Safety and effectiveness of uterine fibroid embolization in patients with scarred uterus.

AIM: To evaluate the safety and effectiveness of uterine fibroid embolization (UFE) in patients with a scarred uterus caused by a previous myomectomy or cesarean section. METHODS: A total of 140 patients who underwent embolization for symptomatic fibroids were included in this retrospective study. The patients were divided into two groups, those with a history of myomectomy and/or cesarean section (scarred uterus group, n = 56), and those without surgical history involving the uterus (no-scar group, n = 84). Demographics, embolization details, outcomes, and complications were analyzed. RESULTS: The overall clinical success rate was 89.28% in the scarred uterus group and 95.24% in the no-scar group. There was no statistical difference in infarction rate or change in fibroid volume in follow-up magnetic resonance imaging between the groups. There was one major complication in the no-scar group, but there was no statistical difference in complications between the groups. The mean follow-up period was 25.9 months. The mean symptom-free time was 27.2 months in the scarred uterus group and 21.9 months in the no-scar group without a significant difference. There were no statistically significant differences in symptom changes, recurrence, and complication rates between the groups. Recurrence seen on imaging or regrowth was more common in the group with myomectomy history. However, there was no significant difference in symptom recurrence rates. CONCLUSION: No statistically significant difference in technical and clinical outcomes was observed between the two groups. There was no significant increase in complication rates of UFE in scarred uterus group.

Transcatheter arterial embolization for hemorrhage after gynecologic hysterectomy: a multicenter study.

BACKGROUND: Transcatheter arterial embolization (TAE) is not common for hemorrhagic complications after gynecologic hysterectomy. PURPOSE: To evaluate the effectiveness and safety of TAE for hemorrhage after hysterectomy for gynecologic diseases. MATERIAL AND METHODS: This is a retrospective, multicenter study, which investigated 11 patients (median age = 45 years) who underwent TAE for hemorrhage after gynecologic hysterectomy between 2004 and 2020. RESULTS: The median interval between surgery and angiography was one day (range = 0-82 days). Hemodynamic instability and massive transfusion were present in 6 (54.5%) and 4 (36.4%) patients, respectively. CT scans (n = 7) showed contrast extravasation (n = 5), pseudoaneurysm (n = 1), or both (n = 1). On angiography, the bleeding arteries were the anterior division branches of the internal iliac artery (IIA) (n = 6), posterior division branch (lateral sacral artery, n = 1), and inferior epigastric artery (n = 1) in eight patients with active bleeding. In the remaining three patients, angiographic staining without active bleeding foci was observed at the vaginal stump, and the feeders for staining were all anterior division branches of the IIA. Technical and clinical success rates were 100% and 90.9% (10/11), respectively. In one patient, active bleeding focus was successfully embolized on angiography, but surgical hemostasis was performed for suspected bleeding on exploratory laparotomy. Postembolization syndrome occurred in one patient. CONCLUSIONS: TAE is effective and safe for hemorrhage after hysterectomy for gynecologic diseases. Angiographic findings are primarily active bleeding, but angiographic staining is not uncommon. A bleeding focus is possible in any branch of the IIA, as well as the arteries supplying the abdominal wall.

Image-guided placement of totally implanted vascular access device: retrospective analysis of the clinical outcomes and associated risk factors.

