Benefits of Angiographic Embolization of Inferior Epigastric Arteries Prior to Pedicled TRAM Flap Breast Reconstruction: Results from a Single Center.

    Science.gov (United States)

    Sever, Alysse J; Patel, Chirag; Albeer, Yahya; Darian, Vigen B

    2017-12-01

    To report a single center's experience with selective arterial embolization of the deep inferior epigastric arteries (DIEA) prior to pedicled TRAM flap breast reconstruction including techniques and outcomes. Retrospective chart review was performed for 15 patients who underwent pedicled TRAM flap breast reconstruction after selective embolization of bilateral DIEA. Data were analyzed to display the spectrum of postoperative outcomes following the TRAM flap procedure status post-selective angiographic embolization of the bilateral DIEA to improve vascularity of the TRAM flaps by rendering the tissue partially ischemic to undergo neovascularization. We then compared our results to historical controls of those delayed by ligating the DIEA via traditional surgical means to see if the outcomes are similar. We also compared our results to historical non-delayed TRAM flap reconstruction. One patient had a small area of partial flap skin necrosis, and no patients had total flap loss. 13.3% of patients had clinically significant TRAM flap fat necrosis. Outcomes of TRAM flaps delayed by selective arterial embolization are comparable to historical controls of those delayed by traditional surgical means and better than non-delayed flaps. Angiographic delayed TRAM flap reconstruction procedure is a reasonable safe alternative to the surgical delayed TRAM flap reconstruction procedure with less morbidity and is better than non-delayed TRAM flap procedures.

  5. Thrombolytic treatment given at the and of the first week of stroke due to pulmonary embolism in a patient with middlee cerebral artery infarction

    Directory of Open Access Journals (Sweden)

    Çetin Kürşad Akpınar

    2014-08-01

    Full Text Available Thrombolytic treatment is the most effective and commonly used method into firs 4,5 hours of acute ischemic stroke and massive pulmonary embolism. It is known that thrombolytic treatment is definitely contraindicated in cases who had an ischemic stroke into last three months. In this paper, it was reported that thrombolytic treatment had given for pulmonary embolism which developed one week after stroke in a case with stroke due to middle cerebral artery occlusion. Here, we presented a case which is rarely seen and required difficulty in deciding.

  6. Intra-arterial digital subtraction angiography of the pulmonary arteries using a flow-directed balloon catheter in the diagnosis of pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Rooij, W.J.J. van; Heeten, G.J. den (St. Elisabethziekenhuis Tilburg, Dept. of Radiology (Netherlands))

    1992-04-01

    Selective intra-arterial digital subtraction angiography (IA-DSA) of the pulmonary vessels was performed in 70 patients suspected of acute pulmonary embolism. A flow-directed Swan-Ganz pulmonary angiography catheter was used. The spatial resolution of the equipment used was 3.3 lp/mm for DSA and 6.0 lp/mm for conventional pulmonary angiography (CPA). Image quality of the angiograms was assessed by determining the highest visible branching division of the main pulmonary artery. The mean visible branching division for IA-DSA was 4.71 (range 3-7). In 10 patients where IA-DSA and CPA were performed during the same procedure there was no difference in visualization of peripheral arteries (mean 4.70 visible or for both modalities). IA-DSA makes the procedure rapid, saves on films and contrast material and allows good visualization of areas where exposure is difficult. The spatial resolution of state-of-the-art equipment permits sufficient definition of subsegmental vessels. The use of the flow-directed balloon catheter makes the examination easy to perform and minimizes the risk of catheter induced cardiac arrhythmias. (orig.).

  7. Surgical dissection of the internal carotid artery under flow control by proximal vessel clamping reduces embolic infarcts during carotid endarterectomy.

    Science.gov (United States)

    Yoshida, Kazumichi; Kurosaki, Yoshitaka; Funaki, Takeshi; Kikuchi, Takayuki; Ishii, Akira; Takahashi, Jun C; Takagi, Yasushi; Yamagata, Sen; Miyamoto, Susumu

    2014-01-01

    To evaluate the efficacy of flow control of the internal carotid artery (ICA) by the clamping of the common carotid artery, external carotid artery, and superior thyroid artery during surgical ICA dissection to reduce ischemic complications after carotid endarterectomy (CEA). Sixty-seven patients (59 men; age, 70.5 ± 6.2 years) who underwent CEA by the same surgeon were retrospectively studied. Both conventional CEA (n = 29) and flow-control CEA (n = 38) were performed with the patient under general anesthesia and with the use of somatosensory-evoked potential and near-infrared spectroscopy monitoring as a guide for selective shunting. The number of new postoperative infarcts was assessed with preoperative and postoperative diffusion-weighted images (DWIs) obtained within 3 days of surgery. In addition to surgical technique, the effects of the following factors on new infarcts also were examined: age, side of ICA stenosis, high-grade stenosis, symptoms, and application of shunting. New postoperative DWI lesions were observed in 7 of 67 patients (10.4%), and none of them was symptomatic. With respect to operative technique, the incidence rate of DWI spots was significantly lower in the flow-control group (2.6%) than in the conventional group (20.7%), odds ratio: 0.069; 95% confidence interval: 0.006-0.779; P = 0.031). On multiple logistic regression analysis, age, side of ICA stenosis, high-grade stenosis, symptoms, and the use of internal shunting did not have significant effects on new postoperative DWI lesions, whereas technique did have an effect. The proximal flow-control technique for CEA helps avoid embolic complications during surgical ICA dissection. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Bilateral Superior Cerebellar Artery Embolic Occlusion with a Fetal-Type Posterior Cerebral Artery Providing Collateral Circulation

    Directory of Open Access Journals (Sweden)

    Taylor J. Bergman

    2016-12-01

    Full Text Available Bilateral infarction of the superior cerebellar arteries with sparing of the rest of the posterior circulation, particularly the posterior cerebral arteries, is an uncommon finding in neurological practice. Most commonly, the deficits of the superior cerebellar arteries and posterior cerebral arteries occur together due to the close proximity of their origins at the top of the basilar artery. A patient was transferred to the neurological intensive care unit with a history of recent-onset falls from standing, profound hypertension, dizziness, and headaches. The neurological exam revealed cerebellar signs, including dysmetria of the right upper extremity and a decreased level of consciousness. Computed tomography of the head and neck revealed decreased attenuation throughout most of the cerebellar hemispheres suggestive of ischemic injury with sparing of the rest of the brain. Further investigation with a computed tomography angiogram revealed a fetal-type posterior cerebral artery on the right side that was providing collateral circulation to the posterior brain. Due to this embryological anomaly, the patient was spared significant morbidity and mortality that would have likely occurred had the circulation been more typical of an adult male.

  9. Transcatheter Embolization for Giant Splenic Artery Aneurisms: Still an Open Question

    Directory of Open Access Journals (Sweden)

    Marianna Mastroroberto

    2012-01-01

    patients with portal hypertension. It is indicated when the SAA diameter reaches 20 mm. Although endovascular techniques are effective and safe for the treatment of medium-sized SAAs, little is known about their applicability to large-sized SAAs. Herein, we report a case of giant SAA, which was treated with transcatheter coil embolization. The case was not considered suitable for surgery because of the presence of severe portal hypertension. The procedure was complicated by bacterial infection of the coils within the aneurismatic sac, leading to the development of hepatic failure. A liver transplant was then successfully performed despite the presence of a nonresponsive infection.

  10. Life-threatening hematoma after recurrent femoral artery puncture on a patient with massive pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Serkan Burc Deser

    2017-09-01

    Full Text Available Acute pulmonary embolism (PE is a life threatening condition which represents with a severe manifestation of a venous thromboembolic disease. The incidence of PE ranges from 2% to 7%. When a patient is suspected with acute PE, she/he must be hemodynamically stabilized including a respiratory support, hemodynamic support, and empiric anticoagulation therapy. Although empirical anticoagulant therapy may protect the patient, sometimes it is not innocent. In these patients, care must be taken in terms of complications after blood gas analysis, which is a clue to PE diagnosis and differential diagnosis. Here, we present management of a patient with a huge femoral hematoma who diagnosed with PE.

  11. Selective arterial embolization for control of haematuria secondary to advanced or recurrent transitional cell carcinoma of the bladder.

    LENUS (Irish Health Repository)

    Halpenny, D

    2014-05-02

    Haematuria is a common symptom in patients with advanced transitional cell carcinoma of the bladder. We report our experience of selective pelvic embolization using gelfoam as an embolic agent to treat intractable haematuria in these patients.

  12. [Super selective transcatheter arterial embolization for treatment of focal nodular hyperplasia of the liver: report of 21 cases].

    Science.gov (United States)

    Yan, Jie-yu; Wang, Mao-qiang; Liu, Feng-yong; Wang, Zhi-jun; Duan, Feng; Song, Peng

    2012-11-06

    To evaluate the efficiency and safety of transcatheter arterial embolization (TAE) for treatment of focal nodular hyperplasia (FNH). From January 2005 to December 2010, super selective TAE was performed for 21 patients with FNH. The patients consisted of 16 men and 5 women with age range of 16 to 44 years (mean age, 28 ± 12). Liver contrast enhancement CT and ultrasonography (US) were performed in all patients, dynamic contrast enhancement MRI was performed in 17 patients. All patients underwent percutaneous needle biopsies and the diagnosis of FNH was proven histologically. The indications for TAE were patients with progressive increase in size of FNH, who were not candidates for surgical treatment, or who refused for surgery. Embolic materials used in this series included emulsion of iodized oil and bleomycin and polyvinyl alcohol particle (PVA). Follow-up examinations included the routine blood tests, liver and renal function tests, US, CT or MRI. Eighteen patients (85.7%) had a single solitary focus and 3 (14.3%) had multiple foci. The diameter of the mass varied from 3.5 cm to 9.5 cm with a mean of 5.5 cm (5.5 ± 3.0 cm). All patients presented angiographically with characteristic findings, such as feeding artery that was distributed with a spinning wheel appearance, an extensive hypervascular mass, without arterio-venous shunt or portal vein invasion. A single session of TAE was performed in all patients. Technical success of TAE was achieved in all cases. No major complications were encountered in any of our patients. All patients were regularly followed up ranging from 1 to 6 years (3.5 ± 2.0) and they were healthy without recurrence. Marked reduction in the size of the FNH without arterial blood supply was found in 16 patients, and almost complete resolution of the FNH was observed in 6 patients. TAE is a safe and effective therapy for the management of patients with FNH. TAE could control FNH very well and even could be considered as a radical treatment.

  13. Occurrence of sectoral choroidal occlusive vasculopathy and retinal arteriolar embolization after superselective ophthalmic artery chemotherapy for advanced intraocular retinoblastoma.

    Science.gov (United States)

    Munier, Francis L; Beck-Popovic, Maja; Balmer, Aubin; Gaillard, Marie-Claire; Bovey, Etienne; Binaghi, Stefano

    2011-03-01

    Superselective ophthalmic artery chemotherapy (SOAC) has recently been proposed as an alternative to intravenous chemoreduction for advanced intraocular retinoblastoma. Preliminary results appear promising in terms of tumor control and eye conservation, but little is known regarding ocular toxicity and visual prognosis. In this study, we report on the vascular adverse effects observed in our initial cohort of 13 patients. The charts of 13 consecutive patients with retinoblastoma who received a total of 30 injections (up to 3 injections of a single agent per patient at 3-week interval) of melphalan (0.35 mg/kg) in the ophthalmic artery between November 2008 and June 2010 were retrospectively reviewed. RetCam fundus photography and fluorescein angiography were performed at presentation and before each injection. Vision was assessed at the latest visit. Enucleation and external beam radiotherapy could be avoided in all cases but one, with a mean follow-up of 7 months. Sectoral choroidal occlusive vasculopathy leading to chorioretinal atrophy was observed temporally in 2 eyes (15%) 3 weeks to 6 weeks after the beginning of SOAC and retinal arteriolar emboli in 1 eye 2 weeks after injection. There was no stroke or other clinically significant systemic side effects except a perioperative transient spasm of the internal carotid artery in one patient. Vision ranged between 20/1600 and 20/32 depending on the status of the macula. Superselective ophthalmic artery chemotherapy was effective in all patients with no stroke or other systemic vascular complications. Unlike intravenous chemoreduction, SOAC is associated with potentially sight-threatening adverse effects, such as severe chorioretinal atrophy secondary to subacute choroidal occlusive vasculopathy or central retinal artery embolism, not to mention the risk of ophthalmic artery obstruction, which was not observed in this series. Further analysis of the risks and benefits of SOAC will define its role within the

  14. Evaluation of Superselective Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate in Treating Lower Gastrointestinal Bleeding: A Retrospective Study on Seven Cases

    Directory of Open Access Journals (Sweden)

    Yuan Zhao

    2016-01-01

    Full Text Available Background. To investigate the safety and efficacy of superselective transcatheter arterial embolization (TAE with n-butyl cyanoacrylate (NBCA in treating lower gastrointestinal bleeding caused by angiodysplasia. Methods. A retrospective study was performed to evaluate the clinical data of the patients with lower gastrointestinal bleeding caused by angiodysplasia. The patients were treated with superselective TAE with NBCA between September 2013 and March 2015. Angiography was performed after the embolization. The clinical signs including melena, anemia, and blood transfusion treatment were evaluated. The complications including abdominal pain and intestinal ischemia necrosis were recorded. The patients were followed up to evaluate the efficacy in the long run. Results. Seven cases (2 males, 5 females; age of 69.55±2.25 were evaluated in the study. The embolization was successfully performed in all cases. About 0.2–0.8 mL (mean 0.48±0.19 mL NCBA was used. Immediate angiography after the embolization operation showed that the abnormal symptoms disappeared. The patients were followed up for a range of 2–19 months and six patients did not reoccur. No serious complications, such as femoral artery puncture point anomaly, vascular injury, and intestinal necrosis perforation were observed. Conclusion. For the patients with refractory and repeated lower gastrointestinal hemorrhage due to angiodysplasia, superselective TAE with NBCA seem to be a safe and effective alternative therapy when endoscopy examination and treatment do not work.

  15. Clinical Results After Prostatic Artery Embolization Using the PErFecTED Technique: A Single-Center Study

    Energy Technology Data Exchange (ETDEWEB)

    Amouyal, Gregory, E-mail: gregamouyal@hotmail.com; Thiounn, Nicolas, E-mail: nicolas.thiounn@aphp.fr; Pellerin, Olivier, E-mail: olivier.pellerin@aphp.fr [Université Paris Descartes - Sorbonne - Paris - Cité, Faculté de Médecine (France); Yen-Ting, Lin, E-mail: ymerically@gmail.com [Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Interventional Radiology Department (France); Giudice, Costantino Del, E-mail: costantino.delgiudice@aphp.fr [Université Paris Descartes - Sorbonne - Paris - Cité, Faculté de Médecine (France); Dean, Carole, E-mail: carole.dean@aphp.fr [Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Interventional Radiology Department (France); Pereira, Helena, E-mail: helena.pereira@aphp.fr [Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit (France); Chatellier, Gilles, E-mail: gilles.chatellier@aphp.fr; Sapoval, Marc, E-mail: marc.sapoval2@aphp.fr [Université Paris Descartes - Sorbonne - Paris - Cité, Faculté de Médecine (France)

    2016-03-15

    BackgroundProstatic artery embolization (PAE) has been performed for a few years, but there is no report on PAE using the PErFecTED technique outside from the team that initiated this approach.ObjectiveThis single-center retrospective open label study reports our experience and clinical results on patients suffering from symptomatic BPH, who underwent PAE aiming at using the PErFecTED technique.Materials and MethodsWe treated 32 consecutive patients, mean age 65 (52–84 years old) between December 2013 and January 2015. Patients were referred for PAE after failure of medical treatment and refusal or contra-indication to surgery. They were treated using the PErFecTED technique, when feasible, with 300–500 µm calibrated microspheres (two-night hospital stay or outpatient procedure). Follow-up was performed at 3, 6, and 12 months.ResultsWe had a 100 % immediate technical success of embolization (68 % of feasibility of the PErFecTED technique) with no immediate complications. After a mean follow-up of 7.7 months, we observed a 78 % rate of clinical success. Mean IPSS decreased from 15.3 to 4.2 (p = .03), mean QoL from 5.4 to 2 (p = .03), mean Qmax increased from 9.2 to 19.2 (p = .25), mean prostatic volume decreased from 91 to 62 (p = .009) mL. There was no retrograde ejaculation and no major complication.ConclusionPAE using the PErFecTED technique is a safe and efficient technique to treat bothersome LUTS related to BPH. It is of interest to note that the PErFecTED technique cannot be performed in some cases for anatomical reasons.

  16. Embolic intracranial arterial occlusion visualized by non-enhanced computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Tomita, Masaaki; Minematsu, Kazuo; Choki, Junichiro; Yamaguchi, Takenori (National Cardiovascular Center, Suita, Osaka (Japan))

    1984-12-01

    A 77-year-old woman with a history of valvular heart disease, atrial fibrillation and a massive infarction in the right cerebral hemisphere developed contralateral infarction due to occlusion of the internal carotid artery. A string-like structure with higher density than normal brain was demonstrated on non-enhanced computed tomography that was performed in the acute stage. This abnormal structure seen in the left hemisphere was thought to be consistent with the middle cerebral artery trunk of the affected side. Seventeen days after the onset, the abnormal structure was no more visualized on non-enhanced CT. These findings suggested that the abnormal structure with increased density was compatible with thromboembolus or intraluminal clot formed in the distal part of the occluded internal carotid artery. The importance of this finding as a diagnostic sign of the cerebral arterial occlusion was discussed.

  17. Endovascular glue embolization of dissecting aneurysm of type-3 accessory middle cerebral artery: A contralateral approach.

    Science.gov (United States)

    Parthasarathy, Rajsrinivas; Goel, Gaurav; Gupta, Vipul; Narang, Karanjit Singh; Anand, Saurabh; Jha, Ajaya Nand

    2015-12-01

    Pediatric intracranial aneurysms are rare with a reported prevalence of 0.5-4.6%. Likewise, anomalous arterial patterns are uncommon in the cerebral circulation. Recognition of these variations and knowledge of vascular territory forms the key to managing pathological conditions associated with these anomalous vessels. Ruptured dissecting aneurysm of type-3 accessory middle cerebral artery (aMCA) has not been reported in the pediatric age group. In addition to type-3 aMCA, the child in this case report had an ipsilateral type-1 aMCA with cortical supply. We describe the patterns of accessory MCA and their vascular territory, state the perplexity involved in deciding the best management strategy, and describe the technical approach we undertook to catheterize this small caliber recurrent artery (type-3 aMCA) originating at an acute angle from the anterior cerebral artery. © The Author(s) 2015.

