Pelvic arterial embolisation with cyanoacrylate during caesarean hysterectomy for placenta accreta.

PURPOSE: To compare n-butyl cyanoacrylate (NBCA) and gelatine sponge (GS) as embolic materials for prophylactic pelvic arterial embolisation during caesarean hysterectomy for placenta accreta spectrum (PAS). MATERIAL AND METHODS: This retrospective study comprised 12 women (age range, 23-42 years; mean, 34.1 years) who underwent caesarean hysterectomy for PAS. Following caesarean delivery, bilateral uterine and non-uterine parasitic arteries were embolized with GS in the first four cases (GS group) and primarily with NBCA mixed with iodized oil in the subsequent eight cases (NBCA group). Procedure time for embolisation and hysterectomy and total blood loss were compared between the two groups using Welch's t-test. RESULTS: Although procedure time for embolisation tended to be longer in the NBCA group than in the GS group (111 ± 47 min versus 71 ± 32 min, p=.11), that for hysterectomy was significantly reduced in the NBCA group when compared to the GS group (158 ± 42 min versus 236 ± 39 min, p=.02). Total blood loss was significantly lower in the NBCA group than in the GS group (1375 ± 565 mL versus 2668 ± 587 mL, p=.01). CONCLUSION: Procedure time for hysterectomy and total blood loss during caesarean hysterectomy can be reduced by using NBCA instead of GS in prophylactic pelvic arterial embolisation for PAS.

A case of renal involvement in juvenile xanthogranulomatosis.

Juvenile xanthogranuloma (JXG) is a type of non-Langerhans cell histiocytosis that rarely involves other than the skin. Here, we present detailed ultrasound (US) findings, including a contrast study, of a rare JXD renal lesion. A 42-year-old woman with JXG had chronic kidney disease. Ultrasound showed multiple cystic masses with fine internal septa in both kidneys. Contrast-enhanced US revealed early staining and late washout consistent with the internal septa inside the masses and led us to suspect cystic renal cell carcinomas in both kidneys. Left nephrectomy was performed for diagnostic purposes. Microscopic examination revealed a foamy component with Touton-type giant cells by histiocytosis; CD68 and S100 were positive, and CD1a was negative, leading the diagnosis of JXD. The US findings of extracutaneous lesions on JXA are variable and can be cystic, and when arising in the kidney may resemble cystic renal cell carcinoma.

Treatment of ruptured rectal artery aneurysm in a patient with neurofibromatosis.

BACKGROUND: Superior rectal artery (SRA) aneurysms are rare. Although melena is the most common symptom, it has not been observed in cases of aneurysms located in the SRA trunk. Here, we report a case of a ruptured SRA trunk aneurysm successfully treated with coil embolization. Including our case, three of the four reported cases of SRA trunk aneurysms were related to neurofibromatosis type 1 (NF1). CASE PRESENTATION: A 52-year-old woman with NF1 was referred to our hospital for the investigation of an abdominal mass with back pain. She had previously undergone a blood transfusion at another hospital for anemia without melena. Computed tomography angiography revealed a ruptured SRA trunk aneurysm measuring 3 cm in diameter and surrounded by a retroperitoneal hematoma. The aneurysm was isolated by embolizing the SRA trunk distally and proximally. Distal embolization was performed retrogradely from the internal iliac artery (IIA) via the middle rectal artery (MRA)-SRA anastomosis because the antegrade approach from the inferior mesenteric artery (IMA) failed. To our knowledge, this is the first case of successful coil embolization of an IMA branch through the IIA. CONCLUSION: SRA trunk aneurysms are rare; however, they are frequently associated with NF1. Antegrade distal embolization beyond the aneurysm is sometimes difficult to achieve. In such cases, a retrograde approach via MRA-SRA anastomosis can be the choice for isolating SRA trunk aneurysms.

Successful transcatheter arterial embolization for uretero-inferior epigastric arterial fistula: A rare complication of cutaneous ureterostomy.

A 70-year-old man presented with pulsatile bleeding upon changing his catheter for cutaneous ureterostomy. He was suspected to have a uretero-arterial fistula. Computed tomography showed an abnormally dilated right inferior epigastric artery, the suspected bleeding source. Angiography revealed a tortuous dilated branch from the inferior epigastric artery. Transcatheter arterial embolization was performed with a gelatin sponge and coil. He was discharged 15 days after the procedure. Uretero-arterial fistula is a rare but fatal complication among patients with long-term indwelling ureter catheters. An abnormal inferior epigastric artery surrounding the cutaneous ureterostomy should be considered a rare cause of uretero-arterial fistula.

Angiographic Findings in Patients with Hepatocellular Carcinoma Previously Treated Using Proton Beam Therapy.

Given the growing interest in using proton beam therapy (PBT) for hepatocellular carcinoma (HCC), it is possible that transarterial chemoembolization (TACE) could be used for selected patients who have previously undergone PBT. However, these cases can be technically challenging to treat and require appropriate preparation. Thus, we aimed to identify angiographic findings in this setting. We retrospectively identified 31 patients (28 men and 3 women, mean age: 69 years, range: 43-84 years) who underwent hepatic angiography plus TACE or transarterial infusion chemotherapy (TAI) for HCC that recurred after PBT (July 2007 to June 2018). We discovered four angiographic findings, which we speculate were related to the previous PBT. 18 patients experienced recurrence in the irradiated field, and 13 patients experienced recurrence outside the irradiated field. 29 patients underwent TACE and only 2 patients underwent TAI. The mean number of previous PBT treatments was 1.3 ± 0.6 (range: 1-4). The median interval from the earliest PBT treatment to hepatic angiography was 559 days (range: 34-5,383 days), and the median interval from the latest PBT treatment to hepatic angiography was 464 days (range: 34-5,383 days). Abnormal staining of the irradiated liver parenchyma was observed in 22 patients, which obscured the angiographic tumor staining in 4 patients. Development of a tortuous tumor feeder vessel was observed in 13 patients. Development of an extrahepatic collateral pathway was observed in 7 patients. Development of an arterioportal or arteriovenous shunt was observed in 4 patients. Based on these findings, we conclude that PBT was associated with various angiographic findings during subsequent transarterial chemotherapy for recurrent HCC, and familiarity with these findings will be important in developing appropriate treatment plans.