OBJECTIVES: To determine risk factors for catheter survival and complications after image-guided implantation of a totally implanted vascular access device (TIVAD). METHODS: A total of 2883 TIVADs (2735 patients, 63.5±13 years old, 1060 men, 1675 women) implanted under guidance by ultrasound and fluoroscopy in our institution from January 2010 to December 2019 were evaluated retrospectively. We used the log rank test and logistic regression to analyse risk factors associated with catheter survival and complications. RESULTS: Female patients (n=1778; 61.7%; mean catheter survival days: 780.6 days) and those with a haematological malignancy (n=277; 10.1%; mean catheter survival days: 1019 days) had significantly better catheter survival than male patients (n=1105; 38.3%; mean catheter survival days: 645.9 days) and those with a solid organ malignancy (n=2447; 89.5%; mean catheter survival days: 701 days) (p<0.001 and p=0.003). Patients with haematological malignancies and benign vascular inflammatory disease (n=11; 0.4%) were vulnerable to infection (n=96; 3.3%) (p<0.001 and p=0.004). Thrombotic malfunction (n=38; 1.3%) was significantly more common in females than males (p=0.005). Non-thrombotic malfunction (n=16; 0.6%) showed a significant association with left positioning of the TIVAD (n=410; 14.2%) (p=0.043). Wound dehiscence (n=3; 0.1%) was significantly more frequent in punctured veins other (n=23; 0.8%) than the internal jugular vein (p<0.001). CONCLUSIONS: Increased attention should be paid to patients with an underlying haematological malignancy, underlying vascular inflammatory disease, female patients, older patients, those accessed via a vein other than the IJV, those with left positioning of the TIVAD system or those with a prolonged TIVAD maintenance.

Kissing stents for radiation-induced bilateral common iliac vein stenosis.

Radiation-induced venous stenosis is rare, with only a few cases reported in the literature. We report a case of radiation-induced venous stenosis of the bilateral iliac vein after radiation therapy for the treatment of recurrent bladder cancer. The patient was successfully treated using endovascular kissing stents.

Evaluation of sclerotherapy for the treatment of infected postoperative lymphocele.

OBJECTIVE: To evaluate the efficacy and safety of sclerotherapy as the treatment of infected postoperative lymphocele in gynecologic malignancy patients. MATERIALS AND METHODS: Percutaneous catheter drainage (PCD) with or without sclerotherapy was performed for postoperative lymphocele in 75 patients from 2002 to 2014. Eighty-eight lymphoceles (43 non-infected as group A, 45 infected as group B) in 75 patients (mean age ± SD; 50.3 ± 11.3) were included. Sclerotherapy was performed in 17 (39.5%, group A-S) lymphoceles in group A and 14 (31.1%, group B-S) in group B. Absolute ethanol was the most frequently used sclerosant (28 of total 36 sessions). Mean follow-up period was 37 months (range: 1-154). RESULTS: Sclerotherapy was clinically successful in 13 lymphoceles in both group A-S (76.5%) and group B-S (92.9%) without statistical significance. Compared to the pre-sclerotherapy period, group B-S demonstrated significantly decreased drainage volume after sclerotherapy (662.7 ml vs. 100.6 ml, p = 0.019). Group A-S failed to demonstrate significant decrease in drainage volume after sclerotherapy. Recurrence occurred in 4 patients in group A-S and 1 in group B-S, without statistical significance. No major complication was noted. CONCLUSION: Sclerotherapy significantly reduces the drainage volume, and might help shorten catheter placement time in infected lymphoceles.

Scaled Signal Intensity of Uterine Fibroids on T2-Weighted MR Imaging as a Predictor of the Potential Response to Uterine Fibroid Embolization.

PURPOSE: To determine feasibility of scaled signal intensity (SSI) of uterine fibroids on T2-weighted magnetic resonance (MR) images to predict volume reduction rate (VRR) after uterine fibroid embolization (UFE). MATERIALS AND METHODS: In this retrospective study, 66 premenopausal women underwent UFE. Patients underwent follow-up MR imaging 3 months after UFE. SSI of predominant fibroids was measured on T2-weighted MR images obtained before the procedure by standardizing the mean signal intensity to a 0-to-100 scale, with 0 representing rectus abdominis muscle and 100 representing subcutaneous fat (100) for reference values. RESULTS: VRR of predominant fibroids was 12.3%-99.0% (mean 53.7%). SSI of predominant fibroids was 0.9-73.6 (mean 24.6). SSI was significantly related to VRR of fibroids (P < .01). The optimal SSI cutoff value to predict VRR > 50% was 18.16 with sensitivity of 78.8% and specificity of 66.7%. The optimal SSI cutoff value to predict VRR < 30% was 14.38 with sensitivity of 75% and specificity of 70.7%. CONCLUSIONS: SSI of fibroids was significantly related to fibroid VRR after UFE. SSI may be useful in the quantified prediction of volume reduction.

Multidetector CT diagnosis of non-traumatic gastroduodenal perforation.