  18. Estenose retal secundária à embolização arterial em trauma pélvico: relato de caso Rectum stenosis secondary to arterial embolization for pelvic fracture: case report

    Directory of Open Access Journals (Sweden)

    Guilherme de Palma Abrão

    2012-09-01

    Full Text Available A embolização de ramos da artéria ilíaca interna é uma técnica empregada no controle da hemorragia secundária à fratura pélvica. Apesar de largamente utilizada, são poucas as complicações relatadas relacionadas ao uso dessa técnica. Apresentamos um caso de estenose isquêmica de reto secundária à embolização da artéria sacral lateral para controle de hemorragia em uma paciente com fratura pélvica.Transcatheter arterial embolization of the internal iliac artery branches is an accepted technique for the control of the hemorrhage due to pelvic fracture. Despite its widespread use, complications of the technique are rarely described. We reported a rectum ischemic stenosis following embolization of lateral sacral artery to control intractable hemorrhage from a pelvic fracture.

  19. Low forced expiratory flow rates and forceful exhalation as a cause for arterial gas embolism during submarine escape training: a case report.

    Science.gov (United States)

    Hartge, Francis J; Bennett, Thomas L

    2015-01-01

    A 26-year-old male U.S. Navy submariner suffered an arterial gas embolism during pressurized submarine escape training. Routine pretraining medical screening revealed no history of asthma, pneumothorax or recent respiratory infection. Pulmonary function testing and posterioranterior/lateral chest X-ray were normal. He forcefully exhaled at the start of his ascent and developed neurological abnormalities including lightheadedness with lower extremity weakness and paresthesias after surfacing. He fully recovered after a U.S. Navy Treatment Table 6. This case represents the first report of an arterial gas embolism since the U.S. Navy resumed pressurized submarine escape training utilizing the Submarine Escape and Immersion Equipment suit. We discuss possible contributing factors and propose that his AGE was caused by pulmonary barotrauma due to a combination of low forced expiratory flow rates and an overly forceful exhalation during his ascent.

  20. [Preoperative Arterial Embolization with N-butyl-2 Cyanoacrylate for Chronic Cavitary Pulmonary Aspergillosis with Trauma Induced Type Ⅰ Diabetes Mellitus].

    Science.gov (United States)

    Nakanishi, Yusuke; Kojima, Fumitsugu; Kamo, Minobu; Wakejima, Ryo; Okura, Mariko; Jinta, Torahiko; Chonabayashi, Naohiko; Bando, Toru

    2016-03-01

    A 50-year-old man with hemoptysis, given a diagnosis of left upper lobe pulmonary aspergilloma with cavity and fungus ball by computed tomography. He has a history of typeⅠ diabetes mellitus due to traumatic injury of pancreas and underwent diaphragm plasty. Despite of systemic anti-fungal medication, symptom and radiological findings were not progressed and surgical intervention was planned. Before surgery we performed intercostal artery embolization, in order to minimize bleeding on dissecting adhesion between the chest wall and the lobe with aspergilloma. Left upper lobectomy with muscle-flap prombage was done safely with a blood loss of 450 ml. Postoperative course was favorable. Intercostal artery embolization with N-butyl-2cyanoacrylate is an effective way to minimize hemorrhage during surgical resection for pulmonary aspergillosis with sever adhesion.

  1. Gastric ulcer bleeding from a variant left gastric artery accompanied by congenital absence of the splenic artery successfully treated with coil embolization: a case report and review of the literature.

    Science.gov (United States)

    Namikawa, Masashi; Kakizaki, Satoru; Takakusaki, Satoshi; Saito, Shuichi; Yata, Yutaka; Mori, Masatomo

    2011-12-01

    Endoscopic hemostasis is a useful treatment modality for gastric ulcer bleeding. However, it is sometimes difficult to achieve hemostasis in cases with arterial bleeding, especially those complicated with vascular abnormalities. We describe a case with gastric ulcer bleeding from a variant left gastric artery accompanied by congenital absence of the splenic artery. A 50-year-old female was admitted to our hospital with dizziness and tarry stools. Upper gastrointestinal endoscopy revealed bleeding from a gastric ulcer, and endoscopic hemostasis by endoscopic clipping was carried out. Computed tomography and abdominal angiography revealed the variant left gastric artery running below the gastric ulcer. In spite of endoscopic hemostasis and medication, re-bleeding from the gastric ulcer occurred. A transcatheter coil embolization for the variant left gastric artery was performed and successfully achieved hemostasis. This case was accompanied by congenital absence of the splenic artery, which is an extremely rare condition. We herein describe this rare case and review previously reported cases.

  2. A case of severe uterine arteriovenous malformation treated with danazol followed by a transarterial embolization of unilateral uterine and ovarian arteries

    OpenAIRE

    Hiroyuki Yazawa; Syu Soeda; Tsuyoshi Hiraiwa; Masayo Takaiwa; Keiya Fujimori

    2015-01-01

    Uterine arteriovenous malformation (AVM) is a potentially life-threatening condition characterized by abrupt and profuse uterine bleeding from abnormal connections between arteries and veins in the myometrium. It is commonly associated with prior pregnancy or uterine trauma. We present a case of severe uterine AVM treated with danazol and transarterial embolization (TAE). A 38-year-old patient with a history of two abortions and a myomectomy was referred to our hospital for intermittent massi...

  3. Effect of transjugular intrahepatic portosystemic shunt combined with splenic artery embolization on hepatic hemodynamics and liver function in patients with liver cirrhosis

    OpenAIRE

    LIANG Xiaohua; ZHANG Feng; ZHUGE Yuzheng

    2016-01-01

    ObjectiveTo investigate the effect of transjugular intrahepatic portosystemic shunt (TIPS) combined with splenic artery embolization (SAE) on hepatic hemodynamics, liver function, and prognosis in patients with liver cirrhosis. MethodsA total of 24 patients who underwent TIPS in the Department of Gastroenterology in Drum Tower Hospital from September 2014 to June 2015 were enrolled and divided into TIPS group (14 patients) and TIPS-SAE group (10 patients) according to whether TIPS was used in...

  4. Cost and Distribution of Hysterectomy and Uterine Artery Embolization in the United States: Regional/Rural/Urban Disparities

    Directory of Open Access Journals (Sweden)

    Marquisette Glass Lewis

    2017-05-01

    Full Text Available Hysterectomy, the driving force for symptomatic uterine fibroids since 1895, has decreased over the years, but it is still the number one choice for many women. Since 1995, uterine artery embolization (UAE has been proven by many researchers to be an effective treatment for uterine fibroids while allowing women to keep their uteri. The preponderance of data collection and research has focused on care quality in terms of efficiency and effectiveness, with little on location and viability related to care utilization, accessibility and physical availability. The purpose of this study was to determine and compare the cost of UAE and classical abdominal hysterectomy with regard to race/ethnicity, region, and location. Data from National Hospital Discharge for 2004 through 2008 were accessed and analyzed for uterine artery embolization and hysterectomy. Frequency analyses were performed to determine distribution of variables by race/ethnicity, location, region, insurance coverage, cost and procedure. Based on frequency distributions of cost and length of stay, outliers were trimmed and categorized. Crosstabs were used to determine cost distributions by region, place/location, procedure, race, and primary payer. For abdominal hysterectomy, 9.8% of the sample were performed in rural locations accross the country. However, for UAE, only seven procedures were performed nationally in the same period. Therefore, all inferential analyses and associations for UAE were assumed for urban locations only. The pattern differed from region to region, regarding the volume of care (numbers of cases by location and care cost. Comparing hysterectomy and UAE, the patterns indicate generally higher costs for UAE with a mean cost difference of $4223.52. Of the hysterectomies performed for fibroids on Black women in the rural setting, 92.08% were in the south. Overall, data analyzed in this examination indicated a significant disparity between rural and urban residence in

  5. Fertility-preserving management of a uterine arteriovenous malformation: a case report of uterine artery embolization (UAE) followed by laparoscopic resection.

    Science.gov (United States)

    Patton, Elizabeth W; Moy, Irene; Milad, Magdy P; Vogezang, Robert

    2015-01-01

    Herein is presented a fertility-preserving approach in the management of a uterine arteriovenous malformation (AVM) resistant to endovascular management. The patient had a documented AVM and underwent 2 uterine artery embolization procedures, with subsequent recurrence of symptoms. Doppler ultrasound demonstrated recanalization of the AVM. Ultimately, laparoscopic resection of the AVM was performed after laparoscopic ligation of the uterine arteries. Postoperatively, the patient has remained asymptomatic. Laparoscopic resection of a uterine AVM may offer a fertility-preserving alternative to hysterectomy in patients in whom endovascular management has failed. Published by Elsevier Inc.

  6. Fluoroscopic guided fogarty embolectomy for an angio-seal embolism in the popliteal artery

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    Hong, Dong; Lee, Seung Hwa; Chung, Hwan Hoon; Seo, Bo Kyoung; Cha, Sang Hoon; Lee, Kee Yeol; Ahn, Jeong Cheon [Korea University Ansan Hospital, College of Medicine, Korea University, Ansan (Korea, Republic of)

    2013-08-15

    The Angio-Seal is a widely used arterial closure device that helps achieve faster hemostasis and provide early ambulation to patients. However, it can cause various complications in clinical practice. We present the uncommon complication of popliteal artery occlusion following Angio-Seal deployment, and describe an effective interventional approach to its treatment. Because fluoroscopy-guided Fogarty embolectomy has the advantages of complete removal of the embolus without fragmentation, and clear visualization of the exact location of the embolus during the procedure, it is a suitable method for treating this complication.

  7. Usefulness of Clinical Prediction Rules, D-dimer, and Arterial Blood Gas Analysis to Predict Pulmonary Embolism in Cancer Patients

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    Shazia Awan

    2017-03-01

    Full Text Available Objectives: Pulmonary embolism (PE is seven times more common in cancer patients than non-cancer patients. Since the existing clinical prediction rules (CPRs were validated predominantly in a non-cancer population, we decided to look at the utility of arterial blood gas (ABG analysis and D-dimer in predicting PE in cancer patients. Methods: Electronic medical records were reviewed between December 2005 and November 2010. A total of 177 computed tomography pulmonary angiograms (CTPAs were performed. We selected 104 individuals based on completeness of laboratory and clinical data. Patients were divided into two groups, CTPA positive (patients with PE and CTPA negative (PE excluded. Wells score, Geneva score, and modified Geneva score were calculated for each patient. Primary outcomes of interest were the sensitivities, specificities, positive, and negative predictive values for all three CPRs. Results: Of the total of 104 individuals who had CTPAs, 33 (31.7% were positive for PE and 71 (68.3% were negative. There was no difference in basic demographics between the two groups. Laboratory parameters were compared and partial pressure of oxygen was significantly lower in patients with PE (68.1 mmHg vs. 71 mmHg, p = 0.030. Clinical prediction rules showed good sensitivities (88−100% and negative predictive values (93−100%. An alveolar-arterial (A-a gradient > 20 had 100% sensitivity and negative predictive values. Conclusions: CPRs and a low A-a gradient were useful in excluding PE in cancer patients. There is a need for prospective trials to validate these results.

  8. Usefulness of Clinical Prediction Rules, D-dimer, and Arterial Blood Gas Analysis to Predict Pulmonary Embolism in Cancer Patients

    Science.gov (United States)

    Karamat, Asifa; Awan, Shazia; Hussain, Muhammad Ghazanfar; Al Hameed, Fahad; Butt, Faheem; Wahla, Ali Saeed

    2017-01-01

    Objectives Pulmonary embolism (PE) is seven times more common in cancer patients than non-cancer patients. Since the existing clinical prediction rules (CPRs) were validated predominantly in a non-cancer population, we decided to look at the utility of arterial blood gas (ABG) analysis and D-dimer in predicting PE in cancer patients. Methods Electronic medical records were reviewed between December 2005 and November 2010. A total of 177 computed tomography pulmonary angiograms (CTPAs) were performed. We selected 104 individuals based on completeness of laboratory and clinical data. Patients were divided into two groups, CTPA positive (patients with PE) and CTPA negative (PE excluded). Wells score, Geneva score, and modified Geneva score were calculated for each patient. Primary outcomes of interest were the sensitivities, specificities, positive, and negative predictive values for all three CPRs. Results Of the total of 104 individuals who had CTPAs, 33 (31.7%) were positive for PE and 71 (68.3%) were negative. There was no difference in basic demographics between the two groups. Laboratory parameters were compared and partial pressure of oxygen was significantly lower in patients with PE (68.1 mmHg vs. 71 mmHg, p = 0.030). Clinical prediction rules showed good sensitivities (88−100%) and negative predictive values (93−100%). An alveolar-arterial (A-a) gradient > 20 had 100% sensitivity and negative predictive values. Conclusions CPRs and a low A-a gradient were useful in excluding PE in cancer patients. There is a need for prospective trials to validate these results. PMID:28439386

  9. Catheter-directed gastric artery chemical embolization for modulation of systemic ghrelin levels in a porcine model: initial experience.

    Science.gov (United States)

    Arepally, Aravind; Barnett, Brad P; Montgomery, Elizabeth; Patel, Tarak H

    2007-07-01

    To prospectively test, in a porcine model, the hypothesis that use of catheter-directed gastric artery chemical embolization (GACE) can result in substantial suppression of systemic ghrelin levels. The institutional animal care and use committee approved this study. Adult healthy swine (40-45 kg, n=8) were tested. GACE was performed by infusing morrhuate sodium selectively into the left gastric artery. Six swine (animals A-F) underwent left GACE by using a dose-escalating regimen of morrhuate sodium, whereas two control swine underwent a sham procedure. Weight and fasting plasma ghrelin levels were compared in swine at baseline and at weeks 1-4. At week 4, stomachs were excised and analyzed. Analysis of the change in ghrelin values and weight was performed with both paired t test and unpaired Student t test. In control swine (n=2), there was no significant difference in ghrelin values before (844.8 pg/mL +/- 40 [standard deviation]) and after (997 pg/mL +/- 93) the procedure (P=.5). Swine that received a low dose of morrhuate sodium (animals A-D) showed a significant increase in serum ghrelin values from 683.7 pg/mL +/- 241 to 1555.9 pg/mL +/- 312 (P=.002). At a higher dose, the mean baseline ghrelin values decreased from 466 pg/mL to 187 pg/mL +/- 162. Weight changes of +1.4% and +8.6% were seen in swine that underwent GACE and control swine, respectively. Histochemical staining showed preservation of overall tissue architecture and parietal cells. Use of GACE can result in increased or suppressed ghrelin levels. (c) RSNA, 2007.

  10. Intra-arterial therapy for cardio embolic internal carotid artery terminus occlusion: The past and present status in real practice

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Seung Guk; Jung, Cheol Kyu; KIm, Jae Hyoung; Choi, Byung Se; Kim, Beomn Joon; Han, Moon Ku; Bae, Hee Joon [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Kwon, Bae Ju [Dept. of Radiology, Myongji Hospital, Goyang (Korea, Republic of); Cha, Sang Hoon [Dept. of Radiology, Chungbuk National University College of Medicine, Daejeon (Korea, Republic of)

    2015-10-15

    There is little data on the effect of intra-arterial therapy (IAT) in acute cardioembolic internal carotid artery terminus (ICAT) occlusion that has poor prognosis. We determined procedural and clinical outcomes in patients with acute cardioembolic ICAT occlusion treated with different methods of IAT. On retrospective review of our registry, patients with cardioembolic ICAT occlusion were categorized as thrombolytic-based IAT group (TLG) and thrombectomy-based IAT group (TEG) according to the primary endovascular technique. Subsequently, procedural and clinical outcomes were compared. Fifty-five patients had cardioembolic ICAT occlusion and 18 patients were assigned to TLG and 37 patients to TEG. The rate of complete reperfusion was significantly higher and the groin puncture to reperfusion time was significantly shorter in TEG than those in TLG. There was a trend towards functional outcome at 3 months in the TEG group; however, it was not statistically significant (p = 0.06). Age, baseline Albert Stroke program early CT score and puncture to reperfusion time were factors affecting unfavorable outcome at 3 months, on multivariable analysis. Thrombectomy-based IAT has advantages over thrombolytic-based IAT in terms of the reduction of groin puncture to reperfusion time and improvement of the rate of complete reperfusion.

  11. Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization

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    Fargeaudou, Yann; Soyer, Philippe; Sirol, Marc; Dref, Olivier le; Boudiaf, Mourad; Dahan, Henri; Rymer, Roland [Hopital Lariboisiere-APHP-GHU Nord et Universite Diderot-Paris 7, Department of Abdominal and Interventional Imaging, Paris (France); Morel, Olivier [Hopital Lariboisiere-APHP-GHU Nord et Universite Diderot-Paris 7, Department of Obstetrics, Paris (France)

    2009-09-15

    The purpose of this study was to report our experience in the management of severe primary postpartum hemorrhage due to genital tract laceration following operative vaginal delivery with forceps using pelvic transcatheter arterial embolization (TAE). Ten women (mean age, 31.9 years) with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps were treated with TAE. TAE was indicated because of intractable bleeding that could not be controlled with uterotonic drugs, blood transfusion, attempted suturing and packing in all patients. Postdelivery perineal examination showed cervical or vaginal tears in all women and associated paravaginal hematoma in four. Angiography revealed extravasation of contrast material in six patients. TAE performed with gelatin sponge allowed to control the bleeding in all patients. Cervical and vaginal suturing was made possible and successfully achieved in the six women who had failed suturing attempts before TAE. Paravaginal hematoma was successfully evacuated in four patients in whom it was present after TAE. No complications related to TAE were noted. We conclude that in women with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps, TAE is effective and safe for stopping the bleeding and helps genital tract suturing and evacuation of hematoma. (orig.)

