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1.
CVIR Endovasc ; 7(1): 46, 2024 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-38744805

RESUMEN

Prostatic artery embolization (PAE) has proven to be an efficacious treatment for urinary symptoms of benign prostatic hyperplasia. PAE is performed in a complex and challenging anatomical field which may pose difficulties from procedural standpoint. Cone beam computed tomography (CBCT) has been proposed as an invaluable tool during the PAE procedure. A review of different techniques and advancements, as well as demonstration of CBCT benefits via a pictorial overview of the salient examples is lacking. The techniques of CBCT are discussed herein and the virtual injection technology as an advancement in CBCT is discussed. To show the merits of CBCT in PAE, a pictorial overview of various clinical scenarios is presented where CBCT can be crucial in decision making. These scenarios are aimed at showing different benefits including identification of the origin of the prostatic artery and avoiding non-target embolization. Other benefits may include ensuring complete embolization of entire prostate gland as angiographic appearance alone can be inconclusive if it mimics a severely thickened bladder wall or ensuring adequate embolization of the median lobe to provide relief from "ball-valve" effect. Further examples include verification of embolization of the entire prostate when rare variants or multiple (> 2) arterial feeders are present.

6.
Semin Intervent Radiol ; 39(6): 547-554, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36561799

RESUMEN

Prostatic artery embolization (PAE) is a safe and effective treatment for benign prostatic hyperplasia. Patient evaluation is a critical and important part of this growing practice. History taking should include symptoms score evaluations for lower urinary tract symptoms, erectile function, and prostatitis symptoms score. The objective evaluations commonly include measurement of prostate specific antigen, postvoid residual volume, and uroflowmetry as well as urodynamic studies in selective patients. Imaging evaluation may include computed tomography angiography or magnetic resonance angiography, elucidating prostate volume, prostate gland morphology, vasculature, and prostate cancer. With evolving knowledge on PAE, we aim to discuss patient evaluation and selection based on updated evidence and discuss specific scenarios.

7.
Ann Biomed Eng ; 50(8): 885-897, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-35524027

RESUMEN

Embolization has tremendously evolved in recent years and has expanded to treatment of a variety of pathologic processes. There has been emerging evidence that the level of arterial occlusion and the distribution of embolic particles may play an important role in the clinical outcome. This is a comprehensive literature review to identify variables that play important role in determination of level of occlusion of blood vessels and distribution of embolic particles. The literature searches between 1996 to 2020 through PubMed and Ovid-MEDLINE yielded over 1030 articles of which 30 studies providing details on the level of occlusion are reviewed here. We divided the playing factors into characteristics of the particles, solution/injection and vascular bed. Accordingly, particle size, type and aggregation, compressibility/deformability, and biodegradability are categorized as the factors involving particles' behavioral nature. Infusion rate and concentration/dilution of the medium are related to the carrying solution. Hemodynamics and the arterial resistance are characteristics of the vascular bed that also play an important role in the distribution of embolic particles. Understanding and predicting the level of embolization is a complex multi-factor problem that requires more evidence, warranting further randomized controlled trials, and powered human and animal studies.


Asunto(s)
Embolización Terapéutica , Animales , Arterias , Tamaño de la Partícula
9.
Semin Intervent Radiol ; 38(5): 535-541, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34853499

RESUMEN

Embolization is an important and widely utilized technique in interventional radiology. There are a variety of different categories and individual products which can be utilized to perform embolization. Understanding the different classes of embolic agents, the important features of each of these classes including strengths and limitations, and the variation in individual products within the classes is critical for interventional radiologist to practice safely and effectively. This article reviews the different kinds of embolics and relays some of the pertinent physical and chemical properties of individual products which should be considered when determining which embolic to select for a given purpose.

10.
Ann Thorac Surg ; 112(6): e423-e426, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-33676901

RESUMEN

Bronchial arteriovenous malformations are usually asymptomatic findings noted on imaging but may present with massive hemoptysis after endobronchial rupture. Initial treatment usually involves transcatheter embolization with surgery reserved for refractory cases. Here, we present a patient with large-volume hemoptysis after bronchial arteriovenous malformation rupture. Attempted endovascular management was unsuccessful owing to unfavorable anatomy and hemodynamic instability, necessitating emergent use of extracorporeal membrane oxygenation followed by right bilobectomy.