INTRODUCTION: To identify reliable CT features and assess the diagnostic performance of 64-multidetector CT (MDCT) in diagnosing non-traumatic gastroduodenal perforation (GDP). METHODS: We retrospectively reviewed 136 CT scans of patients with surgically proven non-traumatic gastrointestinal perforation during 7 years. 92 patients had GDP and 44 patients had other sites of perforation. CT features of perforation were evaluated and the sensitivity, specificity and likelihood ratios of each CT feature were estimated. RESULTS: The cause of GDP was peptic ulcer in 90 patients, gastric cancer in one patient, and foreign body of duodenal diverticulum in one patient. Extraluminal gas (97%) was most common CT feature of GDP, following by fluid or fat strand along gastroduodenum (89%), ascites (89%), wall defect and/or ulcer (84%), and wall thickening (72%). Of CT features, wall defect and/or ulcer showed the best positive likelihood ratios for GDP (36.83). Wall thickening also showed high positive likelihood ratios (10.52). Combined, these CT features showed 95% sensitivity and 93% specificity for localization of perforation site of GDP. CONCLUSION: MDCT is useful in diagnosis of presence and site of GDP. Wall defect and/or ulcer and wall thickening have a high positive predictive value for localization of perforation site.

Analysis of kinetic curve and model-based perfusion parameters on dynamic contrast enhanced MRI in breast cancer patients: Correlations with dominant stroma type.

OBJECTIVE: Our purpose was to evaluate imaging findings of breast cancers according to the dominant stroma type by using kinetic curve analysis and model-based perfusion parameters from dynamic contrast-enhanced magnetic resonance imaging. METHODS: From March 2011 to September 2011, 64 cancers in 64 patients were included for data analysis. Kinetic curve analysis and model based perfusion parameters (Ktrans, Kep and Ve) were obtained using dynamic contrast-enhanced magnetic resonance imaging and post-processing software. Imaging characteristics were analyzed according to the tumor-stroma ratio and dominant stroma type. RESULTS: Ve values were significantly lower in tumors with more than 50% cellularity (0.44 vs. 0.29, p=0.008). Histologic grade, estrogen receptor status and subtype of cancer (triple negative versus non-triple negative) were significantly different (p=0.009, p=0.019 and p=0.03, respectively). Median Kep values were different between collagen dominant, fibroblast dominant and lymphocyte dominant groups. By post hoc comparisons, mean Kep values were significantly higher in lymphocyte dominant group than collagen dominant group (p=0.003). Ktrans and Ve values were not significantly different according to dominant stroma type (p=0.351 and p=0.257, respectively). In multivariate regression analysis, nuclear grade (p=0.021) and dominant stroma type (collagen dominant, p=0.017) were independently correlated with Kep values. In terms of the dominant stroma type, the collagen dominant type showed a decrease of 0.247 in Kep values, compared with the fibroblast-dominant type (p=0.017). CONCLUSIONS: Ve values were significantly lower in tumors with high tumor-stroma ratio. Kep values were significantly lower in breast cancers with dominant collagen type and higher in cancers with high nuclear grade.

A case of catamenial hemoptysis treated by bronchial artery embolization.

Catamenial hemoptysis is a rare condition, characterized by recurrent hemoptysis associated with the presence of intrapulmonary or endobronchial endometrial tissue. Therapeutic strategies proposed for intrapulmonary endometriosis with catamenial hemoptysis consist of medical treatments and surgery. Bronchial artery embolization is a well-established modality in the management of massive or recurrent hemoptysis, but has seldom been used for the treatment of catamenial hemoptysis. We report a case of catamenial hemoptysis associated with pulmonary parenchymal endometriosis, which was successfully treated by a bronchial artery embolization.

Is uterine artery embolization for patients with large myomas safe and effective? A retrospective comparative study in 323 patients.