  12. Treatment failure after uterine artery embolization: prospective cohort study with multifactorial analysis of possible predictors of long-term outcome.

    Science.gov (United States)

    Scheurig-Muenkler, Christian; Koesters, Clemens; Grieser, Christian; Hamm, Bernd; Kroencke, Thomas J

    2012-05-01

    To evaluate the impact of baseline characteristics and residual leiomyoma perfusion after uterine artery embolization (UAE) on clinical long-term outcome. One hundred fifteen patients underwent UAE. All patients were divided into three groups according to achieved infarction rate determined on contrast-enhanced magnetic resonance imaging within 48-72 h after UAE (I: 100%, n=60; II: 90-99%, n=32; and III: 0-89%, n=23). Treatment failure and subsequent re-interventions (surgery, repeat UAE) were assessed for each group and compared using Cox regression analysis (CRA) with respect to the following baseline variables: age, uterine and dominant fibroid volume, number of fibroids, location of largest fibroid, and clinical symptoms. Long-term follow-up was completed after a median of 7.2 years (range 5.1-9.6) with a response rate of 84%. CRA revealed that patients in group III had a 22.2-fold higher risk (pfibroid infarction after UAE is strongly associated with the risk of experiencing treatment failure. Patients with bleeding-related complaints only face the highest likelihood of treatment failure if UAE results in less than 90% fibroid devascularization. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  13. The role of computer tomography in the diagnosis of arterial gas embolism in fatal diving accidents in Tasmania

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    Oliver, J.; Lyons, T.J.; Harle, R. [Royal Hobart Hospital, Tasmania (Australia). Departments of Forensic Pathology and Radiology

    1999-02-01

    Four cases of fatal diving accidents in Tasmania are presented, highlighting the role of CT in the investigation of diving fatalities. The CT technique allows rapid diagnosis when arterial gas embolism (AGE) is suspected. The traditional method of investigation, underwater autopsy, is a difficult procedure that requires specialized training in which the subtle diagnosis of AGE may be completely missed. Facilities for performing underwater autopsies are normally available only in tertiary referral centres, and therefore the diagnosis of AGE may be missed due to lack of facilities. The use of CT in the diagnosis of AGE in divers was first utilized in the early 1980s but has still not become widely adopted in forensic practice. This radiological technique has the advantage of being sensitive, quick, reliable, readily available and provides a permanent record. For hospitals that do not have a resident forensic pathologist, a CT scan can be easily performed and interpreted to eliminate the possibility of AGE. There are a number of pitfalls in the diagnosis of AGE with CT, particularly intravascular gas production following postmortem fermentation and off-gassing. Awareness of these pitfalls will help the radiologist in making a correct diagnosis of AGE. Copyright (1999) Blackwell Science Pty Ltd 7 refs., 8 figs.

  14. Mortality in trauma patients with active arterial bleeding managed by embolization or surgical packing: An observational cohort study of 66 patients

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    Lonnie Froberg

    2016-01-01

    Full Text Available Objective: Exsanguination due to coagulopathy and vascular injury is a common cause of death among trauma patients. Arterial injury can be treated either by angiography and embolization or by explorative laparotomy and surgical packing. The purpose of this study was to compare 30-day mortality and blood product consumption in trauma patients with active arterial haemorrhage in the abdominal and/or pelvic region treated with either angiography and embolization or explorative laparotomy and surgical packing. Material and Methods: From January 1st 2006 to December 31st 2011 2,173 patients with an ISS of >9 were admitted to the Trauma Centre of Copenhagen University Hospital, Rigshospitalet, Denmark. Of these, 66 patients met the inclusion criteria: age above 15 years and active arterial haemorrhage from the abdominal and/or pelvic region verified by a CT scan at admission. Gender, age, initial oxygen saturation, pulse rate and respiratory rate, mechanism of injury, ISS, Probability of Survival, treatment modality, 30-day mortality and number and type of blood products applied were retrieved from the TARN database, patient records and the Danish Civil Registration System. Results: Thirty-one patients received angiography and embolization, and 35 patients underwent exploratory laparotomy and surgical packing. Gender, age, initial oxygen saturation, pulse rate and respiratory rate, ISS and Probability of Survival were comparable in the two groups. Conclusion: A significant increased risk of 30-day mortality (P = 0.04 was found in patients with active bleeding treated with explorative laparotomy and surgical packing compared to angiography and embolization when data was adjusted for age and ISS. No statistical significant difference (P > 0.05 was found in number of transfused blood products applied in the two groups of patients.

  15. Fatal scuba diving incident with massive gas embolism in cerebral and spinal arteries

    Energy Technology Data Exchange (ETDEWEB)

    Ozdoba, C. [University of Bern, Institute of Diagnostic and Interventional Neuroradiology, Bern (Switzerland); Weis, J. [University of Bern, Department of Neuropathology, Institute of Pathology, Bern (Switzerland); RWTH University Hospital, Institute of Neuropathology, Aachen (Germany); Plattner, T.; Dirnhofer, R.; Yen, K. [University of Bern, Institute of Forensic Medicine, Bern (Switzerland)

    2005-06-01

    CT and MRI have the potential to become useful adjuncts to forensic autopsy in the near future. The examination of fatal injuries facilitates a profound experience in the clinical-radiological examination of these cases; the more severe findings in corpses with autopsy verification can help one to understand the tiny signs seen in clinical cases of surviving victims. We present the case of a 44-year-old male diver who died from severe decompression sickness after rapid ascent from approximately 120 m. Post-mortem CT and MRI studies of the brain and spinal cord revealed extensive gas inclusions in cerebral arteries, spinal arteries and cerebrospinal fluid (CSF) spaces, while the intracranial venous sinuses remained unaffected. These findings were confirmed at autopsy. Appropriate imaging techniques can help forensic pathologists to aim their autopsies at findings that might otherwise remain undetected. (orig.)

  16. Reduced embolic load during clinical cardiopulmonary bypass using a 20 micron arterial filter.

    Science.gov (United States)

    Jabur, G N S; Willcox, T W; Zahidani, S H; Sidhu, K; Mitchell, S J

    2014-05-01

    To compare the efficiency of 20 and 40 µm arterial line filters during cardiopulmonary bypass for the removal of emboli from the extracorporeal circuit. Twenty-four adult patients undergoing surgery were perfused using a cardiopulmonary bypass circuit containing either a 20 µm or 40 µm arterial filter (n = 12 in both groups). The Emboli Detection and Classification system was used to count emboli upstream and downstream of the filter throughout cardiopulmonary bypass. The mean proportion of emboli removed by the filter was compared between the groups. The 20 µm filter removed a significantly greater proportion of incoming emboli (0.621) than the 40 µm filter (0.334) (p=0.029). The superiority of the 20 µm filter persisted across all size groups of emboli larger than the pore size of the 40 µm filter. The 20 µm filter removed substantially more emboli than the 40 µm filter during cardiopulmonary bypass in this comparison.

  17. Selective bilateral internal iliac artery embolization for controlling refractory hematuria due to the metastatic squamous cell carcinoma of the urinary bladder: a case report

    Directory of Open Access Journals (Sweden)

    Gholamreza Mokhtari

    2016-09-01

    Full Text Available Bladder squamous cell carcinoma (SCC may lead to gross hematuria. However, the metastasis of head and neck cutaneous SCC to the urinary bladder has not been described in literature. Nowadays, noninvasive methods such as embolization, are considered as an appropriate choice for controlling life-threatening hematuria in patients with high operative risk. However, few reports exist on the effectiveness of this approach in managing the hematuria secondary to metastatic bladder SCC. Here we report a case of bladder SCC originating from the forehead cutaneous SCC. An 83-year-old man, a known case of forehead cutaneous SCC with distant metastasis, referred to our clinic with a chief complaint of hematuria. Pathology confirmed the diagnosis of metastatic urinary bladder SCC. Angiography and embolization were undertaken and resulted in complete alleviation of the symptoms. The recurrence of hematuria or embolization-related complications were not observed during 3-month follow-up. Selective embolization of the bilateral internal iliac artery is a safe and efficient procedure for controlling severe hematuria in patients with primary or metastatic bladder SCC.

  18. Abnormal uterine bleeding due to vascular abnormality caused by D and E : doppler sonography for diagnosis and transcatheter arterial embolization for treatment

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    Kim, Yong Jo; Heo, Chan; Jung, Tae Gun; Kim, Gi Sung; Kwon, Hyeok Po; Lee, Sang Kwon; Kwon, Jung Hyeok [Dongkang Hospital, Ulsan (Korea, Republic of); Lee, Yeong Hwan [Taegu Catholic Univ. School of Medicine, Taegu (Korea, Republic of)

    1996-06-01

    We attempted to evaluate the usefulness of Doppler sonography in the diagnosis of uterine vascular abnormality caused by previous D and E, and to report that transarterial embolization is an excellent treatment modality. We analyzed gray-scale US, color/duplex Doppler US and angiographic findings in seven patients with radiologically proven uterine vascular abnormality. Two of the seven cases were pseudoaneurysms and five of the seven cases were AVMs. n one of the AVMS, two small pseudoaneurysms were combined. In all cases, transarterial embolizations using 3 mm coil or/and gelfoam particles were performed. Follow-up US studies, including color Doppler US, were performed. on color/duplex Doppler sonography, two cases of pseudoaneurysm showed blood pools with turbulent arterial flow, and five cases of AVM showed asymmetrically increased cascularity, with vailable high velocities composed of the pulsatile arterial flow, with a high diastolic component. on angiography, the former showed pseudoaneruysmal sacs, and the latter densely opacified vascular tangles. No more abnormal uterine bleeding was shown following transarterial embolization in all cases. Color/duplex Doppler sonography was valuable in the diagnosis or treatment of abnormal uterine bleeding caused by uterine vascular abnormality such as acquired AVM or pseudoaneruysm.

  19. The association atorvastatin-meloxicam reduces brain damage, attenuating reactive gliosis subsequent to arterial embolism = La asociación atorvastatina-meloxicam reduce el daño cerebral, atenuando la gliosis reactiva consecuente a embolismo arterial

    Directory of Open Access Journals (Sweden)

    Marcela Hernández Torres

    2013-10-01

    Full Text Available The association atorvastatin-meloxicam reduces brain damage, attenuating reactive gliosis subsequent to arterial embolism Introduction: Stroke is the leading cause of disability and the third of death in Colombia and in the world and it is associated with neurodegenerative and mental diseases. Objective: To determine the effects of the atorvastatin- meloxicam association on reactive gliosis in a model of cerebral ischemia produced by arterial embolization. Materials and methods: 56 adult male Wistar rats were used, divided into four ischemic and four control groups, plus 10 additional animals to determine the distribution and extent of infarction by injury in six of them and simulation (sham in the remaining four. The treatments were: placebo, atorvastatin (ATV, meloxicam (MELOX and ATV + MELOX in ischemic and simulated animals. 24 hours post-ischemia mitochondrial enzymatic activity was evaluated with triphenyl- tetrazolium (TTC, and at 120 hours astrocytic reactivity (anti-GFAP was analyzed by conventional immunohistochemistry. Results: The association ATV + MELOX favored the modulation of the response of protoplasmatic and fibrous astrocytes in both the hippocampus and the paraventricular zone by reducing their hypereactivity. Conclusion: Atorvastatin and meloxicam, either individually or associated, reduce cerebral damage by lessening the reactive gliosis produced by arterial embolization; this suggests new mechanisms of neuroprotection against thromboembolic cerebral ischemia, and opens new perspectives in its early treatment.

  20. Trans-arterial chemo-embolization is safe and effective for very elderly patients with hepatocellular carcinoma

    Science.gov (United States)

    Cohen, Matan J; Bloom, Allan I; Barak, Orly; Klimov, Alexander; Nesher, Tova; Shouval, Daniel; Levi, Izhar; Shibolet, Oren

    2013-01-01

    AIM: To assess the safety and efficacy of trans-arterial chemo-embolization (TACE) in very elderly patients. METHODS: A prospective cohort study, from 2001 to 2010, compared clinical outcomes following TACE between patients ≥ 75 years old and younger patients (aged between 65 and 75 years and younger than 65 years) with hepatocellular carcinoma (HCC), diagnosed according to the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases criteria. The decision that patients were not candidates for curative therapy was made by a multidisciplinary HCC team. Data collected included demographics, co-morbidities, liver disease etiology, liver disease severity and the number of procedures. The primary outcome was mortality; secondary outcomes included post-embolization syndrome (nausea, fever, abdominal right upper quadrant pain, increase in liver enzymes with no evidence of sepsis and with a clinical course limited to 3-4 d post procedure) and 30-d complications. Additionally, changes in liver enzyme measurements were assessed [alanine and aspartate aminotransferase (ALT and AST), gamma-glutamyl transpeptidase and alkaline phosphatase] in the week following TACE. Analysis employed both univariate and multivariate methods (Cox regression models). RESULTS: Of 102 patients who underwent TACE as sole treatment, 10 patients (9.8%) were > 80 years old at diagnosis; 13 (12.7%) were between 75 and 80 years, 45 (44.1%) were between 65 and 75 years and 34 (33.3%) were younger than 65 years. Survival analysis demonstrated similar survival patterns between the elderly patients and younger patients. Age was also not associated with the adverse event rate. Survival rates at 1, 2 and 3 years from diagnosis were 74%, 37% and 31% among patients < 65 years; 83%, 66% and 48% among patients aged 65 to 75 years; and 86%, 41% and 23% among patients ≥ 75 years. There were no differences between the age groups in the pre-procedural care

  1. A CASE OF SUCCESSFUL PREGNANCY WITH PROSTHETIC MITRAL VALVE COMPLICATED BY MULTIPLE ARTERIAL EMBOLISM

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    Prabhadevi Kodey

    2017-09-01

    Full Text Available Arterial thromboembolism is very uncommon in pregnancy. It is associated with complications like sudden death and long-term morbidity. Heart valve thrombosis without anticoagulation is devastating. All patients with mechanical prosthetic valves must continue anticoagulation without fail. If patient wants to have pregnancy, the type of anticoagulation should be changed according to period of gestation and condition. Maternal and foetal condition should be closely monitored. In patients of heart disease with mechanical prosthetic mitral valve, pregnancy is avoided due to the risk of complications during pregnancy. But, some patients insist on having a child due to their social need in spite of dreaded complications. Such patients should have anticoagulants under supervision of cardiologist.

  2. ASSESSMENT OF THE IMMEDIATE AND REMOTE RESULTS OF EMBOLIZATION OF UTERINE ARTERIES AT PATIENTS WITH OBSTETRIC BLEEDINGS

    Directory of Open Access Journals (Sweden)

    Жанна Николаевна Теленкова

    2017-08-01

    Full Text Available Obstetrical hemorrhage (OH is one of the leading causes of maternal death in the world. Study and implementation of organ-saving methods of OH treatment, one of wich is uterine artery embolization, is espessially important nowadays. The purpose – evaluation of immediate and long-term results of uterine artery embolization for patients with OH. Materials and methods. Prospective study were conducted on the basis of the maternity department of Khanty-Mansiysk's regional hospital. The observation conducted over 65 women with OH who undergo UAE from 2010 to 2016. The time of observation of patients varied between 6 months and 6 years. Inclusion criteria were: obstetric hemorrhage with a volume of ≥ 1000 ml, UAE. Exclusion criteria were: unstable hemodynamics, obstetric hemorrhage, severity wich required total hysterectomy. The immediate outcomes were estimated: the volume of blood loss before and during UAE, the duration of the intervention, the total volume of hemorrhage, the effectiveness of stopping obstetric hemorrhage, red blood (hemoglobin, hematocrit, erythrocyte, platelets, coagulogram after UAE on the first day, frequency and volume of blood transfusion, plasma-transfusion, the duration of inpatient treatment, the presence of complications. Long-term results of UAE were estimated as well: normal menstrual function recovery, fertility, outcomes of subsequent pregnancies. All of the patients were of reproductive age. 32 of them delivered vaginally while 33 delivered via cesarean section. The volume of blood loss before UAE (Me was 1150 ml. Time gap between arriving at a decision to do UAE and carrying out the operation (Me was 20 min. The average duration of an UAE (Me was 31 min. Results. The additional blood loss during an UAE(Me was 150 ml and the total volume of the blood loss (Me reached 1300 ml. 98,5 % of the group had the bleeding fully stopped. In 90,8 % of the women, the postpartum period was without complications, they

  3. Midterm Results after Uterine Artery Embolization Versus MR-Guided High-Intensity Focused Ultrasound Treatment for Symptomatic Uterine Fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Froeling, V., E-mail: vera.froeling@charite.de; Meckelburg, K., E-mail: katrin.meckelburg@charite.de; Scheurig-Muenkler, C., E-mail: christian.scheurig-muenkler@charite.de; Schreiter, N. F., E-mail: nils.schreiter@charite.de; Kamp, J., E-mail: julia.kamp@charite.de; Maurer, M. H., E-mail: martin.maurer@charite.de; Beck, A., E-mail: alexander.beck@charite.de; Hamm, B., E-mail: bernd.hamm@charite.de; Kroencke, T. J., E-mail: Thomas.kroencke@charite.de [Charite-Universitaetsmedizin Berlin, Department of Radiology (Germany)

    2013-12-15

    Purpose: To compare the rate of reintervention and midterm changes in symptom severity (SS) and Total health-related quality of life (HRQoL) scores after uterine artery embolization (UAE) and magnetic resonance-guided high-intensity focused ultrasound (MR-g HIFU) for symptomatic uterine fibroids. Methods: Eighty women (median age 38.3 years), equally eligible for MR-g HIFU and UAE who underwent one of both treatments between 2002 and 2009 at our institution, were included. The primary end point of the study was defined as the rate of reintervention after both therapies. The secondary outcome was defined as changes in SS and Total HRQoL scores after treatment. SS and Total HRQoL scores before treatment and at midterm follow-up (median 13.3 months) were assessed by the uterine fibroid symptom and quality-of-life questionnaire (UFS-QoL) and compared. Results: The rate of reintervention was significantly lower after UAE than after MR-g HIFU (p = 0.002). After both treatments, SS and Total HRQoL scores improved significantly from baseline to follow-up (UAE: p < 0.001, p < 0.001; MR-g HIFU: p = 0.002, p < 0.001). Total HRQoL scores were significantly higher after UAE than after MR-g HIFU (p = 0.032). Changes in the SS scores did not differ significantly for both treatments (p = 0.061). Conclusion: UAE and MR-g HIFU significantly improved the health-related quality of life of women with symptomatic uterine fibroids. After UAE, the change in Total HRQoL score improvement was significantly better, and a significantly lower rate of reintervention was observed.