Asunto(s)
Malformaciones Arteriovenosas/complicaciones , Bronquios/anomalías , Hemoptisis/cirugía , Neumonectomía , Tratamiento de Urgencia , Hemoptisis/etiología , Humanos , Masculino , Neumonectomía/métodos , Rotura Espontánea , Índice de Severidad de la Enfermedad , Adulto Joven
11.
Vasc Endovascular Surg ; 55(5): 529-533, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33739196

RESUMEN

Budd-Chiari syndrome (BCS) results from the occlusion or flow reduction in the hepatic veins or inferior vena cava and can be treated with transjugular intrahepatic portosystemic shunt when hepatic vein recanalization fails.1-3 Hypercoagulable patients with primary BCS are predisposed to development of new areas of thrombosis within the TIPS shunt or IVC. This case details a patient with BCS, pre-existing TIPS extending to the right atrium, and chronic retrohepatic IVC thrombosis who underwent sharp recanalization of the IVC with stenting into the TIPS stent bridging the patient until his subsequent hepatic transplantation.


Asunto(s)
Síndrome de Budd-Chiari/terapia , Procedimientos Endovasculares , Derivación Portosistémica Intrahepática Transyugular , Trombectomía , Vena Cava Inferior , Adulto , Síndrome de Budd-Chiari/diagnóstico por imagen , Síndrome de Budd-Chiari/fisiopatología , Procedimientos Endovasculares/instrumentación , Humanos , Trasplante de Hígado , Masculino , Stents , Resultado del Tratamiento , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/fisiopatología
12.
Radiology ; 298(1): 221-227, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33201792

RESUMEN

Background Transjugular intrahepatic portosystemic shunt (TIPS) creation is an accepted treatment of portal hypertension. Lower-extremity edema (LEE) is an underreported complication of TIPS creation. Purpose To assess the epidemiologic findings of LEE after TIPS creation and their association with patient survival. Materials and Methods The medical records of patients who underwent TIPS creation between January 2003 and April 2019 at Oregon Health and Science University and patients who underwent TIPS creation between January 2006 and December 2016 at University of Minnesota were retrospectively reviewed. Clinical, laboratory, and technical parameters, development and outcome of edema, and survival data were collected. LEE was defined as new-onset or worsened edema up to 1 year after TIPS creation. Cardiac ventricular function was evaluated with transthoracic echocardiography. Risk factors for LEE were evaluated with logistic regression analysis, and critical P values were additionally assessed by using the false discovery rate. Survival curves were compared by using the log-rank test. Results Three hundred thirty-four patients were included (mean age, 55 years ± 11 [standard deviation]; 208 men). TIPS creation was primarily performed for ascites (159 of 334 patients, 48%), gastrointestinal bleeding (127 of 334 patients, 38%), or a combination of bleeding and ascites (38 of 334 patients, 11%). One hundred seventy of the 334 patients (51%) developed LEE (new onset, 120; worsened edema, 50). Three of 170 patients (2%) had abnormal left ventricular ejection fraction. Multivariable analysis showed TIPS creation for ascites (odds ratio, 1.7; 95% CI: 1.04, 2.7; P = .03) and hepatic hydrothorax (odds ratio, 2.2; 95% CI: 1.1, 4.2; P = .02) was likely associated with LEE; however, it did not reach significance at a critical P value of .009. Among 164 patients with data on the outcome of LEE, LEE eventually improved in 94 (57%). The median survival of patients with LEE was lower than that of patients without LEE (38 months vs 71 months, respectively; P = .02). Conclusion Lower-extremity edema developed in more than 50% of study patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) creation, regardless of left ventricular function. There was suggestion that TIPS creation for ascites might be an underlying risk factor. Lower-extremity edema portends worse survival. © RSNA, 2020 Online supplemental material is available for this article.


Asunto(s)
Edema/etiología , Derivación Portosistémica Intrahepática Transyugular/efectos adversos , Edema/fisiopatología , Femenino , Humanos , Extremidad Inferior/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento
13.
AJR Am J Roentgenol ; 215(1): 215-222, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32432911

