Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma.

OBJECTIVE: The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance. Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); the second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12. Analgesic medication use was translated into a morphine-equivalent dose. RESULTS: The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1. CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed. CONCLUSION: RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.

Emergency percutaneous treatment in surgical bile duct injury.

The aim of this study is to evaluate the efficacy of emergency percutaneous treatment in patients with surgical bile duct injury (SBDI). From May 2004 to May 2007, 11 patients (five men, six women; age range 26-80 years; mean age 58 years) with a critical clinical picture (severe jaundice, bile peritonitis, septic state) due to SBDI secondary to surgical or laparoscopic procedures were treated by percutaneous procedures. We performed four ultrasound-guided percutaneous drainages, four external-internal biliary drainages, one bilioplasty, and two plastic biliary stenting after 2 weeks of external-internal biliary drainage placement. All procedures had 100% technical success with no complications. The clinical emergencies resolved in 3-4 days in 100% of cases. All patients had a benign clinical course, and reoperation was avoided in 100% of cases. Interventional radiological procedures are effective in the emergency management of SBDI since they are minimally invasive and have a high success rate and a low incidence of complications compared to the more complex and dangerous surgical or laparoscopic options.

Emergency percutaneous treatment in iatrogenic hepatic arterial injuries.

The purpose of this report is to present our experience in the emergency percutaneous treatment of patients with iatrogenic hepatic arterial injury (IHAI). Seven patients (six men, one woman; age range 19-78 years; mean age 63 years) with IHAI secondary to surgical or percutaneous procedures were treated with endovascular percutaneous procedures. We performed six transhepatic arterial embolization (TAE) and one placement of an endograft stent. Follow-up was carried out by ultrasound (US) or computed tomography (CT) after 1, 3, 6, and 12 months, yearly thereafter and by laboratory tests in the first 6 months to completely exclude occult and asymptomatic bleeding. All procedures had 100% technical success. No case of further bleeding was seen at follow-up. In one patient, we detected one abscess after 3 weeks, which was treated by antibiotic therapy. In conclusion, endovascular treatment currently represents a valid option in emergency settings, as it the enables diagnosis and treatment of IHAI in a single session.

Emergency endovascular treatment with stent graft of a gastric artery aneurysms (GAA).

The purpose of this paper is to present a case of emergency endovascular treatment of a symptomatic gastric artery aneurysm (GAA) with stent graft. A symptomatic aneurysm of a "gastro-hepatic" trunk in a 63-year-old patient was excluded with stent graft. Treatment was successful and without complications. Follow-up computed tomography-angiography confirmed the exclusion of the aneurysm after 6 months. Endovascular therapy with stent graft can be considered a feasible and effective approach for the treatment of GAAs in patients with suitable anatomy.

Endovascular ligature of splenic artery aneurysm with Amplatzer Vascular Plug: a case report.

Splenic artery aneurysm (SAA) is a rare disease that is asymptomatic for a long time and is often only incidentally discovered during imaging performed for other reasons. The natural history of SAA is a progressive increase in size until rupture. Therefore, treatment is recommended in symptomatic patients and for aneurysms larger than 2 cm in diameter. Using different techniques, endovascular treatment is feasible in nearly all SAAs. In this report, we describe a technique using Amplatzer Vascular Plug in endovascular ligature to exclude an SAA of the middle tract of the splenic artery.

Endovascular treatment of splenic artery aneurysms.

PURPOSE: To assess the feasibility and effectiveness of endovascular treatment of splenic artery aneurysms (SAAs). MATERIALS AND METHODS: Between May 2000 and June 2003 we treated 11 true SAAs in 9 patients (7 females and 2 males; mean age 58 years), 8 saccular and 3 fusiform, 4 located at the middle tract of the splenic artery, 5 at the distal tract and 2 intra-parenchymal. The diagnosis was performed with colour-Doppler ultrasound and/or CT-angiography; 7 patients were symptomless, 1 had left hypochondriac pain, and 1 had acute abdomen caused by a ruptured SAA. Four SAAs were treated by microcoil embolization of the aneurysmal sac with preservation of splenic artery patency; in 2 cases this was associated with transcatheter injection of N-butyl-2-cyanoacrylate. Four cases were treated by endovascular ligature, with sectoral spleen ischaemia. One ruptured SAA received emergency treatment with splenic artery cyanoacrylate embolization. Two intra-parenchymal SAAs were excluded, one by cyanoacrylate embolization of the afferent artery and the other by transcatheter thrombin injection in the aneurysmal sac. RESULTS: Technical success was observed in all cases (in 10/11 at the end of the procedure; in 1/11 at CT performed 3 days after the procedure). The follow-up (mean 18 months; range 6-36) was performed by colour-Doppler ultrasound and/or CT-angiography 3, 6 and 12 months after the procedure and subsequently once a year; the complete exclusion of the aneurysms was confirmed in 11/11 cases. The complications were: 4 cases of mild left pleuritis; fever and left hypochondriac pain 1 day after the procedure (in the same 4 patients and in one other case); 5 cases of sectoral spleen ischaemia and 1 case of diffuse spleen infarction with partial revascularization by collateral vessels. No alteration of the levels of pancreatic enzymes was found; a transitory increase in platelet count occurred only in the patient with diffuse spleen infarction. CONCLUSIONS: Using different techniques, endovascular treatment is feasible in nearly all SAAs. It ensures good immediate and long term results, and no doubt presents some advantages in comparison to surgical treatment, as it is less invasive and allows the preservation of splenic function.