Uterine fibroid embolization: measurement of health-related quality of life before and after therapy.

OBJECTIVE: To determine the change in health-related quality of life associated with uterine fibroid embolization (UFE). MATERIALS AND METHODS: A health-related quality-of-life questionnaire was administered before and after therapy. The questionnaire contained validated scales from the Medical Outcomes Study, with additional domains and symptom items specific to fibroids. Patients treated with UFE for symptomatic uterine leiomyomata completed a health-related quality of life questionnaire before therapy. A follow-up quality of life questionnaire and an additional brief questionnaire to assess symptom improvement were completed 3 and 6 months postprocedure. Confirmatory reliability and validity testing was also conducted. Mean scores for each scale on the quality of life questionnaire were calculated and change scores were computed. RESULTS: Fifty women were enrolled in the study and completed the baseline assessment. Health-related quality of life scores improved in all instances at follow-up. Mean change scores were statistically significant for all domains between baseline and month 3 (P < .01) and between baseline and month 6 (P < .05) except backache (P = .12). CONCLUSION: Patients undergoing UFE report significant improvements in health-related quality of life and fibroid-specific symptoms. These findings suggest that the measurement of health-related quality of life may be an effective means of comparing the outcome of UFE with other fibroid therapies.

Percutaneous varicocele embolization versus surgical ligation for the treatment of infertility: changes in seminal parameters and pregnancy outcomes.

PURPOSE: To compare the success of percutaneous varicocele embolization to surgical ligation with regard to changes in semen characteristics and pregnancy outcome. MATERIALS AND METHODS: Infertility records from 346 men who underwent correction of their varicocele for infertility (surgical ligation 149; embolization 197) were reviewed retrospectively. Preprocedural and postprocedural semen analyses and pregnancy outcomes were obtained with use of chart and telephone follow-up. RESULTS: In men who successfully impregnated their partners, there were significant improvements in sperm density, percent total improvement, motility, and progression. Postprocedural (embolization vs surgery) percentage increases in seminal parameters were density, 156.8% versus 138.5%; total, 168.8% versus 157.91%; and motility, 2.7% versus 3.2%. The percent of individuals who had a change in sperm progression was 31% versus 41%. There was no statistical difference between the techniques based on t tests. The pregnancy rates were similar for the two groups, 39% and 34% for embolization and surgery, respectively. CONCLUSION: There is no significant statistical difference in seminal values or pregnancy outcome between the two techniques.

Aortic balloon control of a traumatic aortoenteric fistula after damage control laparotomy: a case report.

Aortoenteric fistula is a rare complication of abdominal trauma. We present a case of a patient with multiple gunshot wounds to the abdomen and thorax in whom control of injury required staged operations. An aortoenteric fistula developed, presenting a diagnostic and therapeutic challenge. The operative control of aortic bleeding was by a retroperitoneal approach to the aorta and facilitated by the use of percutaneous aortic balloon catheters. The patient survived to leave hospital. This case highlights a rare trauma complication, the use of "damage control" for the severely injured abdomen and the technique of intra-arterial balloon control of bleeding from inaccessible locations.

Transjugular intrahepatic portosystemic shunt-related arterial injuries: prospective comparison of large- and small-gauge needle systems.

PURPOSE: The authors prospectively compared the nature and incidence of hepatic arterial injuries resulting from creation of a transjugular intrahepatic portosystemic shunt (TIPS) with large- and small-gauge needle systems. PATIENTS AND METHODS: Fifty patients underwent hepatic and superior mesenteric angiography immediately before and after shunt creation. A sheathed 16-gauge needle system was used to locate and puncture the portal vein in 24 patients. A 21-gauge needle system was used in 26 patients. RESULTS: Shunts were successfully created in all patients. Three inadvertent hepatic arterial punctures were recognized during shunt placement, two with the small needle and one with the large needle system. No hepatic arterial lesions were detected in any patient. Two incidental hepatomas were identified at angiography. CONCLUSION: TIPS-related hepatic arterial injuries are rare. In this series, large and small needle systems were indistinguishable with respect to this complication.

Renal perfusion in humans: MR imaging with spin tagging of arterial water.

The authors tested a noninvasive technique for magnetic resonance imaging of perfusion in human kidneys. Magnetic labeling (spin tagging) of aortic arterial water was performed to generate an endogenous tracer. Breath-hold renal perfusion images obtained in seven volunteers yielded average perfusion rates in cortex and medulla of 278 mL.100 g-1.min-1 +/- 55 (standard error) and 55 mL.100 g-1.min-1 +/- 25, respectively.

Thrombosed hemodialysis grafts: percutaneous mechanical balloon declotting versus thrombolysis.