PURPOSE: To evaluate the effectiveness, safety, and complications of uterine artery embolization (UAE) in women with large fibroid tumors. MATERIALS AND METHODS: From January 2005 to February 2011, 323 patients underwent UAE for symptomatic uterine leiomyomas without adenomyosis and were included in this study. Patients were divided into two groups: those with a large tumor burden (group 1; n = 63), defined as a dominant tumor with a longest axis of at least 10 cm or a uterine volume of at least 700 cm(3); and the control group (group 2; n = 260). Tumor infarction and volume reduction were calculated based on magnetic resonance imaging findings. Symptom status was assessed with a visual analog scale. Postprocedure complications and repeat interventions were recorded. The data were analyzed with appropriate statistical tests. RESULTS: No significant differences were seen between the two groups in volume reduction of dominant tumors (46.5% in group 1 vs 52.0% in group 2; P = .082) or percentage volume reduction of the uterus (40.7% in group 1 vs 36.3% in group 2; P = .114). Also, no significant differences were seen between the two groups regarding satisfaction scores at immediate or midterm follow-up (P = .524 and P = .497) or in the presence of procedure-related complications (P = .193). CONCLUSIONS: UAE outcomes in large fibroid tumors were comparable to those in smaller tumors, without an increased risk of significant complications. Tumor size may not be a key factor in predicting successful outcomes of UAE.

Covered bronchial stent insertion to manage airway obstruction with hemoptysis caused by lung cancer.

Malignant airway obstruction and hemoptysis are common in lung cancer patients. Recently, airway stent is commonly used to preserve airway in malignant airway obstruction. Hemoptysis can be managed through various methods including conservative treatment, endobronchial tamponade, bronchoscopic intervention, embolization and surgery. In our case studies, we sought to investigate the effectiveness of airway stents for re-opening the airway as well as tamponade effects in four patients with malignant airway obstruction and bleeding caused by tumors or lymph node invasions.

Outcome and prognostic factors of spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization.

BACKGROUND: Rupture of hepatocellular carcinoma (HCC) is a life-threatening condition accompanied by hemorrhage. Transarterial embolization/chemoembolization (TAE/TACE) can be used as the first-line treatment to achieve initial homeostasis. PURPOSE: To investigate the outcome of TAE/TACE for spontaneous ruptured HCC and to determine the prognostic factors affecting survival. MATERIAL AND METHODS: We retrospectively reviewed the clinicoradiologic data of 47 patients (8 women, 39 men; median age 64.4 years) with serum bilirubin levels <3.0 mg/dL that underwent TAE/TACE for ruptured HCC between January 2004 and June 2010. Survival rates were estimated using the Kaplan-Meier method and prognostic factors of poor survival were obtained by univariate and multivariate analyses. RESULTS: The clinical success rate of TAE/TACE was 94% (44/47). The median survival time was 179.6 days. The 1-month, 3-month, 6-month, and 12-month survival rates were 75%, 54%, 48%, and 43%, respectively. Old age, a previous history of TACE for HCC, low initial hemoglobin level, higher blood transfusion requirement, Child-Pugh class C, high serum bilirubin level, low serum albumin level, prolonged prothrombin time, high serum creatinine level on admission, presence of encephalopathy, severe ascites, lobar TAE/TACE, presence of portal vein thrombosis, and tumors involving both lobes were associated with poor survival. Multivariate analysis revealed that higher blood transfusion requirement, Child-Pugh class C, presence of portal vein thrombosis, and tumors involving both lobes were significant predictors of poor survival. CONCLUSION: TAE/TACE is effective for achieving initial hemostasis, which is critical to survival. Regardless of successful TAE/TACE, the survival rate in patients with Child-Pugh class C remains poor. Portal vein thrombosis and tumor extent are significant image parameters for predicting survival after TAE/TACE for ruptured HCC.

Congenital intrahepatic portosystemic venous shunt and liver mass in a child patient: successful endovascular treatment with an amplatzer vascular plug (AVP).

A congenital intrahepatic portosystemic shunt is a rare anomaly; but, the number of diagnosed cases has increased with advanced imaging tools. Symptomatic portosystemic shunts, especially those that include hyperammonemia, should be treated; and various endovascular treatment methods other than surgery have been reported. Hepatic masses with either an intra- or extrahepatic shunt also have been reported, and the mass is another reason for treatment. Authors report a case of a congenital intrahepatic portosystemic shunt with a hepatic mass that was successfully treated using a percutaneous endovascular approach with vascular plugs. By the time the first short-term follow-up was conducted, the hepatic mass had disappeared.