  4. Complications and Reinterventions in Uterine Artery Embolization for Symptomatic Uterine Fibroids: A Literature Review and Meta Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Jason, E-mail: Jason.martin@medportal.ca; Bhanot, Kunal, E-mail: Kunal.Bhanot@medportal.ca [Michael G. DeGroote School of Medicine, McMaster University (Canada); Athreya, Sriharsha, E-mail: harshavbs@yahoo.com [St. Joseph' s Health Care Hamilton, McMaster University, Faculty of Health Sciences (Canada)

    2013-04-15

    To perform a literature review of the spectrum of complications associated with UAE relative to surgery and compare the risk of reintervention as well as minor, major, and overall complications. Literature review was conducted in PubMed, MEDLINE, Cochrane, and CINAHL databases, and meta-analysis was performed. In randomized clinical trials, common complications were discharge and fever (4.00 %), bilateral uterine artery embolization (UAE) failure (4.00 %), and postembolization syndrome (2.86 %). Two trials showed a significantly decreased risk in major complications with UAE, with odds ratios (ORs) of 0.07143 (0.009426-0.5413) and 0.5196 (0.279-0.9678). None of the trials showed a significant difference in OR for minor complications of UAE. None of the trials showed a significant difference in risk for overall complications of UAE. Three trials showed a significantly increased risk for reintervention with UAE with ORs of 10.45 (2.654-41.14), 2.679 (1.289-5.564), and 9.096 (1.269-65.18). In 76 nonrandomized studies, common complications were amenorrhea (4.26 %), pain (3.59 %), and discharge and fever (3.37 %). In 41 case studies, common complications were discharge and fever (n = 22 cases), repeat UAE (n = 6 cases), and fibroid expulsion (n = 5 cases). Overall, UAE has a significantly lower rate of major complications relative to surgery, but it comes at the cost of increased risk of reintervention in the future. Educating patients about the rate and types of complications of UAE versus surgery, as well as the potential for reintervention, should help the patient and clinician come to a reasoned decision.

  5. Epidural Analgesia Versus Patient-Controlled Analgesia for Pain Relief in Uterine Artery Embolization for Uterine Fibroids: A Decision Analysis

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    Kooij, Sanne M. van der, E-mail: s.m.vanderkooij@amc.uva.nl; Moolenaar, Lobke M.; Ankum, Willem M. [Academic Medical Centre, Department of Gynaecology (Netherlands); Reekers, Jim A. [Academic Medical Centre, Department of Radiology (Netherlands); Mol, Ben Willem J. [Academic Medical Centre, Department of Gynaecology (Netherlands); Hehenkamp, Wouter J. K. [VU University Medical Centre, Department of Gynaecology (Netherlands)

    2013-12-15

    Purpose: This study was designed to compare the costs and effects of epidural analgesia (EDA) to those of patient-controlled intravenous analgesia (PCA) for postintervention pain relief in women having uterine artery embolization (UAE) for systematic uterine fibroids. Methods: Cost-effectiveness analysis (CEA) based on data from the literature by constructing a decision tree to model the clinical pathways for estimating the effects and costs of treatment with EDA and PCA. Literature on EDA for pain-relief after UAE was missing, and therefore, data on EDA for abdominal surgery were used. Outcome measures were compared costs to reduce one point in visual analogue score (VAS) or numeric rating scale (NRS) for pain 6 and 24 h after UAE and risk for complications. Results: Six hours after the intervention, the VAS was 3.56 when using PCA and 2.0 when using EDA. The costs for pain relief in women undergoing UAE with PCA and EDA were Euro-Sign 191 and Euro-Sign 355, respectively. The costs for EDA to reduce the VAS score 6 h after the intervention with one point compared with PCA were Euro-Sign 105 and Euro-Sign 179 after 24 h. The risk of having a complication was 2.45 times higher when using EDA. Conclusions: The results of this indirect comparison of EDA for abdominal surgery with PCA for UAE show that EDA would provide superior analgesia for post UAE pain at 6 and 24 h but with higher costs and an increased risk of complications.

  6. Clinical utility of ultrasound versus magnetic resonance imaging for deciding to proceed with uterine artery embolization for presumed symptomatic fibroids

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    Rajan, D.K., E-mail: dheeraj.rajan@uhn.on.c [Department of Medical Imaging, University of Toronto (Canada); Departments of Vascular and Interventional Radiology, University Health Network and Mount Sinai Hospitals, Toronto (Canada); Margau, R. [Department of Medical Imaging, North York General Hospital, Toronto (Canada); Kroll, R.R. [Faculty of Social Science, University of Western Ontario, Toronto, Ontario (Canada); Simons, M.E.; Tan, K.T.; Jaskolka, J.D.; Kachura, J.R.; Sniderman, K.W.; Beecroft, J.R. [Department of Medical Imaging, University of Toronto (Canada); Departments of Vascular and Interventional Radiology, University Health Network and Mount Sinai Hospitals, Toronto (Canada); Haider, M. [Department of Medical Imaging, University of Toronto (Canada)

    2011-01-15

    Aim: To compare the diagnostic utility of pelvic ultrasound (US) and magnetic resonance imaging (MRI) on the clinical decision to proceed with uterine artery embolization (UAE). Materials and methods: Over 2 years, 180 consecutive women (mean age 43) sought consultation for UAE, 116 underwent pelvic US and MRI before possible UAE. US was performed prior to MRI. Imaging was analysed for leiomyoma quantity, size and location, uterine volume, and the presence of potential contraindications to UAE. Discrepancies between imaging methods and cases where discrepancies could have altered management, were recorded. Results: For the 116 patients who completed imaging, the average uterine volume was 701 cm{sup 3} using MRI versus 658 cm{sup 3} using US (p = 0.48). The average dominant leiomyoma volume was 292 cm{sup 3} using MRI versus 253 cm{sup 3} using US (p = 0.16). In 14 (12.1%) patients US did not correctly quantify or localize leiomyomas compared with MRI (p = 0.0005). Thirteen patients did not undergo UAE (patient preference n = 9, pre-procedural imaging findings n = 4). In the four cases where UAE was not performed due to imaging findings, relevant findings were all diagnosed by MRI compared with two by US (p = 0.5). The two cases not detected by ultrasound were adenomyosis and a pedunculate subserosal leiomyoma. Of the 103 patients who underwent UAE, 14 were treated (without complication) despite the presence of a relative contraindication; all 14 relative contraindications were identified by MRI compared with 13 by US (p = 1.0). Conclusion: MRI is more accurate than US for characterizing uterine leiomyomas. In a small but statistically insignificant number of cases, MRI identified findings that were missed by US, which changed management. For patients that are unsuitable to be assessed with MRI, ultrasound alone is sufficient for pre-UAE assessment.

  7. Monitoring Leiomyoma Response to Uterine Artery Embolization Using Diffusion and Perfusion Indices from Diffusion-Weighted Imaging

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    Mengqiu Cao

    2017-01-01

    Full Text Available Purpose. To investigate the potential of diffusion and perfusion indices (ADC and perfusion fraction f from DWI at 3.0 T in monitoring treatment response to uterine artery embolization (UAE at 6-month follow-up. Methods. Twelve female patients with uterine fibroids who underwent 3.0-T pelvic DWI before and 6 months after UAE were included. ADC and perfusion fraction f were calculated from DWI. The Wilcoxon signed-rank test and Spearman rank correlation test were used for statistics. Results. Seventeen fibroids were studied. The median ADCs showed a significant increase from 1.20 × 10−3 mm2/s (range, 0.86–1.66 × 10−3 mm2/s at baseline to 1.56 × 10−3 mm2/s (range, 1.00–1.86 × 10−3 mm2/s at 6-month follow-up (P=0.0003. Conversely, the median perfusion fraction f was significantly decreased after UAE (P=0.0001, with a median pre-UAE value of 14.2% (range, 6.7%–17.6% and a median post-UAE value of 9.2% (range, 3.2%–14.6%. Significant correlations were found between fibroid volume reduction rate and percentage changes in ADC and perfusion fraction f at 6-month follow-up relative to baseline, with ρ values of −0.50 (P=0.04 and 0.55 (P=0.02, respectively. Conclusion. ADC and perfusion fraction f obtained from DWI at 3.0 T may help to evaluate treatment response to UAE.

  8. Effect of Direct Marketing for Uterine Artery Embolization on Rates of Leiomyomas, Incidental Findings, and Management After Pelvic MRI.

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    Gurwara, Sheena; Allen, Brian C; Kouri, Brian; Clingan, M Jennings; Picard, Melissa; Leyendecker, John R

    2016-07-01

    The aim of this study was to determine whether a self-referred population screened by an interventional radiology (IR) clinic and a non-IR, physician-referred population differed with regard to suitability for uterine artery embolization (UAE) for symptomatic leiomyomas on the basis of preprocedure MRI. This was an institutional review board-approved, HIPAA-compliant retrospective study of 301 women evaluated in an IR clinic for possible UAE from January 2009 to September 2012. Subjects were retrospectively divided into two groups: self-referred via direct marketing (group A, n = 203; mean age, 41.8 years; range, 22-58 years) and physician referred (group B, n = 98; mean age, 42.9 years; range, 30-65 years). There was no significant difference between groups in presenting symptoms (multiple symptoms, bleeding, bulk-related symptoms, pain). After initial screening, 73.4% of group A (149 of 203) and 79.6% of group B (78 of 98) underwent MRI (P = .242). On the basis of MRI findings, 91.3% of group A (136 of 149) and 94.9% of group B (74 of 78) had uterine leiomyomas (P = .328). Adenomyosis without leiomyoma was present in 4.0% of group A (6 of 149) and 3.8% of group B (3 of 78) (P = .947). Incidental findings requiring further clinical or imaging evaluation were found in 20.8% of group A (31 of 149) and 24.4% of group B (19 of 78) (P = .539). After MRI, 41.6% of group A (62 of 149) and 48.7% of group B (38 of 78) proceeded to UAE (P = .306). After initial screening, similar proportions of self-referred and physician-referred patients were candidates for UAE. The rates of confirmed leiomyomas and incidental findings on MRI were similar between groups. Copyright © 2016 American College of Radiology. All rights reserved.

  9. Effect of Clinical Suspicion by Referral Physician and Early Outcomes in Patients with Acute Superior Mesenteric Artery Embolism

    Science.gov (United States)

    Kim, Hyung-Kee; Hwang, Deokbi; Park, Sujin; Huh, Seung; Lee, Jong-Min; Yun, Woo-Sung; Kim, Young-Wook

    2017-01-01

    Purpose To investigate the pattern of referral of patients with superior mesenteric artery embolism (SMAE) and its effect on outcomes, and to evaluate the risk factors for bowel infarction. Materials and Methods This retrospective study included 66 consecutive patients diagnosed with acute SMAE between January 2001 and June 2016. Appropriate diagnosis by the referring physician was defined if the referral letter indicated that acute mesenteric ischemia was suspected or had been diagnosed at the referral center. Surgical delay was defined as the interval between symptom onset and surgery for definitive treatment. Results Among 54 patients transferred from other centers, 26 patients (48.1%) were diagnosed appropriately by the referring physician. The rate of appropriate diagnosis was differed significantly by the use of computed tomography (CT) scan at referral center (25/35 with CT and 1/19 without CT, P=0.00). The surgical delay was significantly longer in patients without appropriate diagnosis compared with the patients with appropriate diagnosis (53.5±52.3 hours vs. 28.8±23.6 hours, P=0.04). Initially, 56 patients received surgical treatment with 31 underwent bowel resection due to infarction, 6 received conservative treatment, and the remaining 4 patients refused any treatment. The surgical delay, abdominal distension, tenderness, rebound tenderness, and level of C-reactive protein were associated with bowel infarction at initial operation. Overall in-hospital mortality was 32%. Conclusion A high index of suspicion with appropriate diagnostic modality, such as CT scan is crucial in patients with SMAE for reducing surgical delay as a risk factor of bowel infarction. PMID:28955699

  10. Clinical utility of ultrasound versus magnetic resonance imaging for deciding to proceed with uterine artery embolization for presumed symptomatic fibroids.

    Science.gov (United States)

    Rajan, D K; Margau, R; Kroll, R R; Simons, M E; Tan, K T; Jaskolka, J D; Kachura, J R; Sniderman, K W; Beecroft, J R; Haider, M

    2011-01-01

    To compare the diagnostic utility of pelvic ultrasound (US) and magnetic resonance imaging (MRI) on the clinical decision to proceed with uterine artery embolization (UAE). Over 2 years, 180 consecutive women (mean age 43) sought consultation for UAE, 116 underwent pelvic US and MRI before possible UAE. US was performed prior to MRI. Imaging was analysed for leiomyoma quantity, size and location, uterine volume, and the presence of potential contraindications to UAE. Discrepancies between imaging methods and cases where discrepancies could have altered management, were recorded. For the 116 patients who completed imaging, the average uterine volume was 701 cm(3) using MRI versus 658 cm(3) using US (p=0.48). The average dominant leiomyoma volume was 292 cm(3) using MRI versus 253 cm(3) using US (p=0.16). In 14 (12.1%) patients US did not correctly quantify or localize leiomyomas compared with MRI (p=0.0005). Thirteen patients did not undergo UAE (patient preference n=9, pre-procedural imaging findings n=4). In the four cases where UAE was not performed due to imaging findings, relevant findings were all diagnosed by MRI compared with two by US (p=0.5). The two cases not detected by ultrasound were adenomyosis and a pedunculate subserosal leiomyoma. Of the 103 patients who underwent UAE, 14 were treated (without complication) despite the presence of a relative contraindication; all 14 relative contraindications were identified by MRI compared with 13 by US (p=1.0). MRI is more accurate than US for characterizing uterine leiomyomas. In a small but statistically insignificant number of cases, MRI identified findings that were missed by US, which changed management. For patients that are unsuitable to be assessed with MRI, ultrasound alone is sufficient for pre-UAE assessment. Copyright © 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  11. Uterine artery embolization in patients with a large fibroid burden: long-term clinical and MR follow-up.

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    Smeets, Albert J; Nijenhuis, Robbert J; van Rooij, Willem Jan; Weimar, Emilie A M; Boekkooi, Peter F; Lampmann, Leo E H; Vervest, Harry A M; Lohle, Paul N M

    2010-10-01

    Uterine artery embolization (UAE) in patients with a large fibroid burden is controversial. Anecdotal reports describe serious complications and limited clinical results. We report the long-term clinical and magnetic resonance (MR) results in a large series of women with a dominant fibroid of >10 cm and/or an uterine volume of >700 cm(3). Seventy-one consecutive patients (mean age, 42.5 years; median, 40 years; range, 25-52 years) with a large fibroid burden were treated by UAE between August 2000 and April 2005. Volume reduction and infarction rate of dominant fibroid and uterus were assessed by comparing the baseline and latest follow-up MRIs. Patients were clinically followed at various time intervals after UAE with standardized questionnaires. There were no serious complications of UAE. During a mean follow-up of 48 months (median, 59 months; range, 6-106 months), 10 of 71 patients (14%) had a hysterectomy. Mean volume reduction of the fibroid and uterus was 44 and 43%. Mean infarction rate of the fibroid and overall fibroid infarction rate was 86 and 87%. In the vast majority of patients there was a substantial improvement of symptoms. Clinical results were similar in patients with a dominant fibroid >10 cm and in patients with large uterine volumes by diffuse fibroid disease. In conclusion, our results indicate that the risk of serious complications after UAE in patients with a large fibroid burden is not increased. Moreover, clinical long-term results are as good as in other patients who are treated with UAE. Therefore, a large fibroid burden should not be considered a contraindication for UAE.

  12. Algorithm for management of patients with X-ray endovascular artery embolization of the prostate for its benign hyperplasia

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    O. B. Zhukov

    2016-01-01

    Full Text Available X-ray endovascular prostatic artery embolization (XEPAE is a comparatively new alternative treatment for benign prostatic hyperplasia (BPH, which has shown good results in Russia and foreign countries. The dissimilarity from other treatments for this nosology is the use of superselective artery ischemia of the prostate, which leads to a decrease in its sizes and a progressive reduction in lower urinary tract symptoms. Twelve patients aged 59–71 years (mean age, 66 years with BPH have been operated on since 2014. The mean follow-up period was 8.4 months (3–17 months. The patients were divided into 3 groups in accordance with prostate volume: 1 60–100 cm3 (n = 3; 2 100–200 сm3 (n = 5; 3 ≥ 200 см3 (n = 4. The mean prostatic specific antigen level was 5.1 ± 2.7 ng/ml (2.7–6.3 ng/ml. Due to the increased pro static specific antigen level up to 4 ng/ml, 6 patients underwent transrectal and/or targeted biopsy of the prostate, which failed to reveal the morphological signs of its malignant process. The examination algorithm included all necessary laboratory and clinical examinations, as those during surgery for BPH, as well as multislice spiral computed tomography and/or magnetic resonance imaging, angiography of small pelvic vessels and organs.  Postoperative patient monitoring revealed that the total International Prognostic Scoring System scores decreased by 41.3 and 61.4 % at 3- and 6-month follow-ups, respectively; then these values were insignificant. The prostate volume substantially decreased at 3 months; but at 6 months it was 47 % of the baseline one. The urine flow rate rose from 6.7 to 15.9 ml/sec. The quality of life index became summarily quite satisfactory at 6-month follow-up and amounted to 3.3 ± 1.3. Thus, it may be stated that XEPAE is a safe and highly effective treatment for BPH if its medical treatment is ineffective. This surgical treatment performed for 3–6 months substantially decreases the prostate

  13. Stent-assisted coil embolization of a symptomatic middle cerebral artery aneurysm in an infant.

    Science.gov (United States)

    Savastano, Luis E; Chaudhary, Neeraj; Gemmete, Joseph J; Garton, Hugh J L; Maher, Cormac O; Pandey, Aditya S

    2014-11-01

    Pediatric intracranial aneurysms are rare and challenging to treat. Achieving efficacy and durability of aneurysmal occlusion while maintaining parent vessel patency requires innovative treatment strategies, especially in cases in which aneurysmal location or morphology pose substantial morbidity associated with microsurgical treatment. In the last 3 decades, endovascular treatments have had a remarkable evolution and are currently considered safe and effective therapeutic options for cerebral aneurysms. While endovascular techniques are well described in the English literature, the endovascular management of pediatric aneurysms continues to pose a challenge. In this report, the authors describe the case of a 9-month-old infant who presented with a 1-day history of acute-onset left-sided hemiparesis and left facial droop. Imaging revealed a large symptomatic saccular middle cerebral artery aneurysm. Treatment included successful stent-assisted aneurysm coiling. At follow-up, the patient continued to fare well and MR angiography confirmed complete occlusion of the aneurysm dome. This case features the youngest patient in the English literature to harbor an intracranial aneurysm successfully treated with stent-assisted coiling. Based on this experience, endovascular intervention with vascular reconstruction can be safe and effective for the treatment of infants and could further improve prognosis; however, further studies are necessary to confirm these findings.