PURPOSE: To compare a technique of mechanical balloon declotting of thrombosed hemodialysis grafts with conventional pulsed-spray thrombolysis. MATERIALS AND METHODS: Forty patients had 53 episodes of graft thrombosis over a 19-month period. Twenty-nine grafts were randomly treated with thrombolysis with urokinase and 24 grafts with mechanical declotting by placement of crossed balloon catheters within the graft. Patency was determined by retrospective review of hemodialysis records. RESULTS: Successful hemodialysis for 1 week after the procedure was achieved in 21 (88%) of the 24 grafts treated mechanically and 26 (90%) of 29 grafts treated with thrombolysis. Continuous pulse oximetry showed no change in oxygen saturation in either group, and no clinical signs or symptoms of pulmonary embolism were noted. Average total procedure times were 2.2 hours for mechanical declotting and 3.5 hours for thrombolysis (P < .05). Probability of patency (mechanical vs thrombolysis) was 42% vs 45% at 3 months, 36% vs 25% at 6 months, and 8% vs 4% at 12 months. One major complication of ulnar artery embolization occurred in the thrombolysis group. CONCLUSION: Mechanical declotting of hemodialysis grafts is faster and as effective as thrombolysis.

Cost-effectiveness of MR angiography in cases of limb-threatening peripheral vascular disease.

PURPOSE: To evaluate the cost-effectiveness of magnetic resonance (MR) angiography in the preoperative planning of treatment in patients with limb-threatening peripheral vascular disease (PVD). MATERIALS AND METHODS: A decision model was developed to study the effects of MR angiography on the outcome and cost of treatment. The authors calculated the incremental cost per quality-adjusted life-years gained (ie, cost-effectiveness ratio) when conventional angiography was replaced or supplemented with MR angiography. Previously reported data regarding the accuracies of MR and conventional angiography were used in the analysis. RESULTS: The cost-effectiveness ratio of MR angiography ranged from negative (cost-reducing) values to $78,000. For the base case in which the sensitivity and specificity of MR angiography for the evaluation of inflow vessels were 92% and 88% and those of conventional angiography were 97% and 97%, respectively, the cost-effectiveness ratio was $25,895. CONCLUSION: MR angiography may be a cost-effective alternative to conventional angiography in patients with limb-threatening PVD if its accuracy for the inflow evaluation reaches certain thresholds. Further prospective investigation is warranted.

Transjugular intrahepatic portosystemic shunt stenosis and revision: early and midterm results.

OBJECTIVE: The purpose of this study was to define the pattern, rate, and interval during which stenosis develops in transjugular intrahepatic portosystemic shunts (TIPS) and to assess the effect of revision in prolonging shunt patency. MATERIALS AND METHODS: TIPS were created in 100 patients during a 34-month period. Sixty-one shunt venograms were obtained in 38 consecutive patients between 1 and 24 months after TIPS placement. Eighteen patients were examined because of recurrent symptoms, and all 38 had routine follow-up. RESULTS: Stenoses attributed to neointimal hyperplasia developed within both the TIPS stent and the outflow hepatic veins. Stenoses of greater than 50% developed in 12 patients within 6 months of TIPS placement. In addition to focal stenoses, the outflow hepatic veins diffusely shrank an average of 51% in diameter. Thirty-six shunt interventions were required: eleven balloon dilatations and 25 placements of an additional stent. Life-table analysis showed that patency of the primary shunt was 75% at 6 months, 50% at 1 year, and 32% at 2 years. The primary-assisted patency of the shunt was 85% at 12 months after shunt creation. CONCLUSION: The results indicate that TIPS are prone to significant and frequent early stenosis, warranting follow-up within 3-6 months in all cases. Stenosis of the outflow hepatic vein is the most common cause of shunt malfunction. Revision of a shunt significantly prolongs shunt patency.

Prevalence of infection following hepatic chemoembolization with cross-linked collagen with administration of prophylactic antibiotics.

PURPOSE: The authors present their experience with 494 hepatic chemoembolization (HCE) procedures in 236 patients with administration of a mixture of cross-linked collagen and chemotherapeutic agents. The prevalence of infectious complications was compared in patients who did and did not receive prophylactic administration of antibiotics as part of the HCE procedure. PATIENTS AND METHODS: Fourteen HCE procedures in nine patients were performed without prophylactic antibiotics (PA). These patients underwent embolization with cross-linked collagen alone or with low-dose cisplatinum. All of the remaining 480 procedures in 227 patients were performed with PA. RESULTS: One of the nine patients (11%) who did not receive PA experienced fatal sepsis within 24 hours of HCE. Of the 227 patients who did receive antibiotics, six (2.6%) developed hepatic abscess and no fatal sepsis was encountered. CONCLUSION: Use of PA decreases the prevalence of infectious complications following HCE.