[Selective embolization to treat obstetric hemorrhage]. / Embolización selectiva como tratamiento de la hemorragia obstétrica.

OBJECTIVE: To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility. MATERIAL AND METHODS: We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility. RESULTS: Hemorrhage was classified as primary (25/27) or secondary (2/27). The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1). The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients). Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies. CONCLUSION: Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility.

The COVID-19 pandemic and its repercussions in our interventional radiology unit. / La pandemia COVID-19 y su repercusión en la unidad de radiología intervencionista: nuestra experiencia.

This paper aims to describe our experience in an interventional radiology unit in a hospital in Spain that was severely affected by the COVID-19 pandemic. To this end, we did a prospective observational study of 20 consecutive patients with COVID-19 who underwent 21 interventional radiology procedures between March 13, 2020 and May 11, 2020. We describe the measures taken to reorganize the work and protective measures, as well as the repercussions of the situation on our unit's overall activity and activity in different phases. The COVID-19 pandemic has represented a challenge in our daily work, but learning from our own experience and the recommendations of the Spanish radiological societies (SERVEI and SERAM) has enabled us to adapt successfully. Our activity dropped only 22% compared to the same period in 2019.

Embolisation of prostate arteries in benign prostatic hyperplasia in non-surgical patients. / Embolización de arterias prostáticas en la hiperplasia benigna de la próstata en pacientes no quirúrgicos.

OBJECTIVE: To present the results of a multidisciplinary study of two tertiary hospitals, together with urology services, on 102 consecutive patients not candidates for surgery treated for more than 6 years, in whom prostatic arteries were embolised for the treatment of benign hyperplasia. MATERIAL AND METHODS: From December 2012 to February 2019, 102 patients with symptoms of benign prostatic hyperplasia (BPH) not candidates for surgery or who explicitly rejected surgery, with an average age of 73.9 years (range 47.5-94.5), underwent prostatic artery embolisation. The patients were followed up by questionnaires on urinary symptoms, sexual function and impact on quality of life, as well as measurement of prostate volume, uroflowmetry and prostate specific antigen (PSA) at one, 3 and 6 months and one year following the procedure. RESULTS: The technique was successful in 96% of patients (76.2% bilateral and 19.8% unilateral). The mean duration of the procedure was 92minutes and of the radioscopy 35.2minutes. Statistically significant changes were demonstrated (p <.05) in PSA, peak urinary flow, QoL (quality of life) questionnaire and the International Index of Erectile Function (IPSS). PSA had reduced by 58% from baseline at 3 months. Similarly, the Qmax had increased significantly by 63% in the third month following embolisation. A significant improvement in the QoL and IPSS tests was achieved, with a reduction of 3.7 points and a mean 13.5 points, respectively, at one year's follow-up. Prostate volume showed a non-statistically significant decrease at follow-up of one year following treatment. A series of minor complications was collected, no case of which required hospital admission. CONCLUSIONS: Prostatic embolisation for the treatment of BPH proved an effective and safe technique in patients who were not candidates for surgery.

Using a new device to prevent pulmonary embolisms during pharmacomechanical thrombectomy. / Uso de un nuevo dispositivo para la prevención de embolias pulmonares previo a una trombectomía farmacomecánica.

We have used a new device to prevent pulmonary embolism during pharmacomechanical thrombectomy in a 25-year-old postpartum woman. The Angel® catheter (BiO2 Medical Inc., Golden, CO, USA) is a temporary device that combines the functions of a vena cava filter (VCF) with those of a triple-lumen central venous catheter. Normally, a VCF is implanted to prevent pulmonary embolism during pharmacomechanical thrombectomy. However, the complications associated with VCFs increase with time, not all of the filter can always be retrieved, and there can be iatrogenic effects both during implantation and retrieval. In our experience, this new device is much simpler to deploy and to retrieve. As is shown in this case, this temporary device can be an interesting alternative to a VCF for preventing pulmonary embolisms during pharmacomechanical thrombectomy.

Stenting as first option for endovascular treatment of malignant superior vena cava syndrome.

OBJECTIVE: Endoprostheses were inserted in cancer patients with superior vena cava syndrome to assess their effectiveness as first-choice, initial treatment for relief of symptoms. SUBJECTS AND METHODS: Wallstent prostheses (n = 73) of various lengths (5-14 cm; median, 7 cm) and diameters (10-16 mm; median, 16 mm) were inserted in 52 cancer patients (51 men, 1 woman; age range, 44-78 years; mean, 63 years) who were diagnosed and confirmed by cavography or phlebography as having superior vena cava syndrome. A single stent was sufficient in 37 patients, two stents were required in 11, three stents in two, and four stents in another two patients. Contraindications for the procedure were severe cardiopathy or coagulopathy. RESULTS: Resolution of symptoms was achieved in all patients within 72 hr. At follow-up, six obstructions, one partial migration to the right atrium, two incorrect placements, and four stent "shortenings" were noted. All were successfully resolved by repeated stenting. Symptom-free survival ranged from 2 days to 17 months (mean, 6.4 months). At the time of this writing, eight patients are alive and have patent stents. The rest have died from their cancer. CONCLUSION: The Wallstent vascular endoprosthesis is an effective initial treatment in superior vena cava syndrome of neoplastic origin. Morbidity and complications are minimal. Clinical relief of symptoms is rapid; therefore, the Wallstent endoprosthesis is highly recommended as the first choice for palliative treatment of superior vena cava syndrome, especially because the clinical decision for subsequent chemotherapy or radiotherapy or surgery is not in any way prejudiced.

Nasolacrimal stents in the management of epiphora: medium-term results of a multicenter prospective study.

PURPOSE: To evaluate in a prospective multicenter setting the clinical utility of polyurethane stents in the percutaneous management of epiphora. MATERIALS AND METHODS: Patients (N = 163; age range = 22-85 y, mean = 52 y; 29 men, 134 women) with severe epiphora had stents (n = 183) inserted under fluoroscopic guidance in 180 lacrimal systems (unilateral = 146; bilateral = 17) to treat complete (n = 172) or partial (n = 8) obstruction of the nasolacrimal duct or sac. The junction between sac and duct was the most frequent location (n = 102), followed by the sac alone (n = 48), and the duct alone (n = 30). The etiology of the obstruction was idiopathic in 113 cases (63%) and chronic dacryocystitis in 67 (37%). The set designed by Song was used in all patients and the original technique was slightly modified by the authors. All patients were treated on an outpatient basis. Average time of the procedure was 14 minutes (range = 3-70 min). RESULTS: Initial technical success rate of stent placement was 97%. Resolution of epiphora was complete in 175 eyes and partial in five. On follow-up (mean = 450 d; range = 8-730 d), 157 of 183 stents remained patent (85.8%). Of the 24 obstructed, 19 were easily withdrawn and 17 of these patients remained asymptomatic for a mean of 15 months (secondary patency rate = 89.5%). CONCLUSIONS: The procedure is simple and safe. It can be performed on an outpatient basis and the original technique could be improved with some technical modifications. It is well tolerated by patients and may be considered as a valid alternative technique for the resolution of epiphora.