  14. Transcatheter arterial embolization with trisacryl gelatin microspheres (Embosphere® leads to life-threatening tumor lysis syndrome in a rectal carcinoid patient with hepatic metastases

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    Yuan-Hao Lo

    2012-11-01

    Full Text Available The incidence of gastrointestinal carcinoids appears to be increasing, and the rectum is the third most common location. Transcatheter arterial embolization (TAE with trisacryl gelatin microspheres (Embosphere® has been reported as an effective method for hepatic metastases of rectal carcinoids. Complications are uncommon and usually of minor consequence. We report an unusual case of a 34-year-old man with tumor lysis syndrome following TAE with Embosphere® in a patient with multiple hepatic metastases of a rectal carcinoid. Early detection and effective treatment are essential for this rare but potentially catastrophic complication.

  15. A delayed splenic rupture after transcatheter arterial embolization required total splenectomy in a patient with an implantable left ventricular assist device.

    Science.gov (United States)

    Kitahara, Hiroto; Nawata, Kan; Kinoshita, Osamu; Itoda, Yoshifumi; Kimura, Mitsutoshi; Yamauchi, Haruo; Ono, Minoru

    2016-12-01

    We successfully managed a splenic injury and delayed splenic rupture in a patient with an implantable left ventricular assist device (iLVAD). A 42-year-old man with an iLVAD for idiopathic dilated cardiomyopathy was admitted to our department complaining of dizziness. Laboratory data showed severe anemia, and computed tomography demonstrated a traumatic splenic injury. Following conservative treatment, partial splenic embolization was performed. Fifteen days after the intervention, the patient went into hemorrhagic shock due to delayed splenic rupture. Emergency total splenic embolization was performed, and total splenectomy was conducted later to prevent re-bleeding or abscess formation. His postoperative course was uneventful, and he was discharged on postoperative day 22. Finally, he underwent orthotropic heart transplantation without post-splenectomy sepsis or thrombotic complications 472 days after splenectomy. Splenic injury should be considered as a possible complication of iLVAD. In addition, careful follow-up after transcatheter arterial embolization for splenic injury is essential for managing delayed splenic rupture.

  16. Spherical polyvinyl alcohol versus tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a limited randomized comparative study.

    Science.gov (United States)

    Spies, James B; Allison, Sandra; Flick, Pamela; Cramp, Michelle; Bruno, Jill; Jha, Reena C; Ascher, Susan A

    2005-11-01

    To compare the outcomes of uterine artery embolization (UAE) for leiomyomas with use of tris-acryl gelatin microspheres (TAGM) versus spherical polyvinyl alcohol (PVA) particles. Patients undergoing UAE were randomly assigned to receive TAGMs or PVA. Embolization was performed in a standardized manner. Outcome data were collected at 3 months after embolization, including assessment of clinical symptoms, scores from a fibroid tumor-specific symptom and quality of life (QOL) questionnaire, and findings on contrast material-enhanced magnetic resonance (MR) imaging, including the degree of tumor infarction and volume reduction. Data were analyzed with use of t tests, the Mann-Whitney U test, and chi2 tests as appropriate. Thirty-six patients were treated. There were no differences in the two treatment groups at baseline. Clinical follow-up was obtained in 35 patients. Among the clinical outcome measures, QOL score improvement was greater for UAE with TAGMs compared with PVA (49.0 vs 27.9; P = .02), but no other differences were noted. Of the 25 patients in whom 3-month MR imaging follow-up was completed, those treated with TAGM were significantly more likely to have complete infarction of all leiomyomas (six patients vs one patient; P = .02), were more likely to have at least 90% tumor infarction (eight patients vs four patients; P = .03), and had a lower mean percent of residual perfused fibroid tumor tissue (9.6% vs 44.3%; P = .004) compared with patients treated with PVA. Based on these differences between the embolic agents, enrollment in this study was terminated. The use of spherical PVA particles in the manner described herein results in an unacceptably high rate of failed tumor infarction in UAE.

  17. [Embolization of a ruptured pseudo-aneurysm of the uterine artery at 26weeks of gestation: Materno-fetal consequences; a case-report].

    Science.gov (United States)

    Maignien, C; Marcellin, L; Anselem, O; Silvera, S; Dousset, B; Grangé, G; Goffinet, F

    2015-09-01

    Rupture of a uterine artery pseudo-aneurysm during pregnancy is a rare condition with potential life-threatening complications, and management should take into account the fetal impact of the therapeutic choice. We report the case of a 2cm left uterine artery pseudo-aneurysm revealed by pelvic pain, in a 30-year-old pregnant woman at 26(+0)weeks of gestation (WG). Diagnosis was suspected at ultrasound scan, and confirmed with Magnetic Resonance angiography that showed signs of pre-rupture. An emergency selective embolization attempted in utero allowed the complete exclusion of the aneurysmal sac. The patient gave birth one month later to a girl at 31(+1)WG, initially managed by neonatologists, who is currently in good health. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  18. Outcome of high-intensity focused ultrasound and uterine artery embolization in the treatment and management of cesarean scar pregnancy

    Science.gov (United States)

    Hong, Yufeng; Guo, Quanwei; Pu, Yingjie; Lu, Dongmei; Hu, Min

    2017-01-01

    Abstract The aim of the study was to compare the efficacy and safety between high-intensity focused ultrasound (HIFU) treatment and uterine artery embolization (UAE) treatment; we retrospectively analyzed 152 cases with cesarean scar pregnancy (CSP). Based on our inclusion and exclusion criteria, 152 patients (average age, 31.8 ± 4.6 years old) with CSP were eligible for the HIFU group (85 patients) or the UAE group (77 patients). All patients in 2 groups received the treatment with suction curettage under hysteroscopy prior to HIFU or UAE treatment and followed up for 12 months. The assessment criteria of treatment efficacy included the success rate, intraoperative blood loss, duration of vaginal bleeding, normal menstrual function recovery time, time for β-human chorionic gonadotrophin (β-HCG) back to normal level, duration of hospital stays, and other adverse effects. Following up for 12 months, the HIFU group was of less intraoperative blood loss (76.38 ± 22.89 vs 114.42 ± 30.34 mL, P = .02), shorter duration of postoperative vaginal bleeding (11.28 ± 3.65 vs 15.77 ± 7.24 days, P = .01) and lower adverse effects rate comparing to the UAE group. However, the HIFU group have longer time for the β-HCG recovery to the normal level (35.28 ± 9.86 vs 29.91 ± 7.29, P = .03). Additionally, there were no significantly statistic differences between the 2 groups in baseline characteristics, success rate, and average time of gestational sac disappeared and menstrual recovery and hospital stay. Thus, we concluded that the method of both HIFU and UAE combined with suction curettage under hysteroscopy is safe and effective in the management of CSP. Meanwhile, HIFU is a better therapy option than UAE for those women who are seeking complete relieve of symptom to gain fertility. PMID:28746234

  19. Ginsenoside Rg3 attenuates hepatoma VEGF overexpression after hepatic artery embolization in an orthotopic transplantation hepatocellular carcinoma rat model

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    Zhou B

    2014-10-01

    Full Text Available Bo Zhou, Jianhua Wang, Zhiping Yan Department of Interventional Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, People's Republic of China Background: Hypoxia-induced vascular endothelial growth factor (VEGF upregulation and angiogenesis following treatment of hepatocellular carcinoma (HCC with transarterial embolization (TAE or transarterial chemoembolization (TACE may be mediated by ginsenoside Rg3, an anti-angiogenic saponin extracted from ginseng. Objective: To access the synergistic action of Rg3 and TAE treatment on HCC by VEGF and it's receptor expressions decreasing in a rat model of HCC. Methods: An orthotopic transplantation HCC model was established in Buffalo rats. HCC rats were treated with hepatic artery infusions of normal saline or iodized oil (0.1 mL with or without Rg3 (1 mg/kg (each n=15 in control, Rg3, TAE, and TAE + Rg3 groups. At 1, 2, 4, and 8 weeks, performance status (body weight, tumor progression (longest tumor diameter, metastasis rate, microvessel density (MVD, and overall survival rate were assessed. Additionally, cluster of differentiation 31 (CD31, VEGF, VEGF receptor 2 (VEGF-R2 and VEGF-R2 phosphorylation levels were assessed by immunohistochemistry, enzyme-linked immunosorbent assay (ELISA, and Western blot. Results: Combined Rg3 and TAE treatment reduced tumor progression, body weight loss, angiogenesis, and metastasis rate, and led to better overall survival in the HCC rat model. ELISA results showing VEGF expression in the control, Rg3, TAE, and TAE + Rg3 groups at 4 weeks following treatment were 132.6±2.38, 37.9±0.8, 87.4±0.7, and 45.3±0.4 pg/mL, respectively. Combined Rg3 and TAE reduced the protein expression of CD31 and VEGF-R2 phosphorylation, compared with those in the TAE group at 4 weeks of treatment. Conclusion: Combined Rg3 and TAE treatment limited metastasis and promoted survival by downregulating VEGF overexpression in HCC tumors. Thus, this treatment may have

  20. Comparison of Particulate Embolization after Femoral Artery Treatment with IN.PACT Admiral versus Lutonix 035 Paclitaxel-Coated Balloons in Healthy Swine.

    Science.gov (United States)

    Kolodgie, Frank D; Pacheco, Erica; Yahagi, Kazuyuki; Mori, Hiroyoshi; Ladich, Elena; Virmani, Renu

    2016-11-01

    Different carrier excipients unique to individual drug-coated balloons (DCBs) may influence embolic safety characteristics in peripheral vascular territories through embolization of released particulates. A comparator study of IN.PACT Admiral vs Lutonix 035 balloons in healthy swine was therefore performed to assess which balloon produces more downstream emboli. Single or overlapping 80-mm IN.PACT and Lutonix 035 DCBs were assessed in the femoral arteries of 21 swine with 28- and 90-day follow-up, with standard balloon angioplasty as a control. Histologic analysis of arterial wall and downstream skeletal muscle and coronary band was performed. This analysis was supported by an analytic measurement of paclitaxel levels. IN.PACT DCBs demonstrated a more pronounced change in medial wall composition, characterized by a paclitaxel-induced loss of medial smooth muscle cells accompanied by increased proteoglycans. The percentage of sections with arterioles exhibiting paclitaxel-associated fibrinoid necrosis in downstream tissues was higher at 90 days with overlapping IN.PACT DBCs compared with Lutonix 035 DCBs (46.2% [interquartile range, 19.2-57.7] vs 0.0% [0.0-11.5]; P = .01), with similar trends noted for 28-day single and overlapping DCBs. Drug analysis in parallel tissues further confirmed higher paclitaxel concentrations in nontarget tissues for IN.PACT than Lutonix 035 balloons for single and overlapping configurations at both time points. Rare embolic crystalline material was observed in downstream tissues, but only for IN.PACT balloons. There was more fibrinoid necrosis in tissues treated with IN.PACT DCBs compared with Lutonix DCBs, suggesting increased emboli debris with higher paclitaxel levels. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  1. Bronchial compression in an infant with isolated secundum atrial septal defect associated with severe pulmonary arterial hypertension

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    Sung-Hee Park

    2012-08-01

    Full Text Available Symptomatic pulmonary arterial hypertension (PAH in patients with isolated atrial septal defect (ASD is rare during infancy. We report a case of isolated ASD with severe PAH in an infant who developed airway obstruction as cardiomegaly progressed. The patient presented with recurrent severe respiratory insufficiency and failure to thrive before the repair of the ASD. Echocardiography confirmed volume overload on the right side of heart and severe PAH (tricuspid regurgitation [TR] with a peak pressure gradient of 55 to 60 mmHg. The chest radiographs demonstrated severe collapse of both lung fields, and a computed tomography scan showed narrowing of the main bronchus because of an intrinsic cause, as well as a dilated pulmonary artery compressing the main bronchus on the left and the intermediate bronchus on the right. ASD patch closure was performed when the infant was 8 months old. After the repair of the ASD, echocardiography showed improvement of PAH (TR with a peak pressure gradient of 22 to 26 mmHg, and the patient has not developed recurrent respiratory infections while showing successful catch-up growth. In infants with symptomatic isolated ASD, especially in those with respiratory insufficiency associated with severe PAH, extrinsic airway compression should be considered. Correcting any congenital heart diseases in these patients may improve their symptoms.

  2. Spiral computed tomography of the pulmonary arteries in the diagnosis of acute and chronic pulmonary embolism; Spiralcomputertomographie der Pulmonalarterien: Diagnostik der akuten und chronischen Lungenembolie

    Energy Technology Data Exchange (ETDEWEB)

    Kauczor, H.U. [Mainz Univ. (Germany). Klinik fuer Radiologie; Schwickert, H.C.; Cagil, H.; Schweden, F.; Mildenberger, P.

    1995-03-01

    The use of tailored acquisition spiral CT protocols together with standardized contrast medium injections result in a detailed visualization of the pulmonary arteries. Since spiral CT is a quick and noninvasive imaging modality, it is especially suited for severely ill patients suspected to be suffering from acute pulmonary embolism. In contrast to perfusion scintigraphy, spiral CT will directly visualize the emboli, and should be performed if scintigraphy is not conclusive before the patient is referred to angiography. In cases of chronic pulmonary embolism spiral CT will directly visualize thromboemboli, consecutive wall thickening, pulmonary infarctions, and relative hyperperfusion as well as signs of pulmonary arterial hypertension and right heart failure. Acquisition protocols, diagnostic criteria, and clinical value of spiral CT are presented. (orig.) [Deutsch] Die Spiral-Computertomographie (Spiral-CT) ermoeglicht durch gezielte Untersuchungsprotokolle und standardisierte Kontrastmittelapplikation eine detaillierte Darstellung der Pulmonalarterien. Aufgrund der kurzen Untersuchungszeiten und der fehlenden Invasivitaet ist die Spiral-CT auch bei schwerkranken Patienten als Untersuchung bei Verdacht auf akute Lungenembolie geeignet. Sie erlaubt im Gegensatz zur Szintigraphie den direkten Thrombusnachweis und sollte bei unklarem szintigraphischen Befund vor der Angiographie eingesetzt werden. Bei der chronisch rezidivierenden Lungenembolie ermoeglicht sie die direkte Darstellung von Thromben und Gefaessveraenderungen, von Lungeninfarkten und relativer Hyperperfusion sowie den Nachweis der Zeichen der pulmonalarteriellen Hypertonie und der Rechtsherzbelastung. Untersuchungstechnik, diagnostische Kriterien und Aussagekraft der Spiral-CT werden praesentiert. (orig.)

  3. Ovarian protection by selective coil embolization of a uteroovarian anastomosis before uterine fibroid embolization: a report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Im, Han Hyeok [Soonchunhyang University, Gumi (Korea, Republic of); Chang, Yun Woo; Goo, Dong Erk [Soonchunhyang University Hospital, Gumi (Korea, Republic of)

    2006-09-15

    Premature menopause can be developed as a result of undesired nontarget ovary embolization during the performance of uterine fibroid embolization. The etiology of varian failure after uterine fibroid embolization is not yet clearly defined, but one of the leading possibilities is nontarget embolization of the varies. We report here on two cases in which superselective coil embolization of distal uterine artery collateral pathways to the ovary was performed during uterine fibroid embolization.

  4. Pulmonary thrombo-embolic disease

    African Journals Online (AJOL)

    In addition, a number of new and exciting anticoagulant therapies are being developed for this disease. Definition. Pulmonary thrombo-embolic diseases can be either acute or chronic. Pulmonary embolism (PE) occurs with partial or complete obstruction of the central or peripheral pulmonary arteries by emboli. Incidence.

  5. Gas embolism: pathophysiology and treatment

    NARCIS (Netherlands)

    van Hulst, Robert A.; Klein, Jan; Lachmann, Burkhard

    2003-01-01

    Based on a literature search, an overview is presented of the pathophysiology of venous and arterial gas embolism in the experimental and clinical environment, as well as the relevance and aims of diagnostics and treatment of gas embolism. The review starts with a few historical observations and

  6. Transcatheter embolization for splanchnic pseudoaneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Kang, In Ku; Lee, Do Yun; Kim, Young Ju; Youm, Dong Ho; Chang, Young Sim; Park, Si Kyun; Kwack, Kyu Seung; Kwon, Taek Sang; Hong, In Soo [Yonsei Univ. Wonju College of Medicine, Wonju (Korea, Republic of)

    1998-10-01

    To determine the therapeutic effect of transcatheter embolization in the treatment of splanchnic pseudoaneurysm. This study involved eleven patients who underwent embolization for the treatment of splanchnic pseudoaneurysm. Nine were men and two were women; their ages ranged from 8 to 74 (mean, 51) years. The etiology of these cases included postoperative pseudoaneurysm(n=3D4), pancreatitis(n=3D3), stab injury(n=3D1), and suspected infection(n=3D1), while two cases were uncertain. The locations of the pseudoaneurysm were the splenic artery(n=3D4), the gastroduodenal artery(n=3D3), the hepatic artery(n=3D2), the celiac artery(n=3D1), and both the right renal and lumbar artery(n=3D1). All patients underwent angiography prior to embolization. The materials used during embolization were a microcoil, a 5-cm metallic guide wire, and a detachable balloon. Embolization was successful in all eleven cases. Among nine cases in which follow-up was possible, angiography was performed in four, and five cases of thrombus were confirmed by abdominal CT. Three of these nine patients underwent re-embolization. One patient underwent elective surgery for a pseudocyst due to pancreatitis. Transcatheter embolization is a safe and convenient modality for the treatment of splanchnic pseudoaneurysm.=20.