Endobronchial stent insertion to manage hemoptysis caused by lung cancer.

Hemoptysis in patients with lung cancer is not uncommon and sometimes have dangerous consequences. Hemoptysis has been managed with various treatment options other than surgery and medicine, such as endobronchial tamponade, transcatheter arterial embolization and radiation therapy. However, these methods can sometimes be used only temporarily or are not suitable for a patient's condition. We present a case in which uncontrollable hemoptysis caused by central lung cancer was successfully treated by inserting a covered self-expanding bronchial stent. The patient could be extubated and was able to undergo further palliative therapy. No recurrent episodes of hemoptysis occurred for the following three months. As our case, airway stenting is a considerable option for the tamponade of a bleeding lesion that cannot be successfully managed with other treatment methods and could be used to preserve airway patency in a select group of patients.

The effect of transarterial prostate embolization in hormone-induced benign prostatic hyperplasia in dogs: a pilot study.

PURPOSE: To evaluate the feasibility of transarterial prostate embolization for reducing the volume in hormone-induced canine prostate hyperplasia. MATERIALS AND METHODS: Nine beagle dogs were included in this study. Prostate hyperplasia was induced by administering dihydrotestosterone and beta-estradiol. The hormones were given for 12 weeks in group A (n = 4) and 24 weeks in group B (n = 5). Twelve weeks after initiating the hormone treatment, two animals in group A and three in group B underwent prostate embolization with polyvinyl alcohol (PVA) particles. The volume of each prostate was measured three times with magnetic resonance (MR) imaging: once before hormone treatment and at 12 and 24 weeks after initiation of hormone administration. The prostates and bladders were harvested after the third MR study and were grossly and microscopically evaluated. RESULTS: The mean volume of the prostate increased by 156.13% +/- 110.01% in the nine dogs after 12 weeks of hormone administration. In group A (n = 4), the third MR study showed a 67.74% mean decrease in prostate volume in nonembolized dogs and an 81.04% mean decrease in embolized dogs compared with the second MR study. In group B (n = 5), the mean increases in prostate volume between the second and third MR studies were 40.79% in embolized dogs (n = 3) and 75.15% in nonembolized dogs. There was no gross or microscopic change in the bladders except for a focal hemorrhage in one specimen. CONCLUSIONS: Transcatheter arterial embolization is feasible for reducing prostate volume without serious complications in hormone-induced canine prostate hyperplasia.

Diagnosis of the intraductal component of invasive breast cancer: assessment with mammography and sonography.

OBJECTIVE: The aim of this study was to investigate mammographic and sonographic features and their sensitivities for depiction of the intraductal component associated with invasive ductal carcinoma (IDC). METHODS: During a 1-year period, 132 patients with IDC underwent surgical treatment. All patients underwent mammography and high-resolution sonography, and the findings were reported according to the American College of Radiology's Breast Imaging Reporting and Data System lexicon. Tumors were classified as "pure IDC" and "IDC with an intraductal component" by histopathologic evaluation. We compared mammographic and sonographic features between the above 2 groups and attempted to correlate them with histopathologic findings. We also investigated separate and combined sensitivities, specificities, and accuracies of both mammography and breast sonography for showing intraductal components. Finally, imaging measurements were compared with pathologic measurements. RESULTS: One hundred four (79%) of the 132 IDCs contained an intraductal component. Patients with IDC with an intraductal component showed calcifications on mammography and showed an echogenic halo, duct dilatation, calcifications, and increased vascularity in surrounding tissue on sonography more frequently than patients with pure IDC. The sensitivities of mammography, sonography, and their combined assessment for detection of an intraductal component were 55%, 80%, and 86%, respectively. The combined assessment (r = 0.90) measured the extent of the tumor more accurately than mammography (r = 0.71) or sonography (r = 0.79) separately. CONCLUSIONS: Combined assessment with mammography and sonography offers more accurate information for the presence of an intraductal component and the extent of a tumor than each separate assessment.