RESUMEN

OBJECTIVE. The purpose of this study was to compare the ability of the model for end-stage liver disease (MELD) and sodium MELD (MELD-Na) scoring systems to predict outcomes after transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS. Two hundred and nineteen consecutive patients who underwent TIPS placement were retrospectively reviewed. The primary outcomes were death within 30 days and 90 days after TIPS placement (30- and 90-day mortality, respectively), and secondary outcomes included death within 365 days after TIPS placement (365-day mortality), length of hospital stay, and readmission to the hospital within 30 days of TIPS placement. RESULTS. Mortality rates within 30, 90, and 365 days after TIPS placement were 2.3% (5/219), 8.2% (17/207), and 21.7% (41/189), respectively. Logistic regression showed that the MELD score predicted 30-day mortality (odds ratio [OR], 1.13; 95% CI, 1.00-1.27; p = 0.04) and trended toward predicting 90-day mortality (OR, 1.09; 95% CI, 1.00-1.18; p = 0.06), whereas the MELD-Na score did not predict 30-day mortality (OR, 1.02; 95% CI, 0.97-1.06; p = 0.51) or 90-day mortality (OR, 1.01; 95% CI, 0.98-1.15; p = 0.44). In a comparison of the ROC AUCs for MELD and MELD-Na, MELD showed improved prediction of 30-day mortality (p = 0.06) but did not significantly vary in prediction of 90- and 365-day mortality (p = 0.80 and p = 0.76, respectively). When the maximal inflection point for MELD and MELD-Na was analyzed on the basis of 90-day mortality, a score of 23 was found to be most significant for both MELD (OR, 6.6; 95% CI, 1.5-29.1; p = 0.01) and MELD-Na (OR, 3.3; 95% CI, 1.1-9.6; p = 0.03). MELD and MELD-Na both accurately predicted the length of hospital stay after TIPS placement (p = 0.005 and p = 0.01, respectively). CONCLUSION. MELD is superior to MELD-Na for predicting 30-day and, perhaps, 90-day mortality after TIPS placement. At present, decisions regarding patient selection for TIPS placement should be made on the basis of the MELD score rather than the MELD-Na score.


Asunto(s)
Fallo Hepático/etiología , Fallo Hepático/mortalidad , Derivación Portosistémica Intrahepática Transyugular/mortalidad , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
14.
Vasc Endovascular Surg ; 53(5): 415-419, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30929610

RESUMEN

A 57-year-old male presented with intermittent gastrointestinal bleeding (GIB) 1 year after a successful simultaneous pancreas and kidney transplant. No source could be found after 5 tagged red blood cell studies, 3 computed tomographies (CTs), 7 endoscopies, and 4 catheter angiograms. Review of CTs showed pathologically enlarged superior mesenteric vein branches near a jejunal segment near pancreas graft. Transhepatic superior mesenteric venogram showed varicosities near jejunum, which were obliterated with ethylene vinyl alcohol (Onyx). Follow-up CTs confirmed complete obliteration, but he had more GIBs and eventually underwent native jejunal and donor duodenal resection. He has remained GIB-free for 12 months.


Asunto(s)
Embolización Terapéutica/métodos , Yeyuno/irrigación sanguínea , Venas Mesentéricas , Trasplante de Páncreas/efectos adversos , Polivinilos/administración & dosificación , Tantalio/administración & dosificación , Várices/terapia , Angiografía de Substracción Digital , Biopsia , Endoscopía Capsular , Angiografía por Tomografía Computarizada , Procedimientos Quirúrgicos del Sistema Digestivo , Combinación de Medicamentos , Hemorragia Gastrointestinal/etiología , Humanos , Trasplante de Riñón , Masculino , Venas Mesentéricas/diagnóstico por imagen , Persona de Mediana Edad , Flebografía/métodos , Recurrencia , Resultado del Tratamiento , Várices/diagnóstico por imagen , Várices/etiología , Várices/cirugía
15.
J Vasc Interv Radiol ; 30(3): 453-459, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30819493

RESUMEN

PURPOSE: To compare the safety and efficacy of hook wire versus microcoil localization of pulmonary nodules prior to video-assisted thoracoscopic resection (VATS). MATERIALS AND METHODS: A retrospective comparative review was conducted of 46 patients (26 hook wire and 20 microcoil) who underwent computed tomography fluoroscopic-guided nodule localizations prior to VATS in a single center between January 2012 and August 2016. Nodule characteristics, procedural details, clinical outcomes, and pathologic findings were collected. Baseline characteristics and lung nodule distribution were not significantly different between the 2 groups. Nodule sizes ranged from 2 mm to 28 mm and were similar between groups. Twenty-nine patients (63%) were male, with mean (standard deviation) age of 61 (11) years. Adverse events were classified using standard criteria. Patients were followed for up to 90 days, and the clinical outcomes were compared. RESULTS: Successful resection of nodules was achieved in all patients. Twelve cases of displacement of the hook wire were observed compared to only 1 in the coil group (P < .01). The total complication rate was lower in the coil group (25% vs 54%, P = .04). Two patients required transition to thoracotomy in the hook wire group, compared to none in the coil group. Median blood loss was similar in both groups (median loss, 20-22 mL). One patient had positive margins in the hook wire group. There was a nonsignificant trend toward longer hospital stay and higher major complication rates after hook wire localization (P = .4). CONCLUSIONS: Pulmonary nodule localization with coils prior to VATS resection demonstrated fewer displacements and fewer perioperative complications compared to hook wires.


Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Cuidados Preoperatorios/métodos , Nódulo Pulmonar Solitario/diagnóstico por imagen , Cirugía Torácica Asistida por Video , Tomografía Computarizada por Rayos X/métodos , Anciano , Femenino , Fluoroscopía , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/patología , Nódulos Pulmonares Múltiples/cirugía , Valor Predictivo de las Pruebas , Cuidados Preoperatorios/efectos adversos , Cuidados Preoperatorios/instrumentación , Estudios Retrospectivos , Factores de Riesgo , Nódulo Pulmonar Solitario/patología , Nódulo Pulmonar Solitario/cirugía , Tomografía Computarizada por Rayos X/efectos adversos , Tomografía Computarizada por Rayos X/instrumentación , Resultado del Tratamiento , Carga Tumoral
16.
Cerebrovasc Dis ; 44(1-2): 83-87, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28511184

RESUMEN

BACKGROUND AND PURPOSE: New effective recanalization therapies are currently available for acute ischemic stroke; yet a vast majority of stroke patients are left untreated. The lack of early recognition may be because often times, stroke patients present with atypical manifestations that resemble other conditions (which are referred to as "stroke chameleons"). We set to study the proportion of patients with delayed stroke recognition in a single center. METHODS: We performed a retrospective analysis of a prospectively collected data over a 9-year period. All adult patients discharged with the diagnosis of ischemic stroke or transient ischemic attack (TIA) were identified and traced for their diagnosis on admission. Those cases with a diagnosis other than ischemic stroke or TIA on admission were identified as possible stroke chameleons and categorized into different groups according to the occurrence of neurological or non-neurological manifestations at presentation. RESULTS: Of 2,303 cases with discharge diagnosis of ischemic stroke or TIA, 919 (39.9%) were found to be possible stroke chameleons. More than half of these patients (58.4%) presented with neurological manifestations including disorders of the somatic sensation (33%), alteration of consciousness (30%), and disorders of speech/language (11%). The remaining possible stroke chameleons had manifestations pertaining to other organ systems such as cardiopulmonary, gastrointestinal, systemic infection, trauma, and thromboembolic events elsewhere. CONCLUSIONS: In our cohort, a surprisingly large percentage of possible stroke chameleons was observed. It is important to confirm our findings, study the impact on clinical outcome, and develop strategies for early stroke patient recognition.


Asunto(s)
Isquemia Encefálica/diagnóstico , Diagnóstico Tardío , Ataque Isquémico Transitorio/diagnóstico , Accidente Cerebrovascular/diagnóstico , Isquemia Encefálica/complicaciones , Isquemia Encefálica/fisiopatología , Isquemia Encefálica/terapia , Diagnóstico Diferencial , Humanos , Ataque Isquémico Transitorio/complicaciones , Ataque Isquémico Transitorio/fisiopatología , Ataque Isquémico Transitorio/terapia , Minnesota , Admisión del Paciente , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Factores de Tiempo , Tiempo de Tratamiento
17.
Asian J Surg ; 40(5): 415-418, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26922629

RESUMEN

Various surgical approaches may be employed for esophageal resection. Major airway injuries due to transhiatal esophagectomy include vertical tears in the membranous trachea. Tracheal injury is an uncommon but potentially fatal complication. This article describes the technique to repair the posterior membranous tracheal tear, extended just over the carina through a transcervical-transsternal approach, thereby avoiding a second thoracotomy. Six patients with posterior membranous tracheal injury underwent this procedure. The laceration ranged from 3 cm to 5 cm in length. Four patients had received neoadjuvant chemoradiation. The management of tracheal laceration added approximately 60 minutes to the total operation time. There was no mortality related to tracheal injury. Patients were followed up for 6 months after surgery, and both posterior tracheal wall and transverse tracheotomy remained intact without stenosis. The transcervical-transsternal approach decreases the need of thoracotomy and its complications in patients with tracheal laceration in any stage, even in cases of an extended tear down to the carina.