  7. A case of severe uterine arteriovenous malformation treated with danazol followed by a transarterial embolization of unilateral uterine and ovarian arteries

    Directory of Open Access Journals (Sweden)

    Hiroyuki Yazawa

    2015-11-01

    Full Text Available Uterine arteriovenous malformation (AVM is a potentially life-threatening condition characterized by abrupt and profuse uterine bleeding from abnormal connections between arteries and veins in the myometrium. It is commonly associated with prior pregnancy or uterine trauma. We present a case of severe uterine AVM treated with danazol and transarterial embolization (TAE. A 38-year-old patient with a history of two abortions and a myomectomy was referred to our hospital for intermittent massive uterine bleeding. She was diagnosed with uterine AVM by transvaginal color Doppler ultrasonography and helical computed tomography (CT. Diagnostic three-dimensional CT (3D-CT angiography clearly demonstrated hypervascular tangles of uterine vessels, feeding arteries, remarkably dilated draining veins, as well as early filling of the internal iliac vein and the inferior vena cava, indicating massive arteriovenous shunting in the uterus. Danazol was administrated for 10 months to reduce the shunting of the uterine AVM before TAE with N-butyl-cyanoacrylate of the left ovarian artery and left uterine artery was successfully performed. After the procedure, we confirmed that shunting through the uterine AVM was markedly reduced. The patient has not experienced any severe uterine bleeding since the treatment.

  8. Mycotic aneurysm of the superior mesenteric artery after septic embolism; Entwicklung eines mykotischen Aneurysmas der A. mesenterica superior nach septischer Embolie

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, F.; Dinkel, H.P. [Institut fuer Diagnostische Radiologie, Inselspital, Universitaetsklinik Bern (Switzerland)

    2002-07-01

    Mycotic aneurysms of the aorta and the visceral arteries are life-threatening diseases, due to potential rupture and organ or limb ischemia. They occur in endocarditis, immunodeficiency, bacteremia and fungemia, and have a poor prognosis.We report on a case of a 54-year-old male patient suffering from abdominal angina after mitral valve replacement for septic mycotic endocarditis. In presence of a mycotic-embolic occlusion of the left popliteal artery and multiple septic organ infarctions a mycotic aneurysm of the superior mesenteric artery was found in abdominal spiral-CT.Based on sequential spiral-CT examinations, this case demonstrates the development of a septic aneurysm of the superior mesenteric artery. (orig.) [German] Mykotische Aneurysmen der Aorta und ihrer Aeste stellen wegen Rupturgefahr und moeglicher Minderperfusion von Organen und Extremitaeten eine lebensgefaehrliche Erkrankung mit unguenstiger Prognose dar. Beguenstigende Faktoren sind geschwaechte Immunabwehr, Endokarditis, Bakteriaemie und Fungaemie.Wir berichten ueber einen 54-jaehrigen Patienten, der nach einem Mitralklappenersatz bei mykotischer Endokarditis zunehmende abdominelle Beschwerden im Sinne einer Angina abdominalis entwickelte. Die abdominelle Spiralcomputertomographie zeigte ein mykotisches Aneurysma der A. mesenterica superior. Daneben bestanden ein mykotischer Verschluss der linken A. poplitea und multiple septische Organinfarkte.Der Fall demonstriert anhand sequentieller Computertomographien eindrucksvoll die Entwicklung eines septischen Viszeralarterienaneurysmas. (orig.)

  9. Bronchial stents

    Directory of Open Access Journals (Sweden)

    Ibrahim Emad

    2006-01-01

    Full Text Available Bronchial stents are mostly used as a Palliative relief of symptoms often caused by airway obstruction, It is also used for sealing of stump fistulas after pneumonectomy and dehiscence after bronchoplastic operations. Advances in airway prosthetics have provided a variety of silicone stents, expandable metal stents, and pneumatic dilators, enabling the correction of increasingly complex anatomical problems. Several series have been published describing the application and results of these techniques. This manuscript reviews the historical development of stents, types, indication, outcome, and complications. Alternative therapies for tracheobronchial stenting were also reviewed

  10. Transcatheter arterial embolization therapy for a hypoplastic pelvic kidney with a single vaginal ectopic ureter to control incontinence: the usefulness of three-dimensional CT angiography using multidetector-row helical CT.

    Science.gov (United States)

    Kudoh, Kouichi; Kadota, Masataka; Nakayama, Yoshiharu; Imuta, Masanori; Yasuda, Tsuyoshi; Yamashita, Yasuyuki; Inadome, Akito; Yoshida, Masaki; Ueda, Shouichi

    2003-01-01

    A girl with continuous urinary incontinence was successfully treated by angiographic embolization of a hypoplastic pelvic kidney with a single unilateral vaginal ectopic opening of the ureter. For this intervention, CT angiography was useful for detecting the corresponding renal artery of the hypoplastic kidney.

  11. Venous and arterial thrombo-embolic complications of hormonal treatment in a male-to-female transgender patient.

    LENUS (Irish Health Repository)

    Mullins, G M

    2012-02-03

    We present a male-to-female (MTF) transgender patient admitted with a pulmonary embolism. The patient had been treated with high-dose oestrogens since the age of 16. Following a prolonged period of hypotension, our patient sustained cerebral border zone infarcts. There was evidence of bilateral carotid stenosis on Doppler ultrasound. We discuss the treatment and vascular complications of gender dysphoria.

  12. Transauricular embolization of the rabbit coronary artery for experimental myocardial infarction: comparison of a minimally invasive closed-chest model with open-chest surgery

    Directory of Open Access Journals (Sweden)

    Katsanos Konstantinos

    2012-02-01

    Full Text Available Abstract Introduction To date, most animal studies of myocardial ischemia have used open-chest models with direct surgical coronary artery ligation. We aimed to develop a novel, percutaneous, minimally-invasive, closed-chest model of experimental myocardial infarction (EMI in the New Zealand White rabbit and compare it with the standard open-chest surgical model in order to minimize local and systemic side-effects of major surgery. Methods New Zealand White rabbits were handled in conformity with the "Guide for the Care and Use of Laboratory Animals" and underwent EMI under intravenous anesthesia. Group A underwent EMI with an open-chest method involving surgical tracheostomy, a mini median sternotomy incision and left anterior descending (LAD coronary artery ligation with a plain suture, whereas Group B underwent EMI with a closed-chest method involving fluoroscopy-guided percutaneous transauricular intra-arterial access, superselective LAD catheterization and distal coronary embolization with a micro-coil. Electrocardiography (ECG, cardiac enzymes and transcatheter left ventricular end-diastolic pressure (LVEDP measurements were recorded. Surviving animals were euthanized after 4 weeks and the hearts were harvested for Hematoxylin-eosin and Masson-trichrome staining. Results In total, 38 subjects underwent EMI with a surgical (n = 17 or endovascular (n = 21 approach. ST-segment elevation (1.90 ± 0.71 mm occurred sharply after surgical LAD ligation compared to progressive ST elevation (2.01 ± 0.84 mm;p = 0.68 within 15-20 min after LAD micro-coil embolization. Increase of troponin and other cardiac enzymes, abnormal ischemic Q waves and LVEDP changes were recorded in both groups without any significant differences (p > 0.05. Infarct area was similar in both models (0.86 ± 0.35 cm in the surgical group vs. 0.92 ± 0.54 cm in the percutaneous group;p = 0.68. Conclusion The proposed model of transauricular coronary coil embolization avoids

  13. Comparing the Use of Uterine Artery Embolization to Gonadotropin-Releasing Hormone Agonists in Shrinking Fibroid Size: A Pilot Study in Kazakhstan

    Directory of Open Access Journals (Sweden)

    Balkenzhe Imankulova

    2015-09-01

    Full Text Available Introduction: Uterine fibroids are the most common benign tumor in women in Kazakhstan. In the past two decades, endoscopic surgery has played an important role in the development of gynecologic surgery, particularly in the treatment of uterine fibroids. The goal of this paper is to evaluate whether uterine artery embolization (UAE or gonadotropin-releasing hormone agonists (GnRHa prior to myomectomy was more effective in decreasing fibroid size and improving surgical outcomes in a pilot study of women in Kazakhstan.Methods: This pilot investigation included 24 patients separated into 2 groups: medication group (pre-treatment with GnRHa – 13 patients and embolization group (pre-treatment with UAE – 11 patients. All patients had uterine fibroids, 3-10 cm in diameter, and were treated with myomectomy at the National Research Center for Maternal and Child Health, Astana, Kazakhstan. All patient data were obtained by a retrospective medical records review. Descriptive statistics were utilized to characterize participant demographics data. Independent t-tests were used to analyze continuous variables, and Chi-square and Fisher’s exact tests were used where appropriate for count data.Results: The group treated with GnRHa had an operating time of 40±10 minutes longer than the group treated with UAE, due to the peri-operative difficulties encountered by surgeons in detecting the layer between the myometrium and fibroid capsule. The group treated with UAE experienced better patient outcomes (less blood loss, less surgical time, and reduced use of anesthesia and was a technically easier surgery due to visible differences in uterine layers.Conclusions: Despite the fact that both treatments (GnRHa and UAE were effective for fibroid shrinking, embolization resulted in more optimal surgical time and improved patient outcomes. Results of this pilot study need to be confirmed in a randomized clinical trial, specifically focused on Kazakhstan and the

  14. Embolia gasosa Gas embolism

    Directory of Open Access Journals (Sweden)

    Rafael Fagionato Locali

    2006-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A embolia gasosa é uma lesão iatrogênica que possui alta morbimortalidade. É uma complicação decorrente de procedimentos clínico-cirúrgicos, sendo necessário o conhecimento dessa entidade pelos profissionais de saúde. O objetivo deste estudo foi realizar uma revisão dessa entidade, abrangendo seus aspectos fisiopatológicos, diagnósticos e terapêuticos. CONTEÚDO: Este artigo revisa conceitualmente a embolia gasosa, separando-a em arterial e venosa. Relata as principais características fisiopatológicas, diagnósticas e terapêuticas das embolias arterial e venosa. Além disso, aborda-se a embolia paradoxal, evento advindo da conversão de embolia venosa em arterial. CONCLUSÕES: A embolia gasosa é uma complicação relevante e presente em muitas especialidades médicas. Uma compreensão acerca da sua fisiopatologia e dos métodos diagnósticos e terapêuticos é essencial para garantir maior segurança aos pacientes.BACKGROUND AND OBJECTIVES: Gas embolism is an iatrogenic injury that has high morbidity and mortality. It's a complication of clinical-surgical procedures, and it's necessary that the health professionals know this entity. The aim of this study was to realize a review of the gas embolism, considering its pathophysiology, diagnosis and therapeutics aspects. CONTENTS: This article revises conceptually the gas embolism, dividing it in arterial and venous. Relate the mains physiopathology, diagnosis and therapeutics characteristics of the arterial and venous embolism. In addition, it's also approach the paradoxical embolism, event that occurs by conversion of a venous embolism to an arterial embolism. CONCLUSIONS: Gas embolism is an important complication, and it's present in many medical specialties. Knowledge about its physiopathology, and its diagnosis and therapeutic methods is essential to guarantee higher safety to the patients.

  15. Comparison of an Additional Transdermal Fentanyl Patch Compared to Intravenous NSAID and Opioid Analgesics within 24 Hours of an Uterine Artery Embolization for Myoma and Adenomyosis

    Energy Technology Data Exchange (ETDEWEB)

    Song, Suk Yun; Kang, Byung Chul; Rho, Kyung Min [Dept. of Radiology, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul (Korea, Republic of)

    2011-05-15

    To evaluate the effectiveness of an additional transdermal fentanyl patch compared to intravenous analgesics in pain control during the 24-hour period following uterine artery embolization (UAE) for myoma and adenomyosis. Between September 2009 and August 2010, 42 patients underwent UAE for myoma or adenomyosis. Of these, 21 received an intravenous opioid (pethidine) and a nonsteroidal anti-inflammatory drug (group A), and 21 received an additional transdermal fentanyl patch (group B). Pain perception levels were established verbally on a 0-10 scale during the 24-hour period following UAE. Differences in pain trends, mean dose of intravenous pethidine, and adverse effects were compared between the two groups. Pain perception was most severe at 6 hours after UAE and the mean pain level of group B at that time was 6.3 {+-} 0.7, which was significantly lower than that of group A, 8.2 {+-} 0.7 (p<0.05). The mean dose of intravenous pethidine was 114.3 {+-} 59.5 mg in group A and 90.5 {+-} 49.0 mg in group B, while the incidence of nausea was 67% in group A and 77% in group B. In both cases, the differences were not significantly different (p>0.05), and no evidence of respiratory distress was demonstrated. The addition of a transdermal fentanyl patch to intravenous analgesics is effective in reducing post-embolization pain during the 24-hour period after UAE.

  16. Uterine Fibroid Embolization (UFE)

    Science.gov (United States)

    ... hysterectomy , which is the operation to remove the uterus. top of page What are some common uses of the UAE procedure? Uterine artery embolization has been used for decades to stop severe pelvic bleeding caused by: trauma malignant gynecological tumors hemorrhage after childbirth Uterine fibroid ...

  17. Acute embolic occlusion of the right common iliac artery after revision total hip arthroplasty treated with catheter-directed thrombolysis and balloon angioplasty: A case report

    Directory of Open Access Journals (Sweden)

    Hongqi Yang

    2015-07-01

    Full Text Available Methods: A 63-year-old woman with atrial fibrillation presented clinical symptoms and signs of acute ischemia in the right lower extremity on the 17th postoperative day after revision total hip arthroplasty of the left hip for aseptic loosening of femoral component. Aspirin was discontinued 7 days before surgery. Both computed tomography angiography and digital subtraction angiography demonstrated complete occlusion of the right common iliac artery. An emergency catheter-directed thrombolysis with urokinase combined with balloon angioplasty was performed to obtain complete patency of the right common iliac artery. Results: The patient received anticoagulation and antiplatelet therapy postoperatively and was fine at the 2-year follow-up. Conclusions: This case demonstrated that catheter-directed thrombolysis combined with balloon angioplasty could be an efficacious, minimally invasive approach for the treatment of acute embolic occlusion of the common iliac artery. Preoperative anticoagulation for patients undergoing total hip arthroplasty with long-term use of aspirin for atrial fibrillation needs further investigation.

  18. Aberrant ovarian artery arising from the common Iliac artery: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Won Kyung [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of); Yang, Seung Boo; Lee, Jae Myeong [Dept. of Radiology, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi (Korea, Republic of); Goo, Dong Erk; Kim, Yong Jae; Chang, Yun Woo [Dept. of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul (Korea, Republic of)

    2013-01-15

    A 46-year-old Vietnamese woman received embolization therapy in order to control postpartum hemorrhage. Angiography revealed an aberrant ovarian artery arising from the right common iliac artery. Superselective catheterization and subsequent embolization of the aberrant ovarian artery and bilateral uterine arteries were performed. Precise knowledge of the anatomic variations of the ovarian artery is important for successful embolization.

  19. Pulmonary embolism and pulmonary infarction; Lungenembolie und Lungeninfarkt - pathologische Anatomie

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, K.M.; Mueller, A.M. [Berufsgenossenschaftliche Kliniken Bergmannsheil, Bochum (Germany). Inst. fuer Pathologie]|[Bochum Univ. (Germany). Universitaetsklinikum

    1998-03-01

    Radiological and nuclear medical evaluation of pulmonary embolisms and their consequences is often problematic, since parenchymal alterations in the form of possible pulmonary infarctions occur in only 10-15% after vessel obliteration. Small embolisms rather frequently cause hemorrhagic pulmonary infarctions, which can clinically be demonstrated by radiological and nuclear medical methods, after obliteration of the pre-capillary arterio-arterial anastomoses type I. In pre-existing chronic lung diseases with often markedly developed bronchial artery systems and additional anastomoses hemorrhagic pulmonary infarctions are extremely rare. Thus, today, radiological and nuclear medical studies, such as spiral computer scanning, have to rely largely on the results of thrombembolic vessel obstruction and transitory perfusion deficits and less on parenchymal infiltration patterns. (orig./MG) [Deutsch] Die radiologischen und nuklearmedizinischen Begutachtungen von Lungenembolien und deren Folgen sind oft problematisch, weil Parenchymveraenderungen in Form moeglicher Lungeninfarkte in nur 10-15% nach der Gefaessverlegung entstehen. Kleine Embolien fuehren haeufiger zu haemorrhagischen Lungeninfarkten, die mit radiologischen und nukelarmedizinischen Verfahren fassbar werden. Bei vorbestehenden chronischen Lungenerkrankungen mit meist verstaerkt ausgebautem Bronchialartheriensystem und zusaetzlichen Anatomosen sind haemorrhagische Lungeninfarkte besonders selten. Die radiologische und nuklearmedizinische Diagnostik muss sich daher heute nach vielversprechenden Studien, z.B. unter Einsatz der Spiralcomputertomographie, wesentlich auf die Befunde der thrombembolischen Gefaessobstruktion und transitorische Perfusionsausfaelle und weniger auf parenchymatoese Infiltratmuster stuetzen. (orig./MG)

  20. Adenomatous-Dominant Benign Prostatic Hyperplasia (AdBPH) as a Predictor for Clinical Success Following Prostate Artery Embolization: An Age-Matched Case–Control Study

    Energy Technology Data Exchange (ETDEWEB)

    Little, M. W., E-mail: m.little@doctors.org.uk; Boardman, P.; Macdonald, A. C.; Taylor, N.; Macpherson, R. [Oxford University Hospitals NHS Foundation Trust, Department of Radiology, Churchill Hospital (United Kingdom); Crew, J. [Oxford University Hospitals NHS Foundation Trust, Department of Urology, Churchill Hospital (United Kingdom); Tapping, C. R., E-mail: crtapping@doctors.org.uk [Oxford University Hospitals NHS Foundation Trust, Department of Radiology, Churchill Hospital (United Kingdom)

    2017-05-15

    PurposeTo investigate the clinical impact of performing prostate artery embolization (PAE) on patients with adenomatous-dominant benign prostatic hyperplasia (AdBPH).Materials and MethodsTwelve patients from the ongoing proSTatic aRtery EmbolizAtion for the treatMent of benign prostatic hyperplasia (STREAM) trial were identified as having AdBPH; defined as two or more adenomas within the central gland of ≥1 cm diameter on multi-parametric MRI (MP-MRI). These patients were age-matched with patients from the STREAM cohort, without AdBPH. Patients were followed up with repeat MP-MRI at 3 months and 1 year. International prostate symptom score (IPSS), international index for erectile function (IIEF), and quality of life assessment from the IPSS and EQ-5D-5S questionnaires were recorded pre-PAE and at 6 weeks, 3 months, and 1 year.ResultsThe mean age of patients was 68 (61–76). All patients had PAE as a day-case procedure. The technical success in the cohort was 23/24 (96%). There was a significant reduction in prostate volume following embolization with a median reduction of 34% (30–55) in the AdBPH group, compared to a mean volume reduction of 22% (9–44) in the non-AdBPH group (p = 0.04). There was a significant reduction in IPSS in the AdBPH group following PAE when compared with the control group [AdBPH median IPSS 8 (3–15) vs. non-AdBPH median IPSS 13 (8–18), p = 0.01]. IPSS QOL scores significantly improved in the AdBPH group (p = 0.007). There was no deterioration in sexual function in either group post-PAE.ConclusionsThis is the first time that AdBPH has been identified as being a predictor of clinical success following PAE.

  1. The application of dual-source Flash post-processing software for the evaluation of bronchial artery%双源 Flash 后处理软件在支气管动脉评价中的应用

    Institute of Scientific and Technical Information of China (English)

    康瑞; 王锡明; 程召平; 段艳华; 纪晓鹏; 陈宝锦

    2016-01-01

    目的:探讨双源 Flash 后处理软件(Bone Reading)应用于支气管动脉(BA)CTA 后处理重建中的可行性及时间效率分析。方法由2位放射科医生对70例临床拟诊断为支气管动脉扩张患者的 CTA 影像资料进行评价。首先,利用多平面重组(MPR)、最大密度投影(MIP)及容积再现(VR)技术对支气管动脉的起源、数目、分支类型、走行分布及管腔直径进行评价及测量,记录相关数据及诊断时间;30 d 后再使用后处理软件(Bone Reading)对上述患者的影像资料重新进行评价。结果2位阅片者的诊断一致性无统计学差异,且有良好的相关性;后处理软件(Bone Reading)的使用在诊断时间上有统计学差异,平均减少诊断时间35%。结论后处理软件(Bone Reading)应用于 BA CTA 后处理重建是可行的,可以缩短后处理及诊断所需的时间。%Objective To evaluate feasibility and time efficiency of dual-source flash post-processing software (Bone Reading)for reconstruction of bronchial artery.Methods The imaging data of 70 patients with suspected bronchial artery dilatation who underwent bronchial artery-CTA were evaluated by 2 independent radiologists.First,the related contents of bronchial artery such as origination,number, type,route and lumen diameter were evaluated by multiple planar reconstruction (MPR),maximum intensity projection (MIP)and volume rendering technique (VRT).The results and process time were recorded.After a month,the post-processing software(Bone Reading)was used to evaluate the same contents.Results There was very good correlation between both readers for both reading methods without significant differences.There was significant difference of process time between with regular method and with Bone Reading (P<0.05)for both readers.Process time could be decreased by approximately 35%.Conclusion The application of CT software (Bone Reading)is feasible in the CTA of bronchial artery.This method

  2. Numerical modeling process of embolization arteriovenous malformation

    Science.gov (United States)

    Cherevko, A. A.; Gologush, T. S.; Petrenko, I. A.; Ostapenko, V. V.

    2017-10-01

    Cerebral arteriovenous malformation is a difficult, dangerous, and most frequently encountered vascular failure of development. It consists of vessels of very small diameter, which perform a discharge of blood from the artery to the vein. In this regard it can be adequately modeled using porous medium. Endovascular embolization of arteriovenous malformation is effective treatment of such pathologies. However, the danger of intraoperative rupture during embolization still exists. The purpose is to model this process and build an optimization algorithm for arteriovenous malformation embolization. To study the different embolization variants, the initial-boundary value problems, describing the process of embolization, were solved numerically by using a new modification of CABARET scheme. The essential moments of embolization process were modeled in our numerical experiments. This approach well reproduces the essential features of discontinuous two-phase flows, arising in the embolization problems. It can be used for further study on the process of embolization.

  3. Three-Dimensional Spheroid-Cultured Mesenchymal Stem Cells Devoid of Embolism Attenuate Brain Stroke Injury After Intra-Arterial Injection

    Science.gov (United States)

    Guo, Ling; Ge, Jianfeng; Zhou, Ying; Wang, Shan; Zhao, Robert C.H.

    2014-01-01

    The therapeutic effect of mesenchymal stem cells (MSCs) in tissue repair/regeneration is substantially dampened by the loss of primitive properties and poor engraftment to target organs. In this study, the multipotency and cell sizes of human MSCs, which had been expanded in monolayer culture for several passages, were dramatically restored after an episode of three-dimensional (3D) spheroid culture. Unlike MSCs derived from monolayer, which caused embolism and blindness, MSCs derived from 3D spheroids did not cause vascular obstructions, after intra-carotid artery infusion in rats. Importantly, intra-carotid infusion of 1 million 3D spheroid MSCs in rats 24 h after middle cerebral artery occlusion and reperfusion resulted in engraftment of the cells into the lesion and significant (over 70%) reduction of infarct size along with restoration of neurologic function. Moreover, the enhanced effect of spheroid MSCs was coincided with significantly increased differentiation of the MSCs into neurons and markedly increased number of endogenous glial fibrillary acidic protein–positive neural progenitors in the peri-infarct boundary zone. However, the similarly administered monolayer MSCs resulted in a modest functional improvement. Our results suggest that 3D MSCs, in combination with intra-carotid delivery, may represent a novel therapeutic approach of MSCs for stroke. PMID:24341685

  4. Intrahepatic arterioportal fistulae: role of transcatheter embolization.

    Science.gov (United States)

    Tarazov, P G

    1993-01-01

    Management of 26 arterioportal fistulae (APFs) is reported. Among 13 hepatoma-induced fistulae (group A), conservative treatment was ineffective in 8 patients, and arterial embolization alleviated portal hypertension in the other 5. Of 10 iatrogenic APFs (group B), the 3 largest were successfully embolized, the remaining lesions resolved spontaneously. Three spontaneous nonmalignant APFs (group C) were embolized. Excellent results were obtained in 2 patients, and the other died of severe postembolization hepatic failure. Because long-standing APFs may cause severe portal hypertension with consequent variceal bleeding they should be treated. Arterial embolization is indicated in most patients.

  5. [Stenting of subtotal conclusion of internal carotid artery and comparing the cerebral embolic load of proximal balloon protection device with distal filter protection device].

    Science.gov (United States)

    Yang, Qing-wei; Ji, Xun-ming; Li, Shen-mao; Zhu, Feng-shui; Chen, Yan-fei; Ye, Ming; Jiao, Li-qun

    2013-07-16

    To study the safety, efficacy and perioperative complications of endovascular therapy in the treatment of subtotal conclusion of internal carotid artery(ICA) in patients. To compare the cerebral embolic load of proximal balloon protection device versus distal filter protection device during the operation. Review all the operations of stenting for subtotal conclusion of ICA in Xuanwu hospital. New cerebral infarction after stenting was assessed by diffusion-weighted magnetic resonance imaging. Count the number of new ischemic lesions of every patient. 35 patients with subtotal conclusion of ICA received endovascular stenting. Proximal protective device was used for 21 patients. Distal protective device was used for 14 patients. All procedures succeeded. 32 patients received the cerebral MRI 1 week before and within 48 hours after the operation. Compared with filter protection(n = 14), proximal balloon device(n = 18) resulted in a significant reduction in the incidence of new cerebral infarction (6/18 vs 10/14, P = 0.03). The number of new cerebral ischemic lesions were significant reduced by proximal balloon device (1/18 vs 4/14, P = 0.0006) . There were no serious cardiovascular events in 35 patients during the operation and the following up 3 months. 3 patients had restenosis which was demonstrated by ultrasound of ICA at 3 months after stenting. Endovascular stenting may be a safe and valid method for the treatment of subtotal occlusion of ICA. For the stenting of subtotal occlusion of ICA, proximal balloon protection device as compared with filter protection may reduce the embolic load to the brain more effectively. The stenting of subtotal occlusion of ICA still needs the randomized trails to confirm the safety and validity.

  6. Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Apfaltrer, P., E-mail: paul.apfaltrer@medma.uni-heidelberg.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Henzler, T.; Meyer, M. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Roeger, S.; Haghi, D.; Gruettner, J.; Süselbeck, T. [Department of Internal Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Wilson, R.B.; Schoepf, U.J. [Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, MSC 226, Charleston, SC 29401 (United States); Schoenberg, S.O.; Fink, C. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany)

    2012-10-15

    Objective: To correlate CTA pulmonary artery obstruction scores (OS) with right ventricular dysfunction (RVD) and clinical outcome in patients with acute pulmonary embolism (PE). Materials and methods: In a prospective study of 50 patients (66 ± 12.9 years) with PE pulmonary artery OS (Qanadli, Mastora, and Mastora central) were assessed by two radiologists. To assess RVD all patients underwent echocardiography within 24 h. Furthermore, RVD on CT was assessed by calculating the right ventricular/left ventricular (RV/LV) diameter ratios on transverse (RV/LVtrans) and four-chamber views (RV/LV4ch) as well as the RV/LV volume ratio (RV/LVvol). OS were correlated with RVD and the occurrence of adverse clinical outcomes (defined as death, need for intensive care treatment, or cardiac insufficiency ≥NYHA III). Results: Mean Mastora, Qanadli, and Mastora central OS were 26.4 ± 17.7, 12.6 ± 9.9 and 7.5 ± 9, respectively. Echocardiography demonstrated moderate and severe RVD in 10 and 5 patients, respectively. Patients with moderate and severe RVD showed significantly higher Mastora central scores than patients without RVD (14 ± 10.8 vs. 5.9 ± 7.8 [p = 0.05]; 17.6 ± 13.2 vs. 5.9 ± 7.8 [p = 0.038]). A relevant correlation (i.e. r ≥ 0.6) between OS and CT parameters for RVD were only found for the Mastora score and the Mastora central score (RV/LV4ch: r = 0.61 and 0.68, RV/LVvol: r = 0.61 and 0.6). 18 patients experienced an adverse clinical outcome. None of the OS differed significantly between patients with and without adverse clinical outcome. Conclusion: Pulmonary artery obstruction scores can differentiate between patients with and without RVD. However, in this study, obstruction scores were not correlated to adverse clinical outcome.

  7. Use of three-dimensional power Doppler sonography in the diagnosis of uterine arteriovenous malformation and follow-up after uterine artery embolization: Case report and brief review of literature.

    Science.gov (United States)

    Tullius, Thomas G; Ross, Jason Robert; Flores, Melanie; Ghaleb, Melhem; Kupesic Plavsic, Sanja

    2015-06-01

    Arteriovenous malformations (AVM) of the uterus can cause life-threatening hemorrhage. Unexplained, heavy vaginal bleeding in a reproductive age woman should raise suspicion for an AVM. Here a 37-year-old woman had increasingly severe vaginal bleeding for 15 days. Serum β-hCG was elevated. Two-dimensional transvaginal ultrasound suggested retained products of conception. Before dilation and curettage (D&C), color Doppler and three-dimensional (3D) power Doppler demonstrated findings indicative of uterine AVM. A bilateral uterine artery embolization was performed without complications. Three months after uterine artery embolization, 3D power Doppler ultrasonography found complete resolution of the AVM. This case illustrates the importance of assessing both gray-scale and 3D power Doppler, and the ability of postprocedure Doppler to assess resolution. © 2014 Wiley Periodicals, Inc.

  8. Face skin necrosis following embolization for arteriovenous malformations: a case report.

    Science.gov (United States)

    Tarkan, Ozgür; Sürmelioğlu, Ozgür; Tuncer, Ulkü; Akgül, Erol

    2010-03-01

    Arteriovenous malformations (AVMs) are rare in the oral and maxillofacial regions. AVMs may induce severe complications such as uncontrollable bleeding. Superselective intra-arterial embolization is an effective method for this bleeding that is refractory to conservative treatment. Arterial embolization may cause ischemic complications. We report the case of a patient who developed face skin necrosis following bilateral facial artery embolization.

  9. Fat Embolism

    Directory of Open Access Journals (Sweden)

    V. N. Yakovlev

    2013-01-01

    Full Text Available The incidence of fat embolism ranges from 0.5 to 30% in injuries with long and pelvic bone fractures; it also occurs in other diseases and conditions. Moreover, mortality accounts for 3 to 67%. There is still no clear idea on the pathogenesis, prevention, and treatment of fat embolism. This review gives current views on this problem. Key words: fat embolism, poly-trauma.

  10. Cardiovascular parameters to assess the severity of acute pulmonary embolism with computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Dian-Jiang Zhao; Da-Qing Ma; Wen He; Jian-Jun Wang; Yan Xu; Chun-Shuang Guan (Dept. of Radiology, Beijing Friendship Hospital, Capital Medical Univ., Beijing (China)), e-mail: madaqing@263.net

    2010-05-15

    Background: Computed tomographic pulmonary angiography (CTPA) has been established as a first-line test in the acute pulmonary embolism (APE) diagnostic algorithm, but the assessment of the severity of APE by this method remains to be explored. Purpose: To retrospectively evaluate right ventricular (RV) dysfunction and severity in patients with APE without underlying cardiopulmonary disease using helical computed tomography (CT). Material and Methods: Seventy-three patients (35 men and 38 women) were divided into two groups according to the clinical findings: severe APE (n=22) and non-severe APE (n=51). Pulmonary artery CT obstruction index was calculated according to the location and degree of clots in the pulmonary arteries. Cardiovascular parameters including RV short axis and left ventricular (LV) short axis, RV short axis to LV short axis (RV/LV) ratio, main pulmonary artery, azygous vein, and superior vena cava diameters were measured. Leftward bowing of the interventricular septum, reflux of contrast medium into the inferior vena cava and azygous vein, and bronchial artery dilatation were also recorded. The results were analyzed by Mann-Whitney U test, x2 test, Spearman's rank correlation coefficient, and the area under the receiver operating characteristic curve (Az). Results: CT obstruction index in patients with severe APE (median 43%) was higher than that of patients with non-severe APE (median 20%). Comparison of cardiovascular parameters between patients with severe and non-severe pulmonary embolism showed significant differences in RV short axis, LV short axis, RV/LV ratio, RV wall thickness, main pulmonary artery diameter, azygous vein diameter, leftward bowing of the interventricular septum, and bronchial artery dilatation. The correlation between CT obstruction indexes and cardiovascular parameters was significant. Spearman's rank correlation coefficient was highest between RV/LV ratio and CT obstruction index. Az values were

  11. Long-term results of symptomatic fibroids treated with uterine artery embolization: In conjunction with MR evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Man Deuk [Department of Diagnostic Radiology Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of)], E-mail: mdkim@cha.ac.kr; Lee, Hyun Seok [Department of Diagnostic Radiology Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of); Lee, Mee Hwa [Department of Obstetrics and Gynecology, Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of); Kim, Hee Jin [Department of Diagnostic Radiology Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of); Cho, Jin Ho; Cha, Sun Hee [Department of Obstetrics and Gynecology, Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of)

    2010-02-15

    Objective: The aim of the present study is to determine long-term clinical efficacy of uterine fibroid embolization (UFE) for symptomatic fibroids in conjunction with MR evaluation. Materials and methods: Sixteen patients with a follow-up period of 4 years or longer were analyzed retrospectively. Ages ranged from 27 to 45 (mean 39.5) years. Mean follow-up periods were 5.8 years (range: 4.1-6.9 years). The symptom changes, in terms of menorrhagia and dysmenorrhea and bulk-related symptoms, were assessed. The primary embolic agent was polyvinyl alcohol particle (250-710 {mu}m). All patients underwent preprocedural and long-term follow up MR imaging. Uterine volumes were calculated using MRI. Results: Symptom improvements were reported for menorrhagia (8/9, 88.9%), dysmenorrhea (5/5, 100%), and bulk-related symptoms (7/9, 77.8%) at long-term follow up. Two patients (12.5%) had symptom recurrences at long-term follow-up. Tumor regrowth from incomplete infarction was a cause of recurrence in one patient and newly developed leiomyomas in the other one. One patient underwent hysterectomy because endometriosis developed 4 years after UFE. Of the 14 necrotic myomas on short-term follow up MR after UFE, eight (57.1%) demonstrated maintaining necrosis with further shrinkage and six (42.9%) were no longer visualized on long-term follow up MR images. Overall, the mean volume reduction rates of the predominant fibroid and uterus were 80.5%, 36.7% at long-term follow up, respectively. Conclusion: UFE is an effective treatment for symptomatic fibroids with an acceptable long-term success rate. Long-term MR imaging after UFE revealed persistent necrotic fibroid, non-visualization of fibroids and tumor regrowth when incompletely infarcted.

  12. Outcomes in Adenomyosis Treated with Uterine Artery Embolization Are Associated with Lesion Vascularity: A Long-Term Follow-Up Study of 252 Cases.

    Directory of Open Access Journals (Sweden)

    Jing Zhou

    Full Text Available To study the therapeutic effects of uterine artery embolization (UAE on adenomyosis and to investigate the association between uterine blood supply and artery embolization treatment outcomes.Using digital subtraction angiography (DSA imaging data, we retrospectively evaluated the vascular features of 252 adenomyosis patients treated with UAE. The cases were classified based on the equality of uterine blood supply (equal and unequal subgroups and the degree of vascularity at the adenomyosis lesion site (hypervascular, isovascular and hypovascular subgroups. Patients were followed-up for 5 years after UAE. Improvements in dysmenorrhea and menorrhagia were evaluated based on the relief of the patients' symptoms. The improvement rates among the different subgroups were analyzed and compared.The improvement rates of dysmenorrhea and menorrhagia were 74.0% and 70.9%, respectively, at the short-term (12-month follow-up and 70.4% and 68.8%, respectively, at the long-term (5-year follow-up. No statistically significant differences were observed in the improvement rates for dysmenorrhea or menorrhagia between the equal and unequal blood supply subgroups at either the short- or long-term follow-up. The improvement rates for dysmenorrhea among the hypervascular, isovascular and hypovascular subgroups were 86.5%, 71.8% and 58.8%, respectively, at the short-term follow-up (p = 0.002 and 83.6%, 67.3% and 52.8%, respectively, at the long-term follow-up (p = 0.005. The improvement rates for menorrhagia in the hypervascular, isovascular and hypovascular subgroups were 81.0%, 68.3% and 60.7%, respectively, at the short-term follow-up (p = 0.024 and 79.4%, 61.4% and 62.2%, respectively, at the long-term follow-up (p = 0.052.UAE is effective in treating patients with adenomyosis in both the short and long term. The outcomes of patients with adenomyosis were significantly correlated with lesion vascularity.

  13. Embolization of the first diagonal branch of the left anterior descending coronary artery as a porcine model of chronic trans-mural myocardial infarction.

    Science.gov (United States)

    Hanes, Derek W; Wong, Maelene L; Jenny Chang, C W; Humphrey, Sterling; Grayson, J Kevin; Boyd, Walter D; Griffiths, Leigh G

    2015-06-06

    Although the incidence of acute death related to coronary artery disease has decreased with the advent of new interventional therapies, myocardial infarction remains one of the leading causes of death in the US. Current animal models developed to replicate this phenomenon have been associated with unacceptably high morbidity and mortality. A new model utilizing the first diagonal branch of the left anterior descending artery (D1-LAD) was developed to provide a clinically relevant lesion, while attempting to minimize the incidence of adverse complications associated with infarct creation. Eight Yucatan miniature pigs underwent percutaneous embolization of the D1-LAD via injection of 90 µm polystyrene micro-spheres. Cardiac structure and function were monitored at baseline, immediately post-operatively, and at 8-weeks post-infarct using transthoracic echocardiography. Post-mortem histopathology and biochemical analyses were performed to evaluate for changes in myocardial structure and extracellular matrix (ECM) composition respectively. Echocardiographic data were evaluated using a repeated measures analysis of variance followed by Tukey's HSD post hoc test. Biochemical analyses of infarcted to non-infarcted myocardium were compared using analysis of variance. All eight pigs successfully underwent echocardiography prior to catheterization. Overall procedural survival rate was 83% (5/6) with one pig excluded due to failure of infarction and another due to deviation from protocol. Ejection fraction significantly decreased from 69.7 ± 7.8% prior to infarction to 50.6 ± 14.7% immediately post-infarction, and progressed to 48.7 ± 8.9% after 8-weeks (p = 0.011). Left ventricular diameter in systole significantly increased from 22.6 ± 3.8 mm pre-operatively to 30.9 ± 5.0 mm at 8 weeks (p = 0.016). Histopathology showed the presence of disorganized fibrosis on hematoxylin and eosin and Picro Sirius red stains. Collagen I and sulfated glycosaminoglycan content were

  14. Denosumab: non-surgical treatment option for selective arterial embolization resistant aneurysmal bone cyst of the spine and sacrum. Case report.

    Science.gov (United States)

    Ghermandi, R; Terzi, S; Gasbarrini, A; Boriani, S

    2016-09-01

    Aneurysmal Bone Cyst (ABC) is a cystic lesion of bone, occurring in 70% of cases as a primary lesion. Even if the metaphyseal region of long bones is more frequently involved, vertebral localization is not rare: ABC represents 15% of all primary spine and sacral tumours. Selective arterial embolization (SAE) represents the first treatment option for vertebral ABC. However, in few cases, multiple SAEs are not possible. The aim of this work is to report two cases of vertebral ABC unresponsive to SAE positively treated with Denosumab. Two patients affected by ABC of the lumbar spine were treated by SAE without any response. Thus, the patients were submitted to an off-label treatment with Denosumab, following the same protocol already used in case of Giant Cell Tumour (GCT): 120 mg once a week for 4 weeks consecutively, then once every 40 days. In both cases, patients resulted to be pain-free after 11-13 Denosumab administrations and CT scan showed almost complete ossification of the lesions. The two cases reported here are not conclusive but they may support the project of a prospective study to confirm the effectiveness of Denosumab in ABC treatment as an alternative to SAE.

  15. Cost Analysis of Prostate Artery Embolization (PAE) and Transurethral Resection of the Prostate (TURP) in the Treatment of Benign Prostatic Hyperplasia.

    Science.gov (United States)

    Bagla, Sandeep; Smirniotopoulos, John; Orlando, Julie; Piechowiak, Rachel

    2017-11-01

    Prostatic arterial embolization (PAE) has emerged as a minimally invasive alternative to TURP; however, there are limited cost comparisons reported. The purpose of this study was to compare in-hospital direct costs of elective PAE and TURP in a hospital setting. Institutional Review Board-approved retrospective review was performed on patients undergoing PAE and TURP from January to December 2014. Inclusion criteria included male patients greater than 40 years of age who presented for ambulatory TURP or PAE with no history of prior surgical intervention for BPH. Direct costs were categorized into the following categories: nursing and operating room or interventional room staffing, operating room or interventional supply costs, anesthesia supplies, anesthesia staffing, hospital room cost, radiology, and laboratory costs. Additionally, length of stay was evaluated for both groups. The mean patient age for the TURP (n = 86) and PAE (n = 70) cohorts was 71.3 and 64.4 years, respectively (p supplies for PAE were significantly more costly than TURP ($1472.77 vs $1080.84, p supplies and nursing/staffing, costs were significantly more expensive for TURP than PAE ($2153.64 vs $1667.10 p costs for the TURP group ($5338.31, SD $3521.17) were significantly higher than for PAE ($1678.14, SD $442.0, p costs and shorter hospital stay.

  16. Temporal assessment of splenic function in patients who have undergone percutaneous image-guided splenic artery embolization in the setting of trauma.

    Science.gov (United States)

    Pirasteh, Ali; Snyder, Laura L; Lin, Roger; Rosenblum, David; Reed, Steven; Sattar, Abdus; Passalacqua, Matthew; Prologo, J David

    2012-01-01

    The role of transcatheter splenic arterial embolization (SAE) in the nonoperative management of splenic injury is evolving. The purpose of this study is to evaluate patients who have undergone SAE for laboratory markers of hyposplenism in the years after their procedure. Thirty-four subjects who had undergone SAE as part of nonoperative management of splenic trauma during a period of 10 years were included. A blood sample was collected from each patient for complete blood count and smear analysis for peripheral markers of hyposplenism (as indicated by Howell-Jolly bodies [HJBs]). Sample size and power analysis was performed, and likelihoods for various true prevalences were calculated. The average time interval from procedure to follow-up was 4.4 years. No participants had peripheral markers of hyposplenism or abnormalities in cell count on follow-up. Phagocytic function of the spleen in patients who have undergone SAE is preserved, as evidenced by the absence of HJBs on follow-up peripheral blood smears. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

  17. Paradoxical cerebral air embolism; Embolismo gaseosos paradojico cerebral

    Energy Technology Data Exchange (ETDEWEB)

    Lopez-Negrete, L.; Garcia-Lozano, J.; Sanchez, J. L.; Sala, J. [Hospital Valle del Nalon. Riano.Langreo (Spain)

    2000-07-01

    We present a fatal case of intracranial air embolism produced by the passage of intravenous air to the arteries owing to the existence of a patent foremen ovale associated with pulmonary hypertension, which permitted a right-left shunt (paradoxical embolism). The pathophysiological mechanisms of pneumcephalus and paradoxical embolism are discussed and the pertinent literature is reviewed. (Author) 6 refs.

  18. Onyx embolization of dural arteriovenous fistulas of the cavernous sinus through the superior pharyngeal branch of the ascending pharyngeal artery

    OpenAIRE

    Pero, Guglielmo; Quilici, Luca; Piano, Mariangela; Valvassori, Luca; Boccardi, Edoardo

    2014-01-01

    We report three cases of dural arteriovenous fistula (DAVF) of the cavernous sinus treated by Onyx injection through the superior pharyngeal branch of the ascending pharyngeal artery. The treatment of choice of DAVFs of the cavernous sinus is endovascular, and it is preferentially done via transvenous occlusion of the cavernous sinus. The cavernous sinus can be reached through either the inferior petrosal sinus or the superior ophthalmic vein. When these venous routes are occluded, the first ...

  19. Anomalous Posterior Intercostal Arterial Trunk Arising From the Abdominal Aorta

    Energy Technology Data Exchange (ETDEWEB)

    Jie, Bing, E-mail: jbshh@163.com; Yu, Dong, E-mail: yudong-mail@126.com; Jiang, Sen, E-mail: jasfly77@vip.163.com [Tongji University School of Medicine, Department of Radiology, Shanghai Pulmonary Hospital (China)

    2016-04-15

    A common trunk of the ipsilateral posterior intercostal artery (PIA) arising from the thoracic aorta is usually an anatomical variation. However, a common trunk of bilateral posterior intercostal arterial trunk (PIAT) arising from the abdominal aorta is rare. It is important to recognize this anatomical variation of PIA when performing interventional radiological procedures. We present a rare case of an anomalous PIAT that originated from the abdominal aorta in a patient with hemoptysis caused by tuberculosis sequelae. Bilateral 4th to 11th PIAs arose from a common trunk and the trunk arising from the posterior aspect of the abdominal aorta at the level of T12/L1 intervertebral space. The pathological right 4th and 5th PIAs and bronchial arteries were embolized. Hemoptysis has been controlled for 3 months.

  20. Endovascular uterine artery interventions

    Directory of Open Access Journals (Sweden)

    Chandan J Das

    2017-01-01

    Full Text Available Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs, as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH, placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes.

  1. Endovascular uterine artery interventions

    Science.gov (United States)

    Das, Chandan J; Rathinam, Deepak; Manchanda, Smita; Srivastava, D N

    2017-01-01

    Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs), as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE) may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH), placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes. PMID:29379246

  2. Entropy of T2-weighted imaging combined with apparent diffusion coefficient in prediction of uterine leiomyoma volume response after uterine artery embolization.

    Science.gov (United States)

    Cao, Meng-Qiu; Suo, Shi-Teng; Zhang, Xue-Bin; Zhong, Yi-Cun; Zhuang, Zhi-Guo; Cheng, Jie-Jun; Chi, Jia-Chang; Xu, Jian-Rong

    2014-04-01

    To determine the potential value of entropy of T2-weighted imaging combined with apparent diffusion coefficient (ADC) before uterine artery embolization (UAE) for prediction of uterine leiomyoma volume reduction (VR) after UAE. In this prospective study, 11 patients with uterine leiomyomas who underwent pelvic magnetic resonance imaging including diffusion-weighted imaging before and 6 months after UAE were included. A total number of 16 leiomyomas larger than 2 cm in diameter were evaluated. The volume of each leiomyoma before and after UAE was determined, and the percentage change in volume was calculated. Entropy of T2-weighted imaging and ADC before UAE were assessed. Pearson correction coefficients were calculated between leiomyoma VR after UAE and age, leiomyoma volume, ADC, and entropy, respectively. Multiple regression analysis was performed to investigate the parameters that determine the VR after UAE. Receiver operating characteristic curve analysis was used to determine the sensitivity and specificity of ADC, entropy and the combination of ADC and entropy for predicting volume response. The mean leiomyoma VR was 58.9% (range 25.8%-95.0%) in the 6-month follow-up. The mean ADC of leiomyomas was 1.37 × 10(-3) mm(2)/s (range 1.05 × 10(-3)-2.32 × 10(-3) mm(2)/s) and the mean entropy of T2-weighted imaging was 5.36 (range 4.62-5.91) before UAE. ADC and entropy were significantly correlated with leiomyoma VR, respectively (r = 0.61, P = .012; r = 0.73, P = .001). On multiple regression analysis, a combination of ADC and entropy constituted the best model for determining leiomyoma VR using Akaike information criterion. For predicting ≥50% VR, the optimal cutoff value of ADC was 1.39 × 10(-3) mm(2)/s (sensitivity 45.5%, specificity 80.0%) and the optimal cutoff value of entropy was 5.15 (sensitivity 90.9%, specificity 60.0%). The combination of ADC and entropy (area under the curve [AUC] 0.86) provided better classification accuracy than ADC or entropy

  3. The use of 3D rendering, VCI-C, 3D power Doppler and B-flow in the evaluation of interstitial pregnancy with arteriovenous malformation treated by selective uterine artery embolization.

    Science.gov (United States)

    Valsky, D V; Hamani, Y; Verstandig, A; Yagel, S

    2007-03-01

    Cornual pregnancy is a rare form of ectopic pregnancy. We describe a case of cornual pregnancy suspected by two-dimensional ultrasonography (2DUS) and confirmed by three-dimensional volume contrast imaging in the C-plane. Three-dimensional power Doppler showed a particularly rich blood supply and two-dimensional color Doppler mapping demonstrated arteriovenous malformation (AVM). The feeding vessel originating from the right uterine artery and AVM were demonstrated with B-flow spatio-temporal image correlation (STIC) modality. Conservative management was chosen to preserve the uterus. Angiography confirmed the diagnosis of AVM; embolization with polyvinyl alcohol particles and embolization coils was performed through the right uterine artery until occlusion of the AVM and feeding vessels had occurred. Postprocedure color Doppler mapping and B-flow STIC modalities demonstrated absence of flow in the AVM. Serum human chorionic gonadotropin (hCG) levels gradually fell to non-pregnant levels during the ensuing 5 weeks. To the best of our knowledge this is the first report of cornual pregnancy with AVM. We demonstrate here the value of new three-dimensional ultrasound modalities in the diagnosis of cornual pregnancy and the use of embolization as an effective therapeutic option when conservative treatment with uterine preservation is desired.

  4. Endovascular treatment of hemoptysis: influence of the type of pathology on the post embolization prognosis; Tratamiento endovascular de la hemoptisis: influencia del tipo de patologia en el pronostico postembolizacion

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, J.; Fernandez, M.; Fernandez, A.; Duran, D.; Dominguez, L.; Boullosa, E. [Hospital Xeral de Vigo (Spain)

    2000-07-01

    To describe the course of patients with hemoptysis following embolization of the arteries involved, assessing the incidence of re bleeding in patients grouped according to type of pathology. Over the past five years, we have carried out 77 embolization in bronchial and other systemic arteries in 64 patients (46 men and 18 women) ranging in age from 18 to 83 years (mean: 54{+-}15 years). The underlying diseases were active tuberculosis (n=11), latent tuberculosis (n=15), bronchiectasis (n=14), aspergilloma (n=3), pulmonary neoplasm (n=10), lung abscess (n=10) and miscellaneous conditions (n=10). Rebleeding occurred in 25 patients (32%). Of these, 13 had to undergo repeat embolization, 7 were treated surgically and 3 died during the recurrence of hemoptysis. In two cases, no diseased arteries could be found and embolization was not performed. The overall hemostatic efficacy was 86% after 7 days, 78% after one month and 61% after one year. In the patients with tuberculosis, the rates were 96% at one week and 91% at one month and one year, while among the remaining groups (with neoplasm, abscess, etc.), the incidences were 80% at day 7,70% at one month and 42% at one year. According to our experience, rebleeding occurs most frequently among patients with diseases other than tuberculosis. In these cases, follow-up should be closer and other therapeutic alternatives (surgery, radiotherapy, endobronchial laser) should be considered as a complement to percutaneous endovascular treatment. (Author) 22 refs.

  5. [Pulmonary embolism].

    Science.gov (United States)

    Hecker, M; Sommer, N; Hecker, A; Bandorski, D; Weigand, M A; Krombach, G A; Mayer, E; Walmrath, D

    2017-03-01

    Pulmonary embolism is a potentially fatal disorder and frequently seen in critical care and emergency medicine. Due to a high mortality rate within the first few hours, the accurate initiation of rational diagnostic pathways in patients with suspected pulmonary embolism and timely consecutive treatment is essential. In this review, the current European guidelines on the diagnosis and therapy of acute pulmonary embolism are presented. Special focus is put on a structured patient management based on the individual risk of early mortality. In particular risk assessment and new risk-adjusted treatment recommendations are presented and discussed in this article.

  6. COMBINATION OF AMPLATZER VASCULAR PLUG 4 IN OCCLUSION OF THE LEFT VERTEBRAL ARTERY, WITH MICROSPHERES PLUS COILS FOR EMBOLIZATION OF THE DEEP CERVICAL BRANCHES FOR PRESURGICAL TREATMENT OF A HYPERVASCULAR C-5 METASTASIS: CASE REPORT AND REVIEW OF THE LITERATURE

    Directory of Open Access Journals (Sweden)

    Antonio Basile

    2017-05-01

    Full Text Available Clinical use of Amplatzer Vascular Plug in central and peripheral vascular system has been extensively described in the literature. We present a case of occlusion of left vertebral artery (LVA performed by deploying an Amplatzer Vascular Plug, in addition to microspheres plus coils for embolization of the deep cervical branches that feed a cervical metastasis involving the left VA. After the endovascular intervention, the patient underwent surgical resection of the lesion. The application of the device, the use of multiple embolic materials, as well as the angiographic and clinical results of the procedure, were evaluated because not previously reported in the literature. Hence, we provide an updated literature review about clinical use of Amplatzer Vascular Plug in supra-aortic vessels.

  7. Varicocele Embolization

    Science.gov (United States)

    ... and devices that monitor your heart beat and blood pressure. top of page How is the procedure performed? Image-guided, minimally invasive procedures such as varicocele embolization are most often ...

  8. A delayed diagnosis that altered the professional orientation of an athlete with upper limb chronic arterial embolization.

    Science.gov (United States)

    Ioannou, Christos V; Kafetzakis, Alexandros; Kounnos, Christos; Koukoumtzis, Dimitris; Tavlas, Emmanuel; Kostas, Theodoros

    2012-01-01

    Vascular disorders of the upper extremity in young and physically active patients present a comple