Asunto(s)
Esofagectomía/efectos adversos , Laceraciones/cirugía , Complicaciones Posoperatorias/cirugía , Terapia Recuperativa/métodos , Tráquea/lesiones , Anciano , Femenino , Estudios de Seguimiento , Humanos , Laceraciones/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tráquea/cirugía , Resultado del Tratamiento
18.
AJR Am J Roentgenol ; 206(4): 726-33, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26796867

RESUMEN

OBJECTIVE: The Milan criteria for the selection of patients with hepatocellular carcinoma (HCC) for liver transplantation were originally based on the findings of contrast-enhanced CT examinations. Studies have shown improvement in HCC detection of using contrast-enhanced MRI instead of CT, but they have provided little information on the potential downstream effect on patient management that might result from discrepant imaging findings. We sought to assess the effect of discrepant imaging findings on patient eligibility to undergo liver transplantation. MATERIALS AND METHODS: From 2006 to 2013, patients with a diagnosis of HCC who underwent both MDCT and MRI examinations within a 40-day period were studied retrospectively. All examinations were independently reviewed by two abdominal radiologists who recorded the number, diameter, and location of each lesion. Secondary confirmation of the lesions was made on the basis of histopathologic findings, diffusion restriction on DWI, increased T2 signal intensity, lesion growth, presence of fat, uptake of ethiodized oil, or a combination of these findings. RESULTS: Sixty-four patients (48 men and 16 women; mean age, 62 years) met the criteria for inclusion in the study. Of the 129 lesions identified by MRI, only 102 of these lesions (79%) were identified by MDCT. This discrepancy led to a difference in the Milan criteria scoring for nine patients (14%). There was no statistically significant difference in the mean (± SD) greatest lesion diameter measured using the two modalities, with measurements of 3.52 ± 2.8 cm and 3.46 ± 2.8 cm noted on MDCT and MRI, respectively (p = 0.8). Lesions missed on MDCT studies tended to be smaller, with a mean diameter of 2.7 cm. Of the 129 lesions identified by MRI, 112 (87%) had available histopathologic findings or other confirmatory diagnostic evidence. CONCLUSION: MDCT missed one-fifth of the HCC lesions detected by MRI. Had MDCT been the only imaging examination performed, failure to identify these lesions would have led to a different management plan for 14% of patients.


Asunto(s)
Carcinoma Hepatocelular/patología , Interpretación de Imagen Asistida por Computador , Neoplasias Hepáticas/patología , Trasplante de Hígado , Imagen por Resonancia Magnética/métodos , Selección de Paciente , Tomografía Computarizada por Rayos X/métodos , Algoritmos , Medios de Contraste , Femenino , Gadolinio DTPA , Humanos , Yopamidol , Masculino , Persona de Mediana Edad , Compuestos Organometálicos , Estudios Retrospectivos
19.
Vasc Endovascular Surg ; 49(7): 206-9, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26462977

RESUMEN

Fibromuscular dysplasia (FMD) is a well-known disease, but its diagnosis can be challenging. Typically, the symptomatic FMD are reported by young and middle aged people with high blood pressure refractory to medical treatment. We present a rare case of a young, healthy, and normotensive patient who presented with pain secondary to renal infarction, without any prior signs or symptoms or history of hypertension. This presentation of FMD has not been previously described. The typical but subtle angiographic findings of the macro-aneurysmal FMD as well as the successful endovascular treatment are discussed herein. The macro-aneurysmal form of FMD should be considered in the differential diagnosis of acute renal infarction in young and middle aged patients even if they do not have a history of hypertension.


Asunto(s)
Aneurisma/terapia , Embolización Terapéutica , Procedimientos Endovasculares , Displasia Fibromuscular/terapia , Infarto/terapia , Arteria Renal , Adulto , Aneurisma/diagnóstico , Aneurisma/etiología , Diagnóstico Diferencial , Displasia Fibromuscular/complicaciones , Displasia Fibromuscular/diagnóstico , Humanos , Infarto/diagnóstico , Infarto/etiología , Masculino , Valor Predictivo de las Pruebas , Arteria Renal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
20.
Iran J Med Sci ; 40(2): 181-4, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25821300

RESUMEN

Mediastinal lymphangioma is primarily a benign lesion and the majority of the cases are found incidentally. These lesions account for approximately 1% of all mediastinal tumors. Here we present a giant mediastinal cystic mass in a 35-year-old female who was presented with severe respiratory distress. On the plain chest radiography and CT scan, a massive left pleural effusion with large parasternal and mediastinal lymphadenopathy was seen. Thoracentesis was performed and 400 cm³ of clear fluid was drained from the left hemithorax. However, a subsequent CT scan with contrast and the same technique 40 days later showed a large cystic mass in the mediastinum protruding to the right and left hemi thoraces. The giant cystic mass was resected via right and left anterior thoracotomies. Histopathological examination revealed a diagnosis of lymphangioma. The patient has been alive and without tumor recurrence and has been followed for 2 